Under New Requirement, Montana Child Care Centers Must Accept Religious Vaccine Exemptions

A rule change package for child care centers in Montana went into effect after the end of the 2025 legislative session, bringing with it a new requirement that all day care centers must accept religious vaccine exemptions. The new rule is drawing criticism from some local child care centers whose directors say their hand is being forced, and from families concerned with their children’s health.  

The Montana Department of Public Health and Human Services (DPHHS) proposed a mandatory inclusion of religious exemptions in the summer of 2022, but encountered resistance from the Montana Legislature’s Children, Families, Health, and Human Services Interim Committee, whose members objected to it.  

The department introduced the rule again in 2023, this time tucked inside an updated version of an overhaul package that strove to simplify child care licensing requirements in alignment with Gov. Greg Gianforte’s Red Tape Initiative. Though the rewritten licensing package received widespread support, child care centers, families and pediatric advocates protested the religious vaccine exemption rule within, prompting the legislature’s interim committee to informally object again, placing the entire package on a temporary hold. 

DPHHS officials stated that the reason for the religious exemption rule is to ensure that the department complies with the Montana Religious Freedom Restoration Act (RFRA), a Senate bill the 2021 Montana Legislature passed that does not allow state action to “substantially burden a person’s right to the exercise of religion.” 

“Because the child care rules currently provide opportunity for a religious exemption to only one childhood vaccine — while providing for medical exemptions — the department concluded that the failure to provide for a religious exemption for families with a religious objection to any of the required vaccines likely violates Montana RFRA,” the department stated. “The proposed rules address this issue, and ensure compliance with Montana RFRA.” 

The existing religious exemption was for vaccination against Haemophilus influenzae Type B, known as the Hib vaccine.

The DPHHS had already released a discretionary notice in October 2022 out of concern that the department was not in compliance with RFRA, stating that DPHHS officials would not “pursue negative licensing actions” against centers who chose to accept religious exemptions.  

When the interim committee’s informal objection to the package expired in early 2024, the committee filed a formal objection, preventing the package and the exemption rule from going into effect until after the end of the next regular legislative session, theoretically so that legislators would have a chance to address the proposed rule changes or provide additional direction to the agency.  

That direction never materialized during the 2025 legislative session. 

Although Senate Bill 382 sought to require child care centers to accept religious exemption, it failed to pass. Legislators introduced an assortment of other child care bills, including a measure to generally revise child care administrative rules; however, lawmakers didn’t pass any initiatives that would override the DPHHS’ rule change package.  

Without any alternative direction, the department’s package went into effect on May 1 after the session ended.

The immunization directive, on page 45 of the 97-page document, requires all child care centers, defined as a licensed “out-of-home place in which care is provided to 16 or more children,” now accept children with religious vaccine exemptions for all regularly required vaccines. Home-based programs that serve 15 children or less are permitted to make their own decision, as home-based programs are smaller and are not required to separate those too young to be vaccinated from older age groups. 

On April 28, a few days before the package went into effect, Jody Lehman, child care bureau chief for DPHHS, sent out an email to health department licensors, with instructions to forward it to child care providers in their caseloads. The email invited providers to attend a virtual town hall set for the following day to review “child care rules and policies, discuss best practices, share resources and answer discussions.” In the attached agenda were links to the new child care facilities rules, specifically those pertaining to the new health care and immunization requirements.

At the Kalispell day care center the Birds Nest, known as The Nest, Director Corinne Kuntz has paid close attention to the legislative changes. When the 2025 session ended and the DPHHS rule package went into place, however, she was shocked.  

“All of us child care providers thought it was dead,” Kuntz said. “We didn’t realize it’d go into effect regardless of how the interim committee felt.”  

In its wake, Kuntz sent out an email to parents, informing them of the new rule and asking them to participate in a survey to gauge how they felt.  

Of the 69 parents who responded to the question on whether they would keep their child enrolled in a program that accepted religious exemptions, a little over 52% said they would not. Several, however, said they would have no other choice. 

Anaka Broste is an ER and ICU nurse at Logan Health with two children enrolled at The Nest — a 5-and-a-half-year-old son and 2-and-a-half-year-old daughter. While her son starts kindergarten next year, her daughter has another two years at the center. 

“I specifically chose them as I knew they didn’t allow religious exemptions,” Broste said of The Nest. “She is 2-and-a-half, almost 3, and will not be fully protected per the current immunization schedule until she is 4.”  

If nothings changes, Broste said she and her partner will have to keep their daughter in day care as they “both work full time and have no other options.”  

Broste said her concerns are intensified with the current measles outbreak in the U.S., including a small outbreak in Montana, and the recent flu season that resulted in over 200 pediatric deaths nationwide.  

“I have seen firsthand the repercussions of choosing to not be vaccinated,” Broste said. “The new ruling takes away my right as a parent to choose an environment for my children where they will be most protected from vaccine-preventable illnesses.”  

Montana is one of 45 states that allows religious exemptions for school age children. An extension to day care centers with children ranging from newborns to 5 year olds, child care directors warn, is problematic in large facilities that hold both infants and preschoolers.  

At The Nest, age-based programs are currently held in five separate homes. That will change by the end of the year when The Nest moves all its programs into a 14,000-square-foot facility that is currently being built to expand Kuntz’s services from her current 92 children to around 150, depending on the time of year. In a center where about half of the enrolled children are infants, along with a majority of the waitlist, Kuntz said the buffer between older, vaccinated children and infants will be gone.  

Even if she only loses 30% of her families, Kuntz said, filling a center with infants is financially unfeasible, particularly as she stands to lose some members of her staff who are immunocompromised.  

“Ultimately, it would be a pretty difficult decision,” said Kuntz. “I’ll have space for 150 children in the valley. If I shut my doors, there’s 150 children that don’t have child care.” 

In the meantime, she’s submitted a form to DPHHS in hopes of waiving the center’s compliance with the rule. 

At the Discovery Developmental Center, Director Collette Box serves children aged 1 through 4. Parents have approached her, Box said, asking if her policy has changed. Her response is that there hasn’t been enough time, and she still has questions about how to create a stronger health policy in line with the exemptions.  

“Can we beef up our health policy even if we have children who are unvaccinated?” Box said. “There’s just a lot of policy pieces that need to get put into play so that all of the kids and families can feel safe. And I just think that the way the state is handling it, it came too fast with too little time to make a plan.” 

Policy analysts have studied what happens when states make it easier for people to apply for non-medical exemptions. Sophia Newcomer, a University of Montana professor in public and community health, said such studies raise concerns.  

“What happens is the rates of exemptions go up, vaccination rates go down, and then you see vaccine preventable disease outbreaks,” she said. “My concern is that we will start to see that here in Montana.”  

Montana, unlike most states, does not currently require schools or day care centers to track vaccinations or exemptions, meaning that the state is “flying blind” when it comes to understanding what the impact of requiring centers to allow religious exemptions might be, Newcomer said. 

According to the DPHHS website, the role of the state’s Child Care Licensing program, other than to “monitor, inspect and support” licensed facilities, is to “establish regulations for the health, safety, and well-being of the children in these facilities.”  

Newcomer said she questioned how the decision to require religious exemptions fell under the department’s purview.  

“My understanding is that they are responsible for making sure that child care settings are healthy settings for children,” Newcomer said. “And it’s unclear how adding an exemption from vaccination requirements makes these settings more healthy.”  

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