But even with these two new pools of money intended to last two years, the state’s schools may struggle to remove all but the most dangerous sources of lead, considering about half the schools that tested their water between July 2020 and February 2022 found high lead levels. Medical experts say of lead is safe to ingest.

“When you start replacing faucets and drinking fountains in the hundreds of schools that we have in Montana, that gets eaten up pretty quickly,” said Democratic state Rep. , who added the state funding to an passed this spring.

If the total were divided evenly among the approximately 590 schools that need to meet the state’s new lead testing rules, each school would receive less than $8,000 from the state to test and upgrade its faucets, pipes, and water fountains. The state already knows that 110 schools have had at least one water fixture with lead levels of 15 parts per billion or higher, three times the level that requires action under Montana rules.

Most schools with lead levels over the state limit could address their “exceedances” with the state money, according to state Department of Environmental Quality spokesperson Moira Davin. “Our plan is to address as many schools as possible with this funding,” she said.

But part of the challenge for Montana is that it doesn’t yet know how extensive a problem its schools have. More than a fifth of the state’s schools facing the new rules — 129 facilities — hadn’t completed any sampling as of Aug. 3, said Greg Montgomery, director of the department’s program. And replacing a single school’s pipes can cost hundreds of thousands of dollars.

, an environmental health instructor at the Harvard T.H. Chan School of Public Health, said that the money Montana has in hand is not a lot when it comes to fixing pipes but that it could be enough to get filters on all the faucets.

“We are not talking about solving the whole problem here,” said Levin, who worked on lead exposure during her nearly 40 years at the U.S. Environmental Protection Agency.

Lead is particularly and can lead to brain and nervous system damage and slowed development and growth. It typically gets into drinking water in schools through piping or fixtures. A 2020 requires schools to test water supplies every three years. If lead concentrations surpass 5 parts per billion, fixtures must be addressed — and shut off if higher than 15 ppb.

, an economics professor at Amherst College, said prioritizing fountains or pipes with high lead levels after a “first draw” test could help a lot. The test measures lead in water the first time a faucet is turned on for the day, after the water’s been sitting in a pipe all night. That sample provides the best data to pinpoint the greatest risks, she said.

Running all faucets for a few minutes before kids get to school is quite protective for kids, Reyes added, because the quantity of lead diminishes as the water runs. But Reyes often imagines a kindergartner getting to school early for free breakfast and drinking from a water fountain before anyone in the building clears the pipes.

“Everything kids need to grow — lead is the opposite of those,” Reyes said.

Montana officials will decide how to distribute the money from the legislature, reimbursing schools for costs such as installing new faucets, water filters, plumbing, and water bottle filling stations. The federal grant, meanwhile, will be used for covering costs related to testing, Montgomery said.

Schools will have to participate in the state’s Lead in Schools program by sampling their drinking water to get any of the state funding, he said, and they won’t be able to use the money on projects completed before the state bill was signed into law.

Montgomery said the amount available to schools would depend on whether they have any fixtures over the “action level,” or fixtures with lead concentrations over 5 ppb. Funding will be prioritized on a first-come, first-served basis, he said.

Even if a school doesn’t have high samples of lead in its test results, Montgomery said, it could seek money to install water bottle filling stations with filters. Schools could also use the money for larger projects such as replacing piping, but, Montgomery said, the state will set a limit on how much each school can get. And, he said, it’s unlikely the money will be able to cover something like a $100,000 pipe replacement project.

The goal is to make money available to all schools, regardless of size, and ensure a couple of schools aren’t “gobbling” the entire amount, Montgomery said. That means schools with extensive issues will likely need to pick which areas to fix.

“We want to make sure the small schools have equal footing as the large schools,” Montgomery said.

Many Montana schools have already launched remediation projects after receiving high lead results.

