Adult Day Care in Montana

All states: adult day services map

Montana adult day services at a glance

Last verified against state sources: 2026-10-21.

How is adult day care regulated in Montana?

Montana has one license for adult day care, the adult day-care center license, issued by the Licensure Bureau in the Office of Inspector General of the Montana Department of Public Health and Human Services (DPHHS). There is no separate adult day health care license and no separate dementia license. Montana Medicaid pays for the service under the name Adult Day Health, but the only provider credential it requires is the adult day license.

Two layers of rules apply to a Montana center, and each comes from a different part of DPHHS:

• Licensing (DPHHS Licensure Bureau). The Adult Day Care rules, ARM 37.106.2601 to 37.106.2621, plus the Minimum Standards for All Health Care Facilities (ARM 37.106.301 to 37.106.331). These rules cover the license, staffing, building, services, meals, records and medications for every center, whatever the payer. The adult day rules were last amended effective January 11, 2025.
• Medicaid (DPHHS Senior and Long Term Care Division). The Big Sky Waiver (waiver MT.0148), a home and community based services program for older adults and people with physical disabilities, defines Adult Day Health as a range of health, nutrition, recreation and social services outside the home, with no overnight stay. The waiver adds service authorization, prior authorization for billing and an incident reporting duty, but no separate clinical standards.

State law defines an adult day-care center as a facility, freestanding or connected to another health care facility, that gives adults the care they need for daily living on a regular schedule but no overnight care (50-5-101, MCA). That makes it a health care facility under Montana law, which is why it needs a license.

Where the layers overlap, the licensing rules set nearly all of the operating standards. The Medicaid waiver is stricter in two places: it requires home-to-center transportation as part of the paid service, and it requires an outside incident report within 10 working days.

Do you need a license to open an adult day center in Montana?

Yes. No one may operate a health care facility in Montana without a DPHHS license, and an adult day-care center is a health care facility under state law. This applies to private-pay and Medicaid centers alike. A new center starts with a 6-month provisional license, and adult day care does not need a certificate of need.

How to apply. The Licensure Bureau's 2025 letter to prospective adult day care providers lists what to submit:

• The license application and fee, filed through the bureau's online portal (see the Adult Day Care Center application page).
• A floor plan showing the size of every room and space clients use. Door-swing areas and space behind built-in obstructions are not counted.
• Local building code approval, including a certificate of occupancy for new construction, and a BFS Plan Submittal Form sent to the bureau's construction consultant.
• Your policies and procedures, at least 45 days before you plan to open, and your client agreement.
• Well water and septic reports where they apply, verification of any electronic security system, a fire inspection report, and a signed statement that the administrator has reviewed the rules.

Timing. Do not apply more than 6 months before the date you want to be licensed. After the bureau approves your documents and completes an on-site physical compliance inspection, it issues a 6-month provisional license, and a surveyor visits during that period. You may not admit clients before you are licensed.

Fees. We did not find the license fee amount in the rules, the provider letter or the application page. The fee appears on the online application, or you can ask the Licensure Bureau at 406-444-2676.

Certificate of need. The bureau states that adult day care facilities are not reviewed by the Health Planning Program and do not need a certificate of need. We did not find a moratorium.

One license per site. A license is valid only for the person and the premises named on it (50-5-201, MCA). We did not find an adult day rule written specifically about multiple sites, so plan on a separate license for each location and confirm with the bureau. The current license must be posted where the public can see it.

Buying a center. A Montana license cannot be sold, assigned or transferred. When ownership changes, the license must be returned or destroyed, and the new owner files a change of ownership application through the online portal. The first license after a change of ownership runs 1 year. We did not find a required advance notice period.

Renewal and inspections. DPHHS inspects on each new or renewal application and can issue a license for 1 to 3 years (ARM 37.106.310):

• 3 years after a survey with no deficiencies, or with CMS-approved accreditation.
• 2 years when the survey finds only minor deficiencies.
• 1 year for a center open less than a year, after a change of ownership, or after serious deficiencies in the prior 12 months.

Renewals are filed through the same online portal. Each center also needs an annual local fire inspection, with the record kept at least one year, and any construction or renovation must be approved by the local building official and the state fire marshal or a designee (ARM 37.106.2606).

