Montana adult foster care home license: four residents, light care, and the DPHHS steps

What the license covers in Montana

Montana law defines an adult foster care home as a private home or other facility that gives only light personal care or custodial care to four or fewer disabled adults or aged persons. The residents cannot be related to the owner or manager by blood, marriage or adoption, and cannot be under the owner’s or manager’s full guardianship.⁠¹ The rules repeat the four-resident cap and bar caring for more people than the license allows.⁠⁵

The rules define these terms narrowly:⁠⁵

• Aged person: at least 60 years old.
• Disabled adult: 18 or older and found disabled under the definitions in ARM 37.100.302, 37.100.402 or 37.86.3503.
• Light personal care: help with bathing, dressing, hair grooming and supervising self-medication. “Assisting” means supervision with only occasional hands-on help.
• Custodial care: a sheltered, family-type setting that meets basic needs for food and shelter, with a specific person available to help.
• Supervision: reminding residents about medications and activities, helping them keep appointments, and knowing their general whereabouts.

Two arrangements fall outside the license. A home caring only for relatives or wards does not meet the definition.⁠¹ And the licensing rules do not apply to a “mutual or shared living arrangement,” which the rules define as one where each party shares the money and household responsibilities.⁠⁵ If you charge residents for care and run the household, you are not in a shared living arrangement.

Running an AFCH without a license violates the law, and any person, group or corporation that does so is subject to prosecution.⁠⁵

Who you can admit, and when you need assisted living instead

This limit decides most AFCH plans. Under ARM 37.100.136, an AFCH resident must not:⁠⁵⁠²

• need skilled nursing care;
• need medical, physical or chemical restraint;
• be nonambulatory or bedridden;
• be incontinent to the point that bowel or bladder control is absent; or
• be unable to self-administer medications.

The denial and revocation rule adds more triggers. DPHHS can act against your license if any resident needs physical restraint, would have to be carried out in an evacuation (unless under hospice care), or is totally incontinent and cannot manage it with more than minimal supervision.⁠⁵

There is one statutory exception. A home can be licensed to keep caring for an adult who receives state-funded services through the DPHHS developmental disabilities program, or for an adult who lived in the home before turning 18, even if that adult has one of the conditions above.⁠² Each such resident needs a signed certification, renewed every year, from a physician, physician assistant, nurse practitioner or registered nurse. That person must not work for the home and must have visited it during the year covered. The certification must state that the available services meet the resident’s needs and that the resident does not need a more intensive setting. The home gives DPHHS a copy with its license application.⁠²⁠⁵

Some outside services are allowed without changing the home’s status:⁠⁵

• A home attendant or personal care attendant can step in if you are the only caregiver and are incapacitated for two weeks or less.
• A practitioner can order temporary skilled nursing to prevent a hospital stay, for up to 30 days and no more than two hours a day per resident.
• Hospice can serve a resident for an indefinite period.

The resident pays for these third-party services.⁠⁵

If you want to serve people who need more than this, Montana’s next license is the assisted living facility. The statute defines it as a congregate residential setting that gives or coordinates personal care, 24-hour supervision and assistance, and health-related services.⁠¹ See the Montana assisted living facility license guide for its A to D categories.

Two other combinations are prohibited. You cannot run licensed adult or child day care in an AFCH. You also cannot foster children in it, except a resident who lived there before turning 18, a placement pending adoption, or kinship foster care.⁠⁵ If you were planning to add a day program, see the adult day care center guide and the family and group day care home guide. Either would have to run somewhere other than the AFCH.

Homes serving residents with mental illness

ARM 37.100.149 sets up a mental health version of the AFCH. Residents must:⁠⁵

• have a severe disabling mental illness as defined in ARM 37.86.3503;
• be medically stable;
• not be an immediate danger to themselves or others; and
• be able to take medications when prompted.

