Medicaid is Essential for Behavioral Health

Aug 01, 2024

By Jackie Semmens

In 2024, the Montana Legislature invested $300 million in Montana’s behavioral and developmental disability health system by creating the Behavioral Health for Future Generations Commission. The commission is tasked with allocating these funds across the behavioral health system to stabilize and strengthen behavioral health and developmental disability service providers and create a comprehensive state-wide system of care.

Behavioral health (an umbrella term used to describe both mental health and substance use disorders) and developmental disability providers often rely heavily on Medicaid. For people living with severe disabling mental illnesses, Medicaid can provide stable access to care. In 2022, nearly one in every three (31 percent) of Medicaid members in Montana had a behavioral health diagnosis.

Over the past year, the commission held meetings around the state to hear about challenges faced by providers, families, and clientele of the system. Behavioral health advocates called on the commission to expand care coordination, targeted case management, home support services for at-risk families, and school-based and community-based programs in its recommendations.

This July, the commission presented the draft report, which noted three main gaps in the system:

1. Workforce – including limited availability of specialized professionals in Montana;
2. Case management – including poor coordination of transitions and inconsistency between level of service and understanding of agreements;
3. Continuum capacity – including insufficient crisis services, reliance on out-of-state placements due to inadequate child services, and limited tools for families and individuals to navigate the system.

The commission released 22 long-term recommendations (5 related to developmental disabilities and 18 related to behavioral health) that address these gaps in the system. These recommendations include:

• Reevaluating existing Medicaid service waivers and expanding access to these services;
• Reopening evaluation and diagnostic clinics;
• Enhancing targeted case management;
• Increasing support for people with severe mental illness and/or substance use disorders who are also experiencing homelessness;
• Reducing transportation issues related to care;
• Redesigning rates to improve access to in-state care;
• Improving information technology;
• Expanding peer support; and
• Expanding and sustaining certified community behavioral health clinics.

While the long-term recommendations have yet to be finalized and approved by the governor, the commission has also approved several near-term initiatives, including:

• Fair market rent studies;
• Access to fentanyl testing strips;
• Increasing residential bed capacity; and
• Support for Tribal and Urban Indian Organizations.

While the commission’s priorities have not been finalized, the report noted if all recommendations were implemented, the annual funding requirement would be $131 million, $87 million of which would be federal spending. Because many of the services the commission is interested in improving and expanding are funded by Medicaid, which is mostly paid for by the federal government, Montana can bring in significant federal funding to help support behavioral health across the state.

But the Department of Public Health and Human Services, in their presentation to the commission, also noted that if Montana fails to continue its expanded Medicaid program, millions in potential federal fundings could shift to costs for the state.

Montana’s expanded Medicaid program has brought in millions of dollars into the behavioral health system and strengthened access to substance use disorder treatment, with the number of providers in the state growing from 95 to 208.

According to the Montana Health Care Foundation:

“In Montana in 2023, 37,630 people received a mental health service through expansion (an additional 45,035 received these services through traditional Medicaid). In addition, in 2023, three times more people received an SUD service through expansion than traditional Medicaid (8,285 people on expansion compared to 2,833 people with traditional Medicaid), and the number of people receiving an SUD service via expansion between 2017 and 2023 nearly doubled.”

If Montana fails to continue its expanded Medicaid program, the investments of the BHSFG could be in vain. If thousands of Montanans suddenly become uninsured – with no option for affordable coverage – many behavioral health providers will have difficulty staying open, let alone improving care, as the BHSFG commission hopes.

Montana’s health care system depends on reliable, steady sources of funding. For adults and families seeking help through the behavioral health system, this stability is even more necessary. Montana must continue its current Medicaid program to fully make use of its recent investments in the behavioral health system.