What are the staffing rules for adult day centers in Montana?

Montana sets no staff-to-participant ratio for adult day centers. The licensing rules require a center to employ enough staff at all times to meet the needs of the number and type of clients it serves, and at least one employee must be on site whenever a client is present. The Big Sky Waiver adds no ratio of its own.

• Licensing (DPHHS Licensure Bureau): no ratio specified. Sufficient staff for clients' number and characteristics (ARM 37.106.2602(17)), and at least one employee present whenever a client is present (2602(14)).
• Medicaid (Big Sky Waiver): no ratio specified, and no staff qualifications beyond the adult day license and the rules it cites.
• Dementia or high-needs clients: no ratio specified in either layer.

Schedules and keys. Written daily work schedules showing who is on duty must be kept at least one year. The person in charge of each shift must hold keys to all doors.

Who counts. Volunteers may help, but they may not be counted in the staffing plan in place of employees. Volunteers who do staff duties need a file showing their orientation and training (ARM 37.106.315(3)).

Administrator. Each center must employ an administrator who is responsible for the center at all times, is in good physical and mental health, is of reputable character, and knows the laws and rules that apply. An owner who meets these qualifications may serve as administrator. The rules set no education, license or experience requirement.

Nurses. The adult day rules do not require a nurse. Staff may only help clients with medications the clients take themselves (see the next section).

Training. The administrator must give every employee a documented orientation covering the policy manual, the job description, the services offered, simulated fire, evacuation and disaster drills, hazard identification, and emergency procedures such as basic first aid. The rules set no minimum training hours.

Background checks and health screening. We did not find a background check, registry check, TB test or vaccination requirement for adult day staff in the rules we read. Ask the Licensure Bureau what it expects.

What does an adult day center in Montana have to provide?

Every licensed Montana center helps clients with daily activities such as eating, walking and grooming, offers recreational and social activities, provides a rest area and telephone access, and serves meals based on how long clients stay. Centers may not provide overnight care. Licensing does not address transportation, but Medicaid requires it as part of the paid Adult Day Health service.

Services and activities. Under ARM 37.106.2602, centers assist with activities of daily living, provide recreational and social activities with a posted calendar kept for one year, and give each client access to a telephone. The rules do not require nursing, therapy or social work services.

Meals. Under ARM 37.106.2616, centers serve:

• At least one meal a day for clients who stay up to 10 hours.
• Two meals for stays over 10 hours, and three meals per 16-hour period.
• Snacks between meals, with food cut, chopped or ground to meet each client's needs.

For Big Sky Waiver members, meals served as part of Adult Day Health may not make up a full daily diet of three meals.

Medications. Clients must be able to take their own medications. Staff may only assist, by reminding clients, bringing containers from storage, removing caps, guiding the hand and observing (ARM 37.106.2621). The center keeps a medication administration record for each client.

Transportation. The licensing rules do not address transportation. Under the Big Sky Waiver, transportation between home and the center is part of the Adult Day Health service, and its cost is included in the provider rate.

Building and space. We did not find a square-feet-per-participant figure, a capacity formula or a restroom ratio in the adult day rules. Instead:

• Construction must meet the 2018 FGI Guidelines for Design and Construction of Hospitals and Health Care Facilities, the 2012 NFPA 101 Life Safety Code, and the ANSI A117.1 (2009) accessibility standard, as adopted in ARM 37.106.302.
• Centers need a rest area with a bed or lounge chair, and blankets and pillows for those who need them.
• A client who can walk only with mechanical help may be served only on the ground floor.
• Lighting must be at least 10 foot-candles in general areas, 30 in toilet and bathing areas and at reading lamps, and 50 in food preparation areas.

Hours. We did not find a minimum number of days or hours a center must be open.

Written policies. Each center keeps a policies and procedures manual available to all staff, and to clients on request (ARM 37.106.2603). It must cover:

• A description of all services provided.
• Confidentiality and safekeeping of client records.
• Infection control.
• A disaster and fire plan.

Centers also need a written maintenance program, food service standards for food sources, storage, handling and dishwashing, an infection prevention and control program reviewed at least once a year, and conscience rights and whistleblower policies for medical practitioners. Policy manuals must be reviewed and the review documented at least every other year (ARM 37.106.330).