The home must contract with a licensed mental health center that holds an adult foster care endorsement, or have a formal working relationship with a mental health case management team. The provider takes part in treatment planning and orientation, and the placement agreement spells out who is responsible for what. Chores are assigned only as the treatment plan allows, and house-rule violations go to the mental health center or case team in an incident report within 24 hours.⁠⁵

The household: who must live there and who must be checked

An AFCH is a family setting, and the rules staff it that way. At least one adult must live in the home permanently and not work outside it. DPHHS can grant exceptions if there is adequate alternative care.⁠⁵ A provider, staff member or other adult household member must be present whenever a resident is home. A resident can be left alone only if the case plan or resident agreement allows it, and then for no more than four hours in any 24.⁠⁵

The provider and all staff must be 18 or older and in good physical and mental health.⁠⁵ The applicant, the provider, staff, and every adult living in the home each complete DPHHS’s personal statement of health. The forms go in with the initial application and again at every renewal.⁠⁵ The provider must hold current CPR/First Aid certification. Staff must get it within 30 days of hire and keep it current.⁠⁵

Background checks. The provider, staff and every adult living in the home need these checks before you are licensed or before they start working:⁠⁵

• a Montana criminal background check;
• a state protective-services check; and
• a tribal criminal check, if applicable.

Anyone who lived outside Montana in the past five years needs checks from each of those states.⁠⁵ DPHHS’s release form also authorizes a motor vehicle check. It warns that out-of-state and tribal checks are at the applicant’s or provider’s cost.⁠⁸ The agency page links a list of tribal courts to contact for tribal checks.⁠⁶

DPHHS must deny or revoke the license if the provider, a staff member or anyone living in the home has any of these:⁠⁵

• A conviction for homicide, sexual intercourse without consent, sexual assault, aggravated assault, assault on a minor or an officer, assault with a weapon, kidnapping, prostitution, robbery or burglary.
• A conviction for crimes against children and families, such as child abuse or neglect, incest, felony partner or family member assault, or child pornography.
• A felony drug-related conviction, including DUI, within the previous five years.
• A substantiated report naming them as a perpetrator of child abuse or neglect.
• A conviction for abuse, sexual abuse, neglect or exploitation of an elderly person or a person with a developmental disability.

DPHHS may deny or revoke for misdemeanor partner or family member assault, misdemeanor child endangerment, or a crime involving abuse of the public trust.⁠⁵ Anyone charged with physical or sexual violence, or with a felony drug offense, may not give care or be present in the home while the case is pending.⁠⁵ That rule reaches adult children and other relatives living with you.

The house: bedrooms, bathrooms, water and heat

The rules in ARM 37.100.140 are specific enough to measure against before you apply.⁠⁵

Remember that the six-person bathroom ratio counts everyone in the home, not just residents.⁠⁵ Living rooms and dining rooms cannot be used for sleeping by anyone in the household. Resident living and sleeping areas cannot be in separate wings, units or buildings.⁠⁵ Hallways cannot pass through a resident’s bedroom.⁠⁵

The application letter explains how DPHHS measures a bedroom. You measure from the front surface of any built-in closet or bookcase, and the door-swing area does not count toward the square footage.⁠⁷

Heat. You need central heat or its equivalent. Space heaters are banned. A furnace in the basement must be separated from the first floor by at least a 1 3/4-inch solid-core wood door or equivalent, and fuel-fired water heaters get the same protection.⁠⁵ Wood stoves and fireplaces are prohibited unless a qualified inspector documents proper installation and inspection at initial licensure and every year after. You keep those records for three years.⁠⁵ Each level needs at least one carbon monoxide detector.⁠⁵

Water and sewer. You must use public water and sewer where they are available. On a private well, you must test for coliform before licensing and at least twice a year after that. The rule suggests April through June and September through October, or whatever the local health authority directs. Keep test records for three years.⁠⁵ The application letter asks well users for a potability report dated within the past year, and suggests the county health department for help.⁠⁷ A septic system must be in good working order and repaired when it fails.⁠⁵

Location. The home must be reachable by transportation and reasonably close to shopping, churches, senior centers, medical and dental clinics, and hospitals.⁠⁵

Fire safety and emergency drills

Montana’s AFCH fire rules were written with input from the state fire prevention and investigation section of the Department of Justice, as the statute requires.⁠³ ARM 37.100.141 requires:⁠⁵

