HELENA – The Montana Department of Health takes public commentary on part of its plan to combat drug use and the state’s mental illness crises.
In a draft proposal released this month, the Department of Public Health and Human Services proposed distributing federal Medicaid dollars to aid people seeking stable shelter, diagnosed inmates preparing to exit, and specific treatments for stimulant addictions.
The state is also suggesting using Medicaid to pay for inpatient and inpatient treatment at the Warm Springs state hospital and other private community-based providers, a seismic change that has had mixed reactions among behavioral health advocates.
The ideas are embedded in Governor Greg Gianforte’s roughly $ 25 million plan known as the HEART Initiative, or Healing and Ending Addiction through Recovery and Treatment. The plan calls for about $ 6 million in new marijuana tax revenue, as well as other sources, to be used to raise more funding from the federal Medicaid program.
If the state is successful, the policy corrections outlined this month will be funded through new uses of Medicaid dollars – a process that requires the state to provide the federal government with a waiver that explains the proposed changes and how they will affect Medicaid recipients become. The state released its draft waiver in early July, the first opportunity for most citizens to examine the details of the DPHHS proposal.
“The aim of this waiver is to fill gaps in the behavioral health continuum,” said Zoe Barnard, administrator of the DPHHS Addiction and Mental Disorders Division, at a public hearing on the proposed waiver this week. “Since 2016, Montana Medicaid has made great strides in the behavioral health continuum. This is an attempt to fill some of the final gaps we have in the supply system. “
Barnard stressed that the list of issues discussed in the department’s draft disclaimer is not a complete summary of all proposals under Gianforte’s HEART initiative, which may include the provision of additional grant funding for prevention services and the expansion of the range of services included in the state’s Medicaid plan .
The ideas contained in the draft waiver known as the Section 1115 demonstration must be experimental programs that are limited in scope and timeframe, Barnard said.
“An 1115 waiver is an experimental pilot or demonstration project. The initial demonstration period is typically five years and needs to be budget neutral, which means we can’t spend more money than we would otherwise, ”Barnard said during the public hearing on Tuesday.
After the current 60-day public comment period, Barnard said, the state plans to submit its draft waiver to the federal government by September 30. There will be another public comment period once the plan is submitted to federal officials. Ideally, according to Barnard, the final plan would go into effect on January 1, 2022.
Members of the public and behavioral health advocates praised the draft proposal during the virtual meetings, highlighting the support for tenants and inmates as particularly beneficial changes.
“This is so important to everyone’s recovery,” said Thomas Camel, a retired psychologist from Ronan, speaking of the need for stable housing. “If you don’t have an apartment, you’re in trouble.”
While Medicaid federal law does not allow funds to be used to finance housing, the waiver could provide coverage to help Medicaid beneficiaries find and stay safe living environments, as well as pay moving expenses and security deposits. The department said eligible individuals could include individuals diagnosed with severe mental illness or substance use disorder who also have at least one identified “risk factor” such as homelessness, a history of frequent or long-term institutional residences, or previous entanglements in the criminal justice system .
Several public commentators also supported the introduction of 30 days of mental health and medication management for inmates before their release date. Some advocates, including the Behavioral Health Alliance of Montana (BHAM) and the Montana Primary Care Association, recommended providing inmates with prescribed medication for up to 90 days upon leaving a facility to better support them.
Proponents also put forward another provision included in the draft waiver that would allow some healthcare facilities, including Montana State Hospital, to be reimbursed in federal Medicaid dollars for short-term inpatient and inpatient stays.
The waiver would allow these providers to bypass another Medicaid rule that excludes many “mental health institutions” or IMDs from financial reimbursement by the federal government. Currently, the 270-bed hospital is financed exclusively from the state’s General Fund.
Proponents cited the Rimrock Treatment Facility in Billings as a private facility that would benefit from Medicaid reimbursement. In a public letter that BHAM sent to DPHHS in June, the facility said it had serious staff shortages and extensive waiting lists for its nursing homes.
“We need more inpatient beds in the state of Montana,” said Matt Kuntz, executive director of NAMI Montana, who shared a recent experience bringing someone to the Rimrock facility.
“Sitting in her waiting room and watching people beg for care was one of the most heartbreaking things I’ve seen in the field,” said Kuntz.
Other commentators said they wanted only private facilities to have access to Medicaid reimbursement, as opposed to public hospitals, and asked whether federal dollar funding for the roughly 100-year-old facility qualifies as an innovative or experimental approach.
“Reimbursing Medicaid dollars to the state for housing people at the facility as proposed in this demonstration waiver is not a ‘community-based’ solution – nor is it a new or innovative proposal,” said Beth Brenneman, Montana disability attorney , in a written statement to the department. “At best, more people will be sent away from home to be treated for therapy in a large, shared care facility with limited access to healthcare professionals. In the worst case, it will serve to avoid promoting and funding better treatment alternatives in the community – which is difficult and challenging work. “
Brenneman and other commentators also underscored the general need to improve pay and retention for state health workers by increasing the state’s Medicaid reimbursement rates, which some have described as an existential problem for the state.
“Montana desperately needs support, development and a much better pay and compensation package for direct care providers and other workers across the mental health system,” Mary Ann Dunwell, Rep. Mary Ann Dunwell, D-Helena, said in a statement to the department on Tuesday. “It’s a shame that our tariff system restricts the providers. The bottom line is that we don’t have a functioning system without employees. “
The department has planned more public meetings in the coming weeks, including a consultation with tribal nations. The deadline for submitting written comments is September 7th.
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