One sink at Skyview High School in Billings had one of the highest levels of lead detected in schools across the state. Scott Reiter, the executive director of facilities for Billings Public Schools, said the sink was in a control room in the auditorium and people rarely used it. After the results came in, the fixture was removed to make the sink unusable.

On a larger scale, he said, all cold-water piping for drinking and sinks was replaced at Rimrock Learning Center in Billings last summer. Reiter said the school had been remodeled and all fixtures replaced about five years ago, so when lead was detected all over the school, it was clear it wasn’t just one fixture.

“We knew that it had to be in the lines,” Reiter said.

Reiter said the school district used leftover money from a 2013 elementary school district bond to replace Rimrock’s pipes, which he estimated cost $100,000.

While Reiter said he was disappointed costs from the Rimrock pipe replacements and other projects that have already happened couldn’t be reimbursed retroactively, he welcomed the state’s additional funding. “Any help to the schools for something like this is great,” he said.

The Great Falls Public Schools district also exemplifies how extensive and expensive such work can be. The district used $19,511 from an earlier $40,000 state allocation for drinking fountains, water bottle fillers, and filters across schools in the district, said Brian Patrick, its director of business services and operations. He said the district also got 783 tests covered by the state, each costing $25.

His district used a bond passed in 2017 to fund a pipe replacement at Lewis and Clark Elementary School, where 23 tests came in at 5 ppb or higher. The pipes were replaced last summer, Patrick said, costing $411,252.

“It doesn’t get fixed in one fell swoop,” Patrick said.

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

Twenty-three days after her cancer diagnosis, the 36-year-old Helena resident said, she had put $7,579 on three credit cards to pay for her out-of-pocket fertility preservation costs.

Her insurance didn’t cover it. In Montana, fertility preservation for newly diagnosed cancer patients whose pending treatment could cause infertility isn’t required to be covered by insurance.

On March 15, 2023, Beall finished her chemotherapy and began to lobby Montana’s legislature to change that.

Beall has taken the helm in advocating for that would require insurance to cover the initial costs of fertility preservation for people diagnosed with cancer. That includes requiring coverage of appointments with a reproductive endocrinologist and the retrieval of sperm, eggs, or embryos, but not their storage or procedures like in vitro fertilization.

Amid a to Montana’s legislative session, the bill, which has already been approved by the state Senate, is close to passing its final hurdle. The legislature is scheduled to end its 90-day session on May 5, which means the bill has just a few days before the House of Representatives will need to give it final approval before it heads to the governor’s desk.

The bill has bipartisan support, but Beall is worried about how lawmakers will respond to what she says is an inaccurate estimate of what it will cost. Beall said the bill’s prepared by state agencies contains a handful of errors. For example, Beall said, it assumes men’s and women’s fertility preservation costs the same. But the cost for sperm banking is around $700, while women can pay between $7,000 and $11,000, according to an estimate by Billings Clinic. The fiscal note also includes the cost of eight years of storage, which is not included in the bill, and budgets for 2.1 female fertility cycles.

According to Stacy Shomento, one of two reproductive endocrinologists in Montana, who practices at Billings Clinic, there has not been a cancer patient in their program who has undergone two rounds of fertility medication before starting cancer treatment since 2011.

Estimates from Blue Cross and Blue Shield of Montana place a $75,000-a-year price on the bill for the insurance company. Spokesperson John Doran said the company didn’t include costs for men in its estimation since they were “negligible,” and estimated that seven to 10 of their female members would use the coverage annually.

The bill would cost BCBS members about 12 cents extra a month, Doran said. Montana’s Department of Public Health and Human Services estimated a similar increase for Medicaid members.

The that a total of between 18 and 39 men and women each year would participate if the bill passes.

Insurance covers fertility preservation in .

When Beall started researching legislation, she called Democratic state Sen. Pat Flowers to ask if he thought a bill could succeed this session, and he said: “Let’s do it.”

