Montana requires a minimum of 75 hours of DPHHS-approved nurse aide training — the exact federal minimum established under OBRA '87. Montana does not exceed the federal floor, making it one of the more accessible states for entry-level healthcare workers. Programs must be approved by the Montana Department of Public Health and Human Services (DPHHS) and must include classroom instruction, skills laboratory practice, and a minimum of 16 hours of supervised clinical training at a licensed nursing facility or healthcare setting. Accelerated full-time programs can complete in 2–3 weeks; part-time evening programs take 6–10 weeks. Tribal colleges and Indian Health Service facilities sometimes offer CNA training programs specifically designed for reservation communities.
Montana uses D&S Diversified Technologies to administer the CNA competency exam — not Prometric. This is a critical distinction for Montana candidates, as many national study guides and online resources reference Prometric. D&S Diversified administers both the written knowledge test (70 questions, 105 minutes, 70% minimum passing score) and the clinical skills evaluation (5 randomly selected skills from the standard NNAAP skill set, all 5 must be passed). After completing your DPHHS-approved training program, you register directly with D&S Diversified at their website. Testing is available at multiple sites in Montana including Billings, Missoula, Great Falls, Helena, Bozeman, and Butte. Candidates who fail one section may retake that section separately without retaking the other.
The Montana DPHHS Nurse Aide Registry is managed by the Montana Department of Public Health and Human Services — not the Montana Board of Nursing. This is a key distinction that confuses many candidates who look up their state board of nursing instead. DPHHS certifies nurse aides, maintains the registry, processes reciprocity applications, and maintains the abuse/neglect/exploitation findings registry. After passing both sections of the D&S Diversified exam, DPHHS typically processes your registry placement within 2–4 weeks. Registry status can be verified online through the DPHHS website. Employers are legally required to verify CNA registry status before hiring. Montana's registry is part of the national nurse aide registry network, which means out-of-state verified CNAs can transfer to Montana via the reciprocity process without retesting in most cases.
Visit the Montana DPHHS website to access the current list of approved nurse aide training programs. Options include City College at MSU Billings, Missoula College, Montana State University Great Falls, Gallatin College MSU, and vocational schools. Red Cross chapters in Billings and Missoula also offer programs. If you live on or near a reservation, check whether your tribal college or Indian Health Service facility offers CNA training. Confirm the program is currently DPHHS-approved before enrolling.
Obtain your TB test within 12 months, physical examination clearance, current immunizations, and CPR/BLS certification. Submit to a Montana DPHHS criminal background check. Most programs require these documents before clinical placement begins. Pre-enrollment drug screening may also be required by specific programs or clinical placement sites. Gather a valid photo ID (Montana driver's license, passport, or state ID).
Complete all 75 required hours of DPHHS-approved training, including classroom/theory instruction (minimum 16 hours), skills laboratory practice, and supervised clinical hours (minimum 16 hours at a licensed Montana nursing facility or approved clinical site). Full-time accelerated programs typically complete in 2–3 weeks; part-time evening/weekend programs take 6–10 weeks. Your instructor will sign off on all required competencies at program completion.
After receiving your program completion certificate from your DPHHS-approved training provider, register directly with D&S Diversified Technologies for both the written knowledge test and the clinical skills evaluation. Testing sites available in Billings, Missoula, Great Falls, Helena, Bozeman, and Butte. The total fee is approximately $85–$120. Select test dates — you have 24 months from training completion to pass both exam sections and apply for registry placement.
Pass the written knowledge test (70 questions, 70% minimum = 49 correct answers, 105 minutes) AND the clinical skills evaluation (5 randomly selected skills from the standard NNAAP skill list, all 5 must pass). If you fail one section, you can retake that section separately — up to 3 total attempts within your 24-month eligibility window. Skills commonly tested include handwashing, vital signs, range of motion exercises, perineal care, and transferring patients.
After passing both exam sections, D&S Diversified reports results to the Montana DPHHS Nurse Aide Registry. DPHHS typically processes registry placement within 2–4 weeks. You will receive written confirmation of your active CNA certification and registry listing. Employers can verify your status immediately through the online registry. Your initial certification is active for 2 years — you must complete 8 hours of paid nursing employment within that period to remain eligible for renewal.
With active DPHHS registry status confirmed, apply to CNA positions at Billings Clinic, Intermountain St. Vincent, Providence St. Patrick, Benefis Health System, Logan Health, Bozeman Health, tribal health facilities, rural critical access hospitals, SNFs, home health agencies, and assisted living facilities. Jobs are available statewide, with the highest wages in Billings, Bozeman, and Missoula. Rural positions in Eastern and Central Montana frequently include significant signing bonuses and housing assistance due to severe staffing shortages.
Montana is one of the most rural states in the continental United States, and this creates unique CNA employment opportunities found in few other states. Healthcare access challenges in rural Montana are severe — many counties have no hospital and rely entirely on critical access hospitals (CAHs) staffed in part by CNAs. The Montana DPHHS has designated numerous areas as Health Professional Shortage Areas (HPSAs), which triggers federal incentives for healthcare workers willing to serve these communities.
Tribal Health Facilities: Montana has seven federally recognized tribes: the Blackfeet Nation, Crow Nation, Northern Cheyenne Tribe, Confederated Salish and Kootenai Tribes, Fort Belknap Indian Community, Fort Peck Assiniboine and Sioux Tribes, and Little Shell Chippewa Tribe. Each maintains tribal health programs and many operate in partnership with the Indian Health Service (IHS). CNA positions at tribal health facilities and IHS Service Units offer:
Rural Critical Access Hospitals: Montana has 54 licensed critical access hospitals — more than almost any other state. Rural CAHs in communities like Havre, Glasgow, Malta, Forsyth, Hardin, Ronan, and Dillon consistently advertise CNA positions with sign-on bonuses ranging from $1,500 to $3,500, housing stipends, and flexible scheduling. CNA-to-LPN bridge programs are frequently employer-sponsored at rural CAHs as facilities invest in workforce development to address chronic staffing shortages.
Montana Older Montanans Medicaid Waiver: Montana's home and community-based services waivers fund a large number of home health CNA positions statewide. The Big Sky Waiver and Community First Choice (CFC) programs allow elderly and disabled Montanans to receive CNA services at home instead of in nursing facilities, creating flexible, community-based CNA employment throughout rural Montana.