• Smoke detectors on every level and in all sleeping and common living areas (not kitchens or bathrooms). Battery units must be tested monthly and get new batteries every calendar year. Keep maintenance records for 24 months.
• Fire extinguishers rated at least 2A10BC on each floor, mounted with the handle 4 to 5 feet from the floor, no more than 75 feet apart, and serviced and tagged each year by a state-certified person.
• Two remote exits from every sleeping, living and dining room, and from every floor residents use. At least one exit from each room must be a door or stairway to ground level. The second can be an egress window with at least 5.7 square feet of clear opening, at least 24 inches high and 20 inches wide, a sill no more than 44 inches above the floor, and no keys or tools needed to open it. The first floor needs two separate exits to the outside.
• Exit doors at least 36 inches wide in new construction and 30 inches in existing homes, and wide enough for wheelchairs in either case.
• Ramps at every outside exit if residents regularly use wheelchairs, with no more than 1 foot of rise per 12 feet of run.
• No trap doors, ladders or folding stairs to resident rooms. Every lockable door must open from the outside in an emergency.

Other safety rules include:⁠⁵

• corridors and stairs at least three feet wide;
• guns in locked storage, with ammunition locked separately;
• a first-aid kit in the home and in every vehicle you use, inventoried quarterly; and
• visual or auditory contact at least every 30 seconds with a resident who bathes alone but has a condition that could leave them helpless.

The whole household, residents included, must do an evacuation drill at least twice a year, no closer than four months apart. Keep written reports for 24 months.⁠⁵ New residents learn the evacuation plan at admission. New staff are oriented within one week of hire and before they are ever the only staff member in the home.⁠⁵

Smoking is prohibited in an AFCH for residents, household members and visitors under the Montana Indoor Clean Air Act.⁠⁵

Zoning: residential use, with one county lever

Montana zoning law lists “a licensed adult foster family care home” as a community residential facility.⁠⁹ A community residential facility serving eight or fewer people with 24-hour care counts as a residential use of property. It is a permitted use in all residential zones, including single-family zones. A state or local safety or sanitary rule that does not apply to residences in general cannot be applied to it.⁠¹⁰ The same section lets a city or county require a conditional use permit for the home once DPHHS has licensed it. Montana bars that permit only for day-care homes, not for these facilities.⁠¹⁰ Check with your city or county planning office whether it uses that option before you commit to a property.

Policies and the resident agreement

The application letter asks for written policies and procedures for DPHHS review, due at least 45 days before your expected opening date.⁠⁷ The rules require written policies or procedures on these topics:⁠⁵

• emergency evacuation, with a plan for residents who need help getting out;
• safe use and storage of fuels and heat sources;
• infection prevention and control, reviewed at least once a year;
• grievances;
• pet care, if you keep pets (ferrets, turtles, lizards and parrot-family birds are banned);
• a written statement of resident rights that includes the Montana Long-Term Care Residents’ Bill of Rights, posted in the home and signed by each resident; and
• for mental health homes, the consequences of breaking house rules.

You must sign a written resident agreement before each admission.⁠⁵ It must cover the limits of AFCH care, the specific services you provide, and transportation. It also covers house rules and resident responsibilities, all charges, including any fines or late fees, and discharge criteria. Your refund and security-deposit policies go in too. The agreement must promise 30 days’ written notice before any rate change.⁠⁵ If you doubt whether someone can be cared for in an AFCH, you must get the resident’s practitioner to recommend the placement in writing.⁠⁵

Other day-to-day rules affect how you run the home:⁠⁵

• Meals: three family-style meals and two snacks a day, with no more than 15 hours between the evening and morning meals. No home-canned food.
• Transportation: you drive residents to medical, dental and mental health appointments unless someone else arranges it.
• Resident labor: residents cannot be used as workers or pressured into housework or yard work.
• Money: you can hold no more than $100 per resident for safekeeping, kept separate from your own funds. You may not borrow from or sell to residents.
• Discharge: 30 days’ written notice, except in a medical emergency, when a resident is an immediate danger, or in the resident’s first 30 days.