Disaster planning. The written disaster plan must cover sheltering in place and evacuation, name at least one off-site evacuation point with a written agreement updated each year, and be reviewed with all staff each year, with records kept three years (ARM 37.106.322). Fire drills are required, but we did not find a set drill frequency for adult day centers.

What rules protect participants in Montana adult day centers?

Montana requires a written agreement with each client before services start, prompt notice to the legal representative if a client is removed, an attendance census, and client records kept for five years. Licensing requires the administrator to review and record injuries, and Big Sky Waiver providers must also file a Serious Occurrence Report within 10 working days. We did not find set discharge reasons, a discharge notice period, or assessment and care plan timelines in the licensing rules.

Client agreement. Each client or legal representative signs a written agreement covering the cost of care, the type of care, the services to be provided, and how the responsible party will be told about significant changes in condition and any need for emergency care (ARM 37.106.2602(6)). The Licensure Bureau reviews your agreement before licensure.

Medicaid enrollment. For Big Sky Waiver members, the case management team should check the center's client agreement before approving admission, to avoid paying twice for the same service (Big Sky Waiver Policy Manual, BSW 703). Waiver services are planned and authorized around the member's own goals and preferences.

Removal from the center. If a client is removed from the center, the legal representative must be told promptly, and the date and the person contacted are noted in the record.

Records.

• An ongoing census of client attendance, kept for at least the past 12 months.
• Client records with identifying information, financial responsibility, next of kin, first and last day of service, physician, medications and a medication administration record, kept at least five years after the last day of service or the client's death, whichever is earlier (ARM 37.106.2620).
• Personnel records, kept at least one year after an employee leaves.

Incidents. Under the licensing rules, the administrator must review every accident or incident that injures a client or employee, take corrective action and keep a record of both. The adult day rules set no deadline for reporting to the department. Big Sky Waiver providers must file a Serious Occurrence Report in the state's QAMS database within ten working days of learning of or witnessing an incident such as suspected abuse or neglect, an injury needing emergency room care, a psychiatric or medication emergency, an unexpected death, or unauthorized restraint. The administrator must also comply with the Montana Vulnerable Adult Prevention of Abuse Act.

What we did not find. We did not find a required physician order, physical exam or TB screening at enrollment, timelines for assessments or care plans at the center, or set discharge reasons and notice periods. Families should ask the center for its written agreement and discharge practices, and operators should ask the Licensure Bureau what it expects.

How does Medicaid pay for adult day in Montana?

Montana Medicaid pays for Adult Day Health through the Big Sky Waiver, run by the DPHHS Senior and Long Term Care Division. Centers bill code S5100 with the UA modifier in 15-minute units at $3.25 per unit (about $13 an hour), with prior authorization. Transportation between home and the center is included in that rate.

Big Sky Waiver. The Big Sky Waiver is a 1915(c) home and community based services waiver for older adults and people with physical disabilities. A center must hold its adult day license and enroll as a Medicaid provider. The state, through its contractor Conduent, checks the license and the center's compliance with the cited rules at enrollment and at each license renewal (waiver MT.0148).

• Billing code and unit: S5100 UA (Adult Day Care), per 15 minutes.
• Rate: $3.25 per unit, effective July 1, 2025, on the July 2025 Big Sky Waiver fee schedule. DPHHS said it would pay claims from July 1, 2026 using its proposed July 2026 fee schedules (provider notice), and that schedule keeps S5100 at $3.25.
• Authorization: prior authorization is required, and the service must be authorized through the member's waiver case management team.
• Transportation: not billed separately. The waiver says home-to-center transportation is part of Adult Day Health and included in the rate. The waiver's separate non-medical transportation codes belong to a different service.

SDMI waiver. The Big Sky Waiver lists Adult Day Health among the services it shares, on one fee schedule, with Montana's Severe Disabling Mental Illness (SDMI) home and community based services waiver. We did not review the SDMI waiver itself, so we did not confirm its unit, modifier or rate. Ask DPHHS if you plan to serve SDMI waiver members.

Attendance documentation. The licensing rules require an ongoing attendance census kept for 12 months, but no sign-in and sign-out or electronic system. Adult Day Health is not on the Big Sky Waiver's list of services that must use electronic visit verification. We did not find a Medicaid rule that spells out time-in and time-out records for 15-minute billing, so keep arrival and departure times that support each claim and ask DPHHS what it expects in an audit.

