Carly Graf, Lee Enterprises, 12/09/24
After 18 months spent examining how to spend $300 million to address shortages in Montana’s hobbled behavioral health system, the nine-member commission of lawmakers, state health officials and representatives from the mental health field now turns to the state Legislature to fund its ideas going forward.
Of the lump sum, $75 million is allocated to capital projects to improve behavioral health infrastructure and another $47 million to near-term initiatives, programs approved by the state health department that can be implemented more quickly. Most of the commission’s funding, though, is dedicated to getting recommended programs up and running, but doesn't fund them sustainably for the long run.
That's a task left up to the State Legislature when it crafts the budget for the next two years.
Gov. Greg Gianforte signed off on the landmark package to fund the Behavioral Health Systems for Future Generations Commission at the end of the last legislative session. House Bill 872 was proposed by the administration and established by the Legislature, then celebrated as a transformational investment in mental health.
Gianforte’s proposed budget for the next two fiscal years includes up to $100 million – a combination of state dollars and federal matches – to bankroll 10 of the commission’s 22 total recommendations. Eight are considered foundational, meaning the commission believes they’re necessary to lay the groundwork for subsequent improvements.
The Montana Budget and Policy Center, a nonprofit that focuses on budget and tax policy, applauded the move, but noted that it leaves out about half of the commission’s recommendations. It also flagged that Medicaid expansion, which makes low income earners eligible for the joint state-federal health insurance program, is important to the federal matching dollars the proposal counts on.
Gianforte’s budget funds continued Medicaid expansion, which will sunset in 2025 unless reauthorized by the State Legislature, though he’s advocated for work requirements that could possibly reduce enrollment.
Additionally, uncertainty around potential efforts under the next White House to cut federal spending on public benefits could greatly impact state governments, including Montana's. Federal match dollars account for $46 million, almost half, of Gianforte’s total proposed allocation toward the behavioral health commission recommendations. Without them, the calculus would change significantly.
The bulk of that federal share is tied to Medicaid reimbursement for services provided, according to Gene Hermanson, who oversees the finances of Montana’s Medicaid program. Many of the people who would be served by the commission-recommended programs are covered by traditional Medicaid. Others, though a smaller number, receive health coverage through Medicaid expansion.
“We want to leverage as much federal funds as possible,” Hermanson said at the July commission meeting.
Montana has the unfortunate distinction of being a national leader in suicide rates among youth and adults. According to data from the Centers for Disease Control, Montanans are more than twice as likely to die by suicide than the national average. The average Montanan is also less likely to be able to find a mental health provider when in need and more likely to report symptoms of depression or anxiety, analysis from KFF shows.
The bipartisan commission worked closely with the Department of Public Health and Human Services to identify holes in the fledgling behavioral health landscape and propose solutions. It ultimately made 22 recommendations to the governor's office.
Recommendations funded in the governor's budget include efforts to retool Medicaid waiver reimbursement rates; expand options for people with complex needs; reopen evaluation and diagnostic clinics for families seek developmental disability services; enhance targeted case management; create care transitions program for patients leaving psychiatric hospitals to go back into communities; adopt electronic bed registry and improve the 988 line; improve in-state youth residential services; invest in school-based behavioral health; create incentives to join the behavioral health workforce; and expand certified community behavioral health clinics.
Rep. Dave Fern, D-Whitefish, was a member of the commission. He said the governor has been a “great partner” in this process and that starting with this selection of recommendations over the next two years made sense to him as an approach.
“It’s got some big stuff in it,” Fern said, specifically referring to the $40 million proposal to expand community behavioral health clinics statewide as a “game-changer” in some places.
Legislators, including Fern in his new office as state senator for Senate District 2, will have the chance to weigh in on whether the $100 million proposal meets the mark as they craft the biennium state budget via House Bill 2.
MBPC is a nonprofit organization focused on providing credible and timely research and analysis on budget, tax, and economic issues that impact low- and moderate-income Montana families.