Medications. Residents take their own medications. You may remove medicines from locked storage, prompt residents, open containers and guide a resident’s hand.⁠⁵ Medication organizers can be filled up to four weeks ahead, and insulin syringes up to seven days ahead. Only the resident, a legal representative, a family caregiver related by blood or marriage, or someone else authorized by law may fill them.⁠⁵ All medications stay in locked storage, and you keep a medication record for every resident you assist.⁠⁵

Applying to the Licensure Bureau, in order

DPHHS lists the AFCH under the Licensure Bureau’s Community Residential Program. The initial and change-of-ownership applications are filed through the online licensure portal linked from the bureau’s Adult Foster Home page.⁠⁶

1. Check the house and the household against ARM 37.100. Measure bedrooms the way DPHHS does, confirm exits and heating, and ask each adult in the home about their background and where they have lived.⁠⁵⁠⁷
2. Time the filing. Do not apply more than six months before you want to be licensed. DPHHS withdraws applications that sit without progress.⁠⁷
3. Submit the online application with the required fee. The rules require a fee with the application.⁠⁵ The rule gives no amount, and neither the 2025 application letter nor the agency page states one as of 2026-10-12. Ask the Licensure Bureau (406-444-2676) for the fee before you apply, and confirm it on the online application.
4. Upload the packet:⁠⁷
   • a personal statement of health for each employee and household member (not residents);
   • a release of information for each employee and each household member over 18;
   • the Safety Compliance Checklist;
   • a well water report, if you use a well;
   • a floor plan with dimensions (hand-drawn is acceptable);
   • CPR/First Aid documentation for each provider and employee; and
   • an attestation from the prospective administrator that they have reviewed the AFCH rules.
5. Send policies and procedures at least 45 days before opening.⁠⁷
6. Schedule the on-site Physical Compliance inspection with the bureau’s Construction Consultant. You need the consultant’s approval and approval of all documents before a license is issued.⁠⁷
7. Receive the six-month provisional license. You may not admit any resident until you are licensed.⁠⁷
8. Pass the survey. A Licensure Bureau surveyor inspects the home during the provisional period.⁠⁷ If the surveyor finds deficiencies, you must submit an acceptable plan of correction within ten business days.⁠⁵ The rule says DPHHS makes a final licensing decision within 45 days of receiving a complete application.⁠⁵

Questions during the process go to the Licensure Bureau at 406-444-2676.⁠⁷ The rules still give the bureau’s mailing address under its former Quality Assurance Division name: P.O. Box 202953, Helena, MT 59620-2953. The 2025 letter uses the same P.O. box under the Office of Inspector General.⁠⁵⁠⁷

License term, renewal and changes

After the survey, DPHHS can issue a license for one to three years.⁠⁵⁠⁴ You must file a written renewal application at least 30 days before the license expires, with fresh health statements. DPHHS renews after another licensing survey.⁠⁵

A license is valid only for the person and premises named on it. It cannot be sold, assigned or transferred, and it goes back to DPHHS when you close or sell.⁠⁵⁠⁴ A new owner applies through the change-of-ownership application on the portal.⁠⁶ Report any change that makes your application information inaccurate before the change takes effect. If you move, notify DPHHS at least three weeks ahead. DPHHS must approve the new house before you operate there.⁠⁵ You must also tell DPHHS, case managers and legal representatives within 24 hours if the home’s phone number changes.⁠⁵

Reporting:⁠⁵

• Serious incidents (falls with injury, injuries needing emergency care, assaults, suspected abuse, deaths): report to the DPHHS licensing surveyor and the resident’s legal representative within 24 hours or by the next business day.
• Suspected abuse, neglect or exploitation: the provider and all employees must report it to adult protective services.
• A resident missing without explanation for four hours: notify local law enforcement, case managers and family.

Enforcement. DPHHS can deny, revoke or suspend for noncompliance, misrepresentation, a substantiated abuse report against anyone in the home, or the resident conditions above. It can revoke immediately if a resident is at imminent risk.⁠⁵ For problems that do not threaten residents and can be fixed within 30 days, DPHHS will not revoke or refuse renewal if you send an approved corrective action plan within ten days.⁠⁵ You can request a fair hearing under ARM 37.5. If the action is based on imminent risk, you must stop operating while the hearing is pending.⁠⁵

How Montana Medicaid pays adult foster homes

Many AFCH residents are paid for through Medicaid home and community-based waivers rather than privately.

