Thinking of launching a home care agency in Big Sky Country? You’re not alone. With Montana’s rapidly aging population, growing rural communities, and a strong preference for aging-in-place, now is the perfect time to start a home care business in Montana. But before you open your doors, you’ll need to understand the state-specific licensing, legal, and compliance requirements that come with it.

This step-by-step guide provides everything you need to legally establish and run a home care agency in Montana—from forming your business and obtaining licenses to understanding state caregiver standards, Medicaid certification, and zoning laws.

Why Montana is a Growing Market for Home Care

Montana is experiencing a demographic shift. According to the U.S. Census Bureau, nearly 20% of the state’s population is aged 65 or older—a figure that’s expected to climb significantly in the coming years. With limited access to long-term care facilities in rural areas, families are turning to in-home services to support aging relatives.

Coupled with Montana’s vast geography and strong community ties, this makes home care a preferred and increasingly necessary solution. The demand for personal care aides and home health aides is expected to grow by over 30% in the next decade—far outpacing the national average.

For entrepreneurs and healthcare professionals, Montana presents a unique opportunity to combine meaningful work with a profitable business model.

Choosing a Business Structure in Montana (LLC, Corporation, etc.)

Your first step in establishing a home care agency is selecting a legal structure. In Montana, the most popular options include:

  • Limited Liability Company (LLC): Offers flexibility, pass-through taxation, and liability protection. Most new home care businesses choose this route.
  • Corporation: Better for businesses planning to raise capital or offer stock, but comes with more administrative requirements.
  • Sole Proprietorship: Easiest to start but offers no liability protection—generally not recommended for home care due to legal exposure.

You can register your business online through the Montana Secretary of State’s business portal.

Getting Your Business Name and EIN

Here’s what you’ll need to officially name and register your agency:

  • Choose a unique business name: Check name availability via the Secretary of State’s database.
  • File your Articles of Organization (for LLCs): Filing fee is currently $35–$70 depending on the business structure.
  • Get an Employer Identification Number (EIN): Required for tax filings and hiring staff. Obtain it free via the IRS website.
  • Open a business bank account: Keeps personal and company finances separate—critical for legal and tax protection.

Home Care Licensing Requirements (Montana Department of Public Health and Human Services – DPHHS)

To operate a home care agency in Montana legally, you must obtain licensure through the Department of Public Health and Human Services (DPHHS). This applies to both medical and non-medical home care services.

Steps for Licensing:

  • Determine your service type:
    • Non-Medical Home Care (e.g., personal care, companionship)
    • Home Health (requires a Registered Nurse and medical oversight)
  • Submit the DPHHS Home Care License Application: Available from the DPHHS website.
  • Provide required documentation:
    • Policies and procedures manual
    • Emergency preparedness plan
    • Staffing plan and training standards
    • Organizational chart and governing documents
  • Pass a site inspection: A DPHHS representative will review your office and recordkeeping practices.
  • Pay license fees: Fees vary depending on care level and number of clients.

Note: Licensing can take 60–90 days or more depending on processing time and application accuracy. Begin early.

Medicaid Certification for Home-Based Services

If you plan to serve Medicaid clients, you’ll need to be certified as a Medicaid provider through Montana’s Medicaid program. This process includes additional documentation and verification to ensure your agency meets federal and state care standards.

Steps to Medicaid Enrollment:

  • Visit the Montana Medicaid Provider Enrollment Portal.
  • Submit application with supporting credentials (e.g., licenses, proof of liability insurance, ownership disclosure).
  • Complete the Medicaid provider agreement and background checks.
  • Enroll in Electronic Visit Verification (EVV), which is mandatory for Medicaid-funded home care services in Montana.

Once certified, your agency can begin billing Medicaid for covered services such as personal care, respite care, and certain medical tasks.

Required Insurance, Bonds, and Legal Documents

Running a home care business in Montana without proper insurance exposes you to unnecessary risk. Here are the core policies required:

  • General Liability Insurance: Protects against third-party injury or property damage claims.
  • Professional Liability (E&O) Insurance: Covers claims of negligence or service mistakes.
  • Workers’ Compensation Insurance: Required if you hire employees (mandatory under MT law).
  • Auto Insurance: If caregivers drive clients or use company vehicles.

You may also be required to file surety bonds depending on your Medicaid or insurance carrier contracts. Always consult a licensed Montana business insurance provider for a customized policy package.

Office Setup and Zoning Laws by County

Even if you operate your home care business from a home office, local zoning laws may apply. Regulations vary significantly by county and municipality.

Steps to Zoning Compliance:

  • Contact your local zoning or planning office (city or county level).
  • Request a Home Occupation Permit or Business Occupancy Certificate.
  • Ensure signage, parking, and client visits (if any) comply with regulations.
  • If renting office space, confirm that the lease allows health-related operations.

Montana counties like Yellowstone, Missoula, and Flathead have distinct zoning codes. Always verify before signing a lease or launching services from your residence.

Caregiver Hiring Standards and Background Checks in Montana

DPHHS and Medicaid regulations require that home care agency employees meet specific eligibility and training criteria.

Required Caregiver Qualifications:

  • Background Checks: Must pass a fingerprint-based FBI background check and Montana criminal history check.
  • CPR and First Aid Certification: Typically required for all field staff.
  • TB Testing: Recommended prior to employment.
  • State-approved training: Non-medical aides must complete DPHHS-required training hours in personal care, safety, and infection control.

Keep complete employment records on file for each staff member, including licenses, training logs, and signed job descriptions. These are reviewed during state inspections.

HIPAA, Compliance, and Client Confidentiality in Montana

Whether you provide medical or non-medical care, HIPAA and patient confidentiality laws apply. Montana follows federal HIPAA guidelines, and DPHHS may also require specific confidentiality policies for licensed providers.

Key Compliance Steps:

  • Train all staff: Every employee must complete annual HIPAA and data security training.
  • Use secure systems: Electronic health records, caregiver scheduling apps, and messaging tools should be HIPAA-compliant.
  • Document policies: Your confidentiality and emergency breach procedures must be written and accessible.
  • Obtain client consent: Always get signed permission forms before sharing information with family, healthcare providers, or third parties.

Maintaining client trust is crucial. One data breach can damage your agency’s reputation and result in costly legal action.

Preparing for State Inspections and Compliance Reviews

Once you are licensed and operating, expect scheduled and unscheduled visits from DPHHS for compliance reviews. These audits ensure that your agency meets all operational, safety, and documentation standards.

Common Inspection Focus Areas:

  • Client files and signed care plans
  • Staff records including background checks and training logs
  • Incident reports and medication logs
  • Billing records and Medicaid service documentation
  • EVV system accuracy and time-tracking records

Pro Tip: Conduct internal audits quarterly to stay prepared. Use a checklist that mirrors the DPHHS evaluation template to catch gaps early.

Final Thoughts: Start Strong and Stay Compliant

Starting a home care business in Montana is a rewarding path—but not without its challenges. From legal setup and licensing to Medicaid enrollment and caregiver training, each step plays a vital role in your agency’s future success.

By following this complete legal and licensing roadmap, you’ll not only get licensed faster but also build a foundation that meets the highest standards of quality and compliance in the state.

Big Sky Country is calling—and your home care business could be the answer many families are looking for in 2025 and beyond.