Flowers’ wife was diagnosed with breast cancer when their two children were young. At an emotional hearing on April 14, Flowers said they were considering a third child but fertility preservation wasn’t much of a discussion, and, if it had been, it wouldn’t have been a financial option for a young family living paycheck to paycheck.

“I know we could not have afforded to spend $7,500 to make that happen,” Flowers said.

Cancer takes a lot from you, Beall said. But what fertility preservation offered was a sense of hope that she still had control over her future.

Beall and her boyfriend want to have kids. She was able to finance the out-of-pocket expenses for fertility preservation but acknowledged that not all young cancer patients can afford to do so, especially within such a short time frame.

Once a patient is diagnosed, oncologists want to start chemotherapy right away, and fertility preservation must happen as quickly as possible. Missing one payment can leave a patient’s timeline “screwed up,” Beall said, and there’s generally no payment plan.

“If you can’t finance this out-of-pocket, it’s too late for you, and you’ll have to go into whatever your next treatment is,” Beall said. “You’re going to know you’re going to be infertile and there was an option but you just couldn’t finance it, so your idea of a biological family is done.”

It was at one of the bill’s legislative hearings that Beall, for the first time, met another woman who had gone through the same thing she had.

Carley VonHeeder was diagnosed with Hodgkin lymphoma when she was 24. VonHeeder, now 25, said she was so “dissociated” through the process of starting cancer treatment and fertility preservation that she wasn’t processing it.

Meeting Beall was the first time she felt someone could appreciate all she’d gone through, VonHeeder said, and it made her feel more empowered each time she returned to the Capitol to testify.

“It filled a hole I didn’t even know I had,” VonHeeder said.

Aimee Grmoljez, a lobbyist for Billings Clinic, said in a hearing on the bill that fertility preservation is within the standard of care — doctors are required to tell patients about the option — yet it’s not covered by insurance.

Grmoljez said she couldn’t think of another procedure that falls along the same lines.

Shomento, Beall’s reproductive endocrinologist, said patients can see a specialist in Bozeman — where Shomento is — or in Billings, where the state’s only other specialist practices.

Shomento said most of her job is helping patients with general infertility, something she said about 1 in 6 or 8 couples deal with.

“It’s not going to affect an everyday person very much,” Shomento said. “But it’s going to affect the cancer person in a huge way.”

Becky Franks, CEO of Cancer Support Community Montana, said people generally think of cancer as an “old person’s disease.”

Franks said that 20 or 30 years ago the focus of cancer treatment was how to keep the patient alive. Now, Franks said, that has shifted to getting the patient “to truly live, and not just keep breathing.”

Blake Underriner was diagnosed with cancer at 14, which is also when he learned the treatment would make him infertile. His mom took him to an appointment to bank his sperm while he came to grips with starting chemotherapy.

Underriner, who lives in Billings, said he preserved the decision to have kids later in life when he preserved his sperm. Underriner married his wife in 2020 and now, at age 37, he has an 8-month-old daughter, Kennedy.

“She’s just so fun,” Underriner said. “She’s turning over in her crib when it’s naptime instead of taking a nap. She’s almost crawling. She’s just a bundle of joy.”

Keely Larson is the ºÚÁϳԹÏÍø News fellow for the UM Legislative News Service, a partnership of the University of Montana School of Journalism, the Montana Newspaper Association, and ºÚÁϳԹÏÍø News. Larson is a graduate student in environmental and natural resources journalism at the University of Montana.

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

“The thing that keeps me up at night is, am I doing a good job for my community?” Zephyr said.

Five days later, the anger bubbled over as Zephyr spoke against amendments from Republican Gov. Greg Gianforte to , which would prohibit minors with gender dysphoria from receiving certain medical and surgical treatments. Zephyr said the lawmakers who voted for the measure should be ashamed.

That prompted Republican Majority Leader Sue Vinton to speak. “We will not be shamed by anyone in this chamber,” Vinton said.