• Big Sky Waiver (Senior and Long Term Care Division). The service is Residential Habilitation, “Adult Residential,” procedure code T2031, delivered in an adult foster home or an assisted living facility.⁠¹¹ It bundles personal care, homemaker services, meals and snacks, medication oversight, social and recreational activities, and 24-hour onsite response. Case management teams have a fixed number of slots.⁠¹¹ The manual is blunt: anyone who cannot self-administer medications should not be in an adult foster home.⁠¹¹ Medicaid does not pay room and board, and absence days are billable only as approved retainer days, up to 30 a year.⁠¹¹ Since January 2025, adult foster homes can request Level II Support Services, a higher rate for members with challenging or disruptive behaviors who have lived in the home at least 30 days and for whom other interventions have failed.⁠¹³
• SDMI waiver (Addictive and Mental Disorders Division). This waiver pays for Adult Foster Care for members with severe and disabling mental illness. The home must hold a Montana license and meet the federal HCBS settings rule. Again there is no room-and-board payment, and retainer days are capped at 30 per plan year.⁠¹²

The waiver rates for adult foster homes were not published in the sources reviewed for this guide.

Rule status

The AFCH rules in ARM 37.100.101 to 37.100.175 were last overhauled in a 2014 amendment effective May 23, 2014. The DPHHS printable version shows no later amendments as of 2026-10-12.⁠⁵ The licensing statute, 50-5-201, was amended in 2025.⁠⁴ DPHHS updated the AFCH application letter in 2025.⁠⁷

If you also plan home-based nursing visits for people outside the home, that is a separate license; see the Montana home health agency guide.

Sources

1. 1
   Montana Legislature, Section 50-5-101, MCA: Definitions Checked 12 Oct 2026 · Back to text ↑
2. 2
   Montana Legislature, Section 50-5-216, MCA: Limitation on care provided in adult foster care home Checked 12 Oct 2026 · Back to text ↑
3. 3
   Montana Legislature, Section 50-5-215, MCA: Standards for adult foster care homes Checked 12 Oct 2026 · Back to text ↑
4. 4
   Montana Legislature, Section 50-5-201, MCA: License requirements Checked 12 Oct 2026 · Back to text ↑
5. 5
   Montana Department of Public Health and Human Services, ARM 37.100.101 to 37.100.175: Adult Foster Care Homes (printable rules) Checked 12 Oct 2026 · Back to text ↑
6. 6
   Montana DPHHS, Office of Inspector General, Licensure Bureau, Adult Foster Home (Community Residential Program) Checked 12 Oct 2026 · Back to text ↑
7. 7
   Montana DPHHS, Office of Inspector General, Licensure Bureau, Dear Prospective Adult Foster Home Provider (initial application letter, 2025) Checked 12 Oct 2026 · Back to text ↑
8. 8
   Montana DPHHS, Licensure Bureau, Release of Information for Adult and Youth Care Facility Providers (background checks) Checked 12 Oct 2026 · Back to text ↑
9. 9
   Montana Legislature, Section 76-2-411, MCA: Definition of community residential facility Checked 12 Oct 2026 · Back to text ↑
10. 10
    Montana Legislature, Section 76-2-412, MCA: Relationship of foster homes, community residential facilities and day-care homes to zoning Checked 12 Oct 2026 · Back to text ↑
11. 11
    Montana DPHHS, Senior and Long Term Care Division, HCBS 728: Residential Habilitation (Big Sky Waiver policy manual) Checked 12 Oct 2026 · Back to text ↑
12. 12
    Montana DPHHS, Addictive and Mental Disorders Division, SDMI HCBS 377: Residential Habilitation, Adult Foster Care Checked 12 Oct 2026 · Back to text ↑
13. 13
    Montana Medicaid, Claim Jumper, January 2025: Big Sky Waiver Level II Residential Habilitation Support Services Checked 12 Oct 2026 · Back to text ↑

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