MT health service. details Medicaid plan to treat addiction, mental health

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HELENA – The Montana Department of Health is collecting public comment on part of its plan to tackle the state’s addiction and mental illness crises.

In one draft proposal published this month, the Department of Public Health and Human Services suggested channeling federal Medicaid dollars to support people seeking stable housing, diagnosed inmates preparing to release from prison, and specific treatment for stimulant addictions. .

The state is also proposing to use Medicaid to pay for inpatient and residential treatment at Warm Springs Public Hospital and other private community providers, a seismic change that has drawn mixed reactions among behavioral health advocates.

The ideas are incorporated into Governor Greg Gianforte’s roughly $ 25 million plan known as the HEART initiative, or Healing and Ending Addiction through Recovery and Treatment. The plan proposes to leverage about $ 6 million in new revenue from marijuana taxes, along with other sources, to trigger more funding for the federal Medicaid program.

If the state is successful, the policy fixes outlined this month will be funded through new uses of Medicaid dollars – a process that requires the state to submit a waiver to the federal government explaining its proposed changes and their impact on drug recipients. Medicaid. The state released its proposed waiver in early July, the first opportunity for most members of the public to review the details of the DPHHS proposal.

“The purpose of this waiver is to fill gaps in the behavioral health continuum,” said Zoe Barnard, administrator of the addictive and mental disorders division of DPHHS, in a public hearing on the proposed waiver this week. . “Since 2016, there have been major advancements in the behavioral health care continuum within Montana Medicaid. This is an attempt to address some of the remaining gaps we have in the healthcare system. “

Barnard pointed out that the list of topics covered in the ministry’s proposed waiver is not a comprehensive summary of all the proposals within Gianforte’s HEART initiative, which could also include releasing more grants for prevention services and expanding the list of benefits included in the state’s Medicaid plan.

The ideas included in the draft exemption, known as Section 1115 Demonstration, must be experimental programs limited in scope and timing, Barnard said.

“An 1115 exemption is an experimental or demonstration pilot project. The initial demo period is usually five years, and it should be budget neutral, which means we can’t spend more money than we would otherwise, ”Barnard said at the public hearing Tuesday.

After the current 60-day public comment period ends, Barnard said, the state plans to submit its proposed waiver to the federal government by September 30. There will be another public comment period once the plan is handed over to federal officials. Ideally, Barnard said, the final plan would go into effect on January 1, 2022.

Members of the public and behavioral health advocates praised the draft proposal in the virtual meetings, highlighting support for tenants and inmates as particularly beneficial changes.

“It’s so important for recovery, for everyone,” said Thomas Camel, a retired mental health counselor from Ronan, speaking of the need for stable housing. “If you don’t have housing, you are in trouble.

Although federal Medicaid rules do not allow the use of funds to pay for housing, the waiver could provide coverage to help Medicaid recipients find and stay in safe environments, as well as pay the costs. moving and security deposits. The department said eligible people could include people who have been diagnosed with severe mental illness or substance use disorder and also have at least one identified “risk factor”, such as homelessness, history. frequent or long-term institutional stays, or a history of involvement with the criminal justice system.

Several public commentators have also expressed support for adding 30 days of mental health and medication management services to inmates before their release date. Some advocates, including the Behavioral Health Alliance of Montana (BHAM) and the Montana Primary Care Association, have recommended providing inmates with up to 90 days of prescribed medication when they leave an institution to provide more support.

Advocates also raised another provision outlined in the proposed waiver that would allow certain health care facilities, including Montana State Hospital, to be reimbursed with federal Medicaid dollars for short-term residential and hospital stays.

The waiver, as drafted, would allow these providers to bypass another Medicaid Rule That Excludes Many “Mental Illness Institutions” or IMDs, receive a financial reimbursement from the federal government. Currently, the 270-bed public hospital is funded solely by the General State Fund.

The lawyers pointed out Rimrock treatment facility in Billings as a private institution that would benefit from Medicaid reimbursement. In a public letter sent by BHAM to DPHHS in June, the facility said it was facing a severe staff shortage and long waiting lists for its residential treatment homes.

“We need more inpatient beds in the state of Montana,” said Matt Kuntz, executive director of NAMI Montana, who recounted a recent experience taking someone to the Rimrock facility.

“Sitting in their waiting room, watching people begging for care, has been one of the most heartbreaking things I’ve seen working in this field,” Kuntz said.

Other commentators clarified that they wanted only private facilities to have access to Medicaid reimbursement, as opposed to the public hospital, and questioned whether funding the approximately 100-year-old facility with dollars federal government would be considered an innovative or experimental approach.

“Reimbursing the state with Medicaid dollars to place people in the institution as proposed in this demonstration waiver is not a ‘community’ solution – nor a new or innovative proposition,” said Beth Brenneman, lawyer for Disability. Rights Montana, written statement provided to ministry. “At best, it will send more people away from their homes for treatment in a large collective care facility with limited access to healthcare professionals for therapy. At worst, this will serve to avoid encouraging and funding better treatment alternatives in the community, which is hard and challenging work. “

Brenneman and other commentators have also pointed to the general need to improve the compensation and retention of the state’s behavioral health workforce by increasing the state’s Medicaid reimbursement rates, which some have described as an existential problem to which the state is confronted.

“Montana is in dire need of support, development and much better pay and compensation for direct caregivers and other workers in the mental health system,” said Representative Mary Ann Dunwell, D-Helena, in a statement to the department on Tuesday. “It’s a shame what our pricing system limits providers to do. At the end of the day, without a workforce, we don’t have a system that works.

The department has programmed more public meetings, including consultation with tribal nations, in the coming weeks. The deadline for submitting written comments is September 7th.

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