“Then the only thing I will say is: If you vote yes on this bill, and yes on these amendments, I hope the next time there’s an invocation, when you bow your heads in prayer, you see the blood on your hands,” Zephyr said in response.

Later that day, the Montana Freedom Caucus, a conservative group of lawmakers, released a statement calling for Zephyr’s censure for using “inappropriate and uncalled-for language.” The release and a Freedom Caucus used male pronouns to refer to Zephyr, leading to fresh outrage by LGBTQ+ supporters accusing Republicans of deliberately misgendering her.

Two days later, Republican House Speaker Matt Regier would not allow Zephyr to speak during a debate on another bill. Regier said it was because she had committed a breach of decorum.

With two weeks to go in the legislative session, Republican lawmakers, who are in the majority, are sponsoring anti-LGBTQ+ bills. There are at least four related measures, including the bill to ban gender-affirming care for minors.

Many similar bills are being heard in conservative-led statehouses across the U.S. The American Civil Liberties Union has tracked so far in 2023 legislative sessions.

Back in the Capitol on April 13, Zephyr stopped at a storytelling event presented by drag performers on the second floor. Parents, children, and supporters sat in folding chairs and on the floor while drag performers read stories.

Zephyr was visibly emotional. A short time later, former Democratic lawmaker Moffie Funk, who also attended the storytelling event, approached Zephyr to thank her for her work.

“I have just been so impressed to see the way Rep. Zephyr has handled questions on the floor, just keeps her calm, stays cool, and is so powerful in her words and so powerful in the way she represents her community and Montana,” Funk said.

Before the session, Zephyr said she had a goal of changing at least on LGBTQ+ issues.

One lawmaker who typically votes in favor of anti-transgender bills told Zephyr about having read something about her in a far-right blog and said, “That doesn’t sound like Zooey; she wouldn’t do that.” The lawmaker, whom Zephyr didn’t name, subsequently stopped reading the blog.

Proponents of measures like SB 99 and , a bill that would have banned minors from drag shows and would have banned events like drag storytelling in public schools or libraries, frame the legislation as necessary to protect children.

In a small victory for LGBTQ+ supporters, HB 359 was amended to remove references to drag performers and now would prohibit minors from attending “adult-oriented” shows.

Democratic Rep. SJ Howell, who is transgender and nonbinary and uses the pronouns “they” and “their,” has been working at the Capitol for a decade, first as a lobbyist and now as a lawmaker representing Missoula. In all their work, Howell said, it’s very clear that relationships matter. Progress is a long game, and it may take years to pass legislation that promotes the rights and recognition of transgender and nonbinary people, Howell said.

One thing that could hinder that progress is the national debate over anti-LGBTQ+ policy proposals.

Erin Reed, who describes herself as a queer writer and content creator, has been tracking the LGBTQ+ bills nationwide and is also Zephyr’s partner of almost a year.

Four years ago, the debate playing out in statehouses was over transgender rights in sports, Reed said, but that’s shifted. Now, a third of the bills target health care — like gender-affirming hormone therapy, mostly related to minors — and the rest focus on banning drag shows or the use of preferred pronouns and bathrooms, or targeting the rights of transgender people in insurance coverage and workplace protections.

But beyond the flood of anti-LGBTQ+ bills, at least have passed LBGTQ+ protections, Reed estimated.

Howell said it’s challenging being a state representative trying to focus on Montana when so much focus has been on this national issue.

Personally, Howell said, they came to the legislature to build relationships and make good policy, and they see many of their colleagues as friends.

“When the mutual respect isn’t present, it can be deeply frustrating and harmful, and we can do better as a body,” Howell said.

Republican Rep. Neil Duram sits between Zephyr and Howell on the House Judiciary Committee, which has heard all the LGBTQ+ bills this session. He said having both in the legislature better represents Montana.

“If it was just me, and 99 other people like me on the House floor, we may not set the best policy for the people of Montana,” Duram said.