Can a private-pay adult day center operate in Montana without Medicaid?

Yes, a center can be fully private pay, but it still needs a DPHHS license. Montana law says no one may operate an adult day-care center without a license, whoever pays. We did not find a licensing exemption for small or social-only programs.

Prices. When it adopted the 2025 rule changes, DPHHS stated that the adult day rules do not regulate the cost of care and that providers may charge what they consider necessary (MAR Notice 37-1099 adoption). The cost of care must still be written into each client agreement.

Protections for private-pay clients. Every licensed center must have the written client agreement described above, must provide a way to identify client property and keep valuables safe, and must keep an accounting of any client funds it handles (ARM 37.106.2602(9)). We did not find a rule on non-discrimination by payment source or a fee disclosure rule beyond the client agreement.

Other funding. The U.S. Department of Veterans Affairs offers Adult Day Health Care to enrolled veterans with a clinical need, through VA centers, State Veterans Homes or community organizations, sometimes with a copay. We did not find whether any Montana VA facility contracts for adult day care. We also could not confirm whether Older Americans Act or state aging funds pay for adult day in Montana. Your local Area Agency on Aging or the DPHHS Senior and Long Term Care Division can tell you what is available in your area.

The market. We did not find a state-published count of licensed adult day centers or a Montana adult day services association. The Licensure Bureau may be able to tell you which centers are licensed in your area.

What is changing next for adult day in Montana?

As of our last check on October 21, 2026, we did not find an upcoming change to Montana's adult day licensing rules or to Big Sky Waiver adult day payment. One pending Medicaid change does not affect the adult day service itself, and two recent changes are already in effect.

• Pending Big Sky Waiver amendment. DPHHS asked CMS to approve a Big Sky Waiver amendment, requested to start in mid-2026, that adds a new intensive assisted living category, a Serious Occurrence Committee and a new incident tracking system, and rewrites the rate methodology section. The Adult Day Health service is unchanged in the draft. We did not find confirmation that CMS has approved it, so watch for changes to incident reporting.
• July 2026 fee schedule (in effect). DPHHS began paying claims from July 1, 2026 using proposed fee schedules while it updates its rules. The Big Sky Waiver schedule keeps Adult Day Care (S5100) at $3.25 per 15 minutes.
• Revised licensing rules (in effect since January 11, 2025). DPHHS amended the adult day rules on general services and staffing, policies, construction, infection control, food service, records and medications, and repealed the separate disaster and fire plan rule, which is now covered by ARM 37.106.322.

Montana adult day sources

• DPHHS Licensure Bureau: Adult Day Care Center
• ARM 37.106.2601 to 37.106.2621: Adult Day Care rules
• ARM 37.106 subchapter 3: Minimum Standards for All Health Care Facilities
• DPHHS Licensure Bureau: Prospective Adult Day Care Provider letter (2025)
• 50-5-101, MCA: definitions
• 50-5-201, MCA: license required
• Big Sky Waiver MT.0148 (amendment draft dated December 16, 2025)
• Montana Medicaid: July 2025 Big Sky Waiver fee schedule
• Montana Medicaid: SFY27 rate adjustment implementation provider notice
• DPHHS: MAR Notice 37-1099 adoption (adult day rule amendments, 2025)

Related reading

• The Compliance Curve: Why Adult Day Services Should Learn from Home Care Before They Have To
• How to Differentiate Your Adult Day Care Center: A Guide for Operators
• Effective Transportation Tracking for Elder Day Centers
• Simplifying Payments with Electronic Billing for Adult Day Care
• Adult day services in every state (map)
• Adult Day Care Services and Reference Guide

Other states that license or certify every adult day center

California, Delaware, Florida, Georgia, Hawaii, Iowa, Kansas, Maine, Missouri, Nebraska, Nevada, New Mexico, North Carolina, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Wyoming. See every state on the adult day services map.

Page history

• October 21, 2026: Page rewritten and checked against state sources.

This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.

Ankota provides software for adult day centers, covering attendance, care plans, transportation and billing. If you would like to talk about running your center, contact Ankota or read more about Ankota's adult day care software.