Starting a care business in Montana

Child care runs on head counts. Care counts as regular when you look after children of separate families within three or more consecutive weeks. A private residence with 3 to 8 children is a family day-care home, and 9 to 15 children make a group day-care home; both are registered rather than licensed. Since 2023, a home with six or fewer children that takes no Best Beginnings scholarship payments is exempt from registration. An out-of-home place with 16 or more children needs a day-care center license. Both tiers now follow ARM chapter 37.96, which replaced chapter 37.95 on May 1, 2025, so DPHHS booklets marked Rev. 12/21 describe repealed rules. State law bars DPHHS from charging any fee for a license or registration certificate, and it makes registered day-care homes a permitted use in every residential zone, with no conditional use permit allowed.

On the adult side, the Licensure Bureau uses the same sequence for each license. You file online no more than six months before your target date, send policies and procedures at least 45 days before opening, and receive a six-month provisional license once your documents are approved; for residential homes, an on-site physical compliance inspection comes first. A surveyor visits during the provisional period, and later licenses run one to three years depending on survey results. None of the bureau's published application letters, web pages or rules states the fee for an assisted living facility, adult foster care home or adult day center, so call the bureau at 406-444-2676 before you budget.

The size line between the two residential licenses is four. An adult foster care home gives only light personal or custodial care to four or fewer unrelated adults who are 60 or older or disabled, and, apart from narrow exceptions, its residents must be ambulatory and able to take their own medications. A fifth resident, or anyone needing skilled, memory or behavioral care, calls for an assisted living facility license, which has no minimum size and is issued in Categories A through D. Rules effective September 26, 2026 added a Category D1 level for restraint, seclusion and involuntary admissions, and they require staff on site around the clock. An adult day-care center is licensed by the same bureau whenever it gives adults scheduled daytime help with daily living, with no overnight stay and no minimum client count. None of these three needs a certificate of need.

A home health agency license applies when your in-home services include a licensed registered nurse plus at least one other therapeutic service. Montana's only agency-specific rule adopts the federal Medicare Conditions of Participation in 42 CFR part 484, so even a private-pay agency is surveyed against them. No certificate of need is required, but the nationwide Medicare enrollment moratorium for new home health agencies, in force since May 13, 2026, has a second effect in Montana: the state's Medicaid program enrolls only Medicare-certified agencies, so a newly licensed agency can serve only clients who pay privately or through other sources until the freeze lifts.

Companion, homemaker and personal care agencies with no nursing fall outside every Licensure Bureau license type. The only enrollment for them is on the Medicaid side: DPHHS's Senior and Long Term Care Division runs the Community First Choice and Personal Assistance Services programs, which include an agency-based option, and the Big Sky Waiver, which also pays licensed assisted living facilities, adult foster care homes and adult day centers.