Duram spoke during a House floor session discussing , which would allow classmates to refer to a transgender student by their birth name or gender assigned at birth, unless it crossed into bullying. He said he’s enjoyed getting to know Judiciary seatmate Zephyr and that he’ll make sure people aren’t “inflicting bullying behavior.”

Duram voted for HB 361. He said his decision was encouraged by his community.

“And, ultimately, that’s where my conscience is going to sit,” he said.

On the morning of April 13, Howell and Zephyr were hearing testimony before the House Judiciary Committee on a bill that would define sex in Montana law, . The vibe in the room felt heavy.

Sen. Carl Glimm, sponsor of SB 458, said the bill seeks to define the terms “sex,” “male,” and “female” in state law. Glimm said the bill was necessary because people conflate sex and gender and maintained the bill wasn’t about gender fluidity or expression.

“Gender is obviously something different than biological sex. Biological sex is immutable and that means you can’t change it, and there’s only two biological sexes,” Glimm said. “You may claim to be able to change your gender or express your gender in a different way, but you can never change your biological sex.”

LGBTQ+ advocates, like the Montana Human Rights Network, say that by defining people as simply male and female, the bill would legislate “transgender, nonbinary, and intersex people out of existence.” The Montana Human Rights Network said the definitions used in SB 458 were based “on an unscientific and archaic understanding of basic biology.”

About an hour after the hearing, people gathered outside the Capitol in an April snowstorm for a drag show.

Performers lip-synced for a crowd ranging from kids to college students to retired folks who were waving rainbow-colored flags and carrying umbrellas.

As “Rise Up” by Andra Day played in the background, Katie Fire Thunder said she came to the drag show from Bozeman to show her allyship with the LGBTQ+ community.

Fire Thunder called this session’s anti-LGBTQ+ bills “disgusting,” and said they don’t represent Montana or what young people care about. But having both Zephyr and Howell serving in the Capitol has made a major difference, Fire Thunder said.

“When things are really hard and there’s all these hateful people, they’re a little glimmer of hope,” Fire Thunder said.

Kole Burdick, 20, also of Bozeman, said it’s important to “uplift queer people and show moments of queer joy,” and commended Zephyr and Howell for their work.

“I think they’ve been working really hard to protect our community and keep our community safe, and I really appreciate them for that,” Burdick said.

Keely Larson is the ºÚÁϳԹÏÍø News fellow for the UM Legislative News Service, a partnership of the University of Montana School of Journalism, the Montana Newspaper Association, and ºÚÁϳԹÏÍø News. Larson is a graduate student in environmental and natural resources journalism at the University of Montana.

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

Prashar, now 14, did a finger stick, saw her blood sugar was 127, and went back to the mat. For most people with diabetes, the target range is , and up to 180 two hours after meals.

Prashar doesn’t have to check her blood sugar often. She wears a continuous glucose monitor, or CGM, that gives her blood glucose readings on her phone every five minutes. When she’s feeling differently than her CGM is showing, as on that March day at the gym, she checks her level by doing a finger stick.

But most of the time, she simply glances at her phone to see whether her numbers are trending low or high, which beats repeatedly pricking her finger, she said.

“I would hate it so much,” Prashar said. “It’s such a pain and it’s harder to see trends.”

Montana lawmakers are considering a bill that would for people with Type 1 and Type 2 diabetes. and experts back up the effectiveness of the devices, showing better blood test results, fewer long-term complications, and a reduction in health care costs.

Studies show CGMs can greatly benefit people with Type 1 diabetes. There are also promising results for people with Type 2 diabetes, the more prevalent of the two types, but the compared with that on Type 1.

House Bill 758 has broad support from lawmakers, but it faces opposition from insurance companies and some providers. That opposition focuses on the cost, whether a CGM is medically necessary at all stages of diabetes, and the possibility that CGM manufacturers will raise their prices if there is an insurance mandate.

CGMs can be worn on the legs, stomach, or arms, and they stay in place with an adhesive patch. A thin tube goes under the skin and measures blood glucose levels from tissue fluid. The data is transmitted via Bluetooth to a phone or similar device. Instead of a finger prick, which provides a reading for a single point in time, a CGM gives the wearer a continuous stream of data.

According to GoodRx Health, CGMs can each year out-of-pocket.

Blue Cross and Blue Shield of Montana, the state’s largest insurer, estimates the bill, if passed, would cost the organization nearly $5 million a year, spokesperson John Doran said.

CGMs aren’t medically necessary in all circumstances, Doran said, and medical necessity should be determined through a partnership between provider and payer. But Doran said that he understands there are instances in which a CGM may be necessary and that Blue Cross already covers CGMs in those cases.

“These things are a convenience,” Doran said. “They provide you real-time information and there is some benefit to a person’s lifestyle to these monitors.”

Lawmakers in several states are to regulate coverage of CGMs, and Illinois’ governor into law last year.

A study published in the Journal of Diabetes Science and Technology in 2022 , a condition in which a person’s body can’t make enough insulin (as in Type 1) or use it effectively (as in Type 2). By 2030, the study estimated, 55 million people in the U.S. will have diabetes, with total medical and societal costs of more than $622 billion — a 53% increase from 2015. According to the American Diabetes Association, have been diagnosed with diabetes.

Various studies, diabetes educators, and health care providers say that CGMs can help people with diabetes reduce their A1C levels, a common measure of blood sugar levels used in diabetes management. Proper management can reduce complications from diabetes — like retinopathy, heart attack, and nerve damage — that lead to higher costs in the health care system through emergency room visits and hospitalizations.

Dr. Brian Robinson, an endocrinologist at St. Peter’s Health in Helena, said supplies for people with Type 1 diabetes are generally covered by insurance. When he considers recommending a glucose monitor for a patient, he said, the decision is driven by insurance rules that are informed by the .

“My patients are better because of CGMs, there’s no doubt about that,” Robinson said. But he noted the science doesn’t yet support his opinion that CGMs should be given to everyone with diabetes, no matter what.

Not all physicians, especially in endocrinology, agree that a person with Type 2 diabetes needs a continuous glucose monitor, Robinson said. But if a person needs a shot each day to manage diabetes, he said, that patient should have access to a CGM.

Lisa Ranes, manager of the diabetes, endocrinology, and metabolism center at Billings Clinic, said the benefits of a CGM are the same for people with Type 1 and Type 2 diabetes.

Many studies have shown that for patients on lower quantities of insulin, like some people with Type 2 diabetes, as for people with Type 1 diabetes, who rely on insulin throughout the day.

“It gives patients that complete picture to help them make the decisions on what they need to do to keep their blood sugar safe,” Ranes said, giving examples like upping the frequency or dose of insulin, having some food, or exercising.

For people with Type 2 diabetes, Ranes said, CGMs could be helpful in early diagnosis. Type 2 diabetes is progressive, Ranes said, so the sooner it is under control, the better.

When Cass Mitchell, 76, was diagnosed with Type 2 diabetes over 30 years ago, her doctor told her that people with Type 2 diabetes don’t live long because they have a hard time managing their care.

Mitchell, who lives in Helena, warmed to finger pricks. But test strips were expensive, about $1 each at the time, she said.

About 10 years ago, she got a CGM. Mitchell went from testing maybe twice a day to looking at her blood sugar on an app 20 to 25 times each day. She said she’s more in tune with her diabetes and uses her device’s time-in-range reports — showing how often blood glucose stays within a set range — to make lifestyle changes.

Mitchell has lowered her A1C from around 11% to 7%. According to the ADA, the target for most adults with diabetes is .

Mitchell’s device is covered under Medicare and supplemental insurance and would remain so with the passage of HB 758. She said if she had to pay out-of-pocket she wouldn’t be able to afford her CGM and that she was excited about the potential of the bill to give more people access to CGMs.

Dr. Hayley Miller, medical director of Mountain States Diabetes in Missoula, initially thought HB 758 sounded good, but now she isn’t so sure. She thinks the biggest risk of the bill passing is that prices for CGMs go up.

“It seems like I’m against it, but it really is, when insurance gets involved everything gets tricky,” Miller said.

Emma Peterson, a former diabetes educator for St. Vincent Healthcare in Billings and Providence Endocrinology in Missoula, said most people working in diabetes care think everyone diagnosed should just have a continuous glucose monitor.

“At the end of the day, both forms of diabetes and all the other many forms of diabetes have the same complications and still face the same struggles of trying to keep blood sugars in range,” Peterson said.

Keely Larson is the KHN fellow for the UM Legislative News Service, a partnership of the University of Montana School of Journalism, the Montana Newspaper Association, and Kaiser Health News. Larson is a graduate student in environmental and natural resources journalism at the University of Montana.

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

As an employee of Family Outreach in Helena, Montana — an organization that assists developmentally disabled people — part of his workday involves driving around, picking up clients, and taking them to work or to run errands.

“What’s up, gangsta?” Johnson said as a client got in the car one day in March.

The pair fist-bumped and Johnson asked what type of music the client liked.

“Gangsta stuff,” came the response. Rap, mainly.

Snoop Dogg played in the background as Johnson and his client drove to McDonald’s, where Johnson helps his client work. The duo washed dishes for two hours in the back of the fast-food restaurant, where it smelled like maple syrup and sulfur.

About two weeks earlier, Johnson testified at a hearing at the Montana Capitol that seeks to raise health providers’ Medicaid reimbursement rates to levels aligned with the average cost of the care they provide. The bill is informed by a 2022 study that recommended benchmark rates after its authors found that Montana Medicaid providers like Family Outreach were being significantly underpaid.

“The provider rates need to be funded so people that work in this field or that work in adjacent fields can have solid ground, a place where you can build a career,” said Johnson, who makes $16.24 per hour in his position as an individual living specialist.

Republican Gov. Greg Gianforte and legislators agree that Medicaid rates need to rise; where they disagree is by how much. The proposals range from the bill Johnson testified for — Democratic Rep. Mary Caferro’s bill to raise rates to the study’s benchmarks — to Gianforte’s plan to fund 91% of that benchmark in 2024 and 86% in 2025.

Meanwhile, the Republicans leading the House Appropriations Committee, a key budget panel, are proposing an average increase of 92% for fiscal year 2024 and 97% in 2025.

Providers and leaders who work in behavioral health, developmental disability, long-term care, and family support services have attended the multiple hearings on rate adjustments, saying thanks for the proposed increases but asking for more. Many providers said the benchmark rates in the study are already outdated.

Providers across the United States say they haven’t seen significant reimbursement increases in more than a decade, according to , president of the National Association for Behavioral Healthcare. Behavioral health can be an afterthought for policymakers, resulting in lower rates than for medical or surgical reimbursement, he said

, associate professor of health policy and management at the Harvard T.H. Chan School of Public Health, said the supply of staff is inadequate to meet demand for behavioral health care across the U.S.

“And it’s not clear we’re going to meet any of that without paying people more,” Barnett said.

Some health providers have raised wages but still struggled to draw workers and keep the ones they’ve got. Family Outreach raised the wages of some direct care workers from $11 per hour to $12.20 per hour this year, and by more in places where the cost of living is higher, such as Bozeman. But even starting wages of $16 or $18 an hour aren’t attracting enough people to work there, Family Outreach Program Manager Tyler Tobol said.

“It’s a field that not a lot of people want to get into, so those that we can find, I think being able to pay a higher wage, a living wage, I think that would be the best benefit we get out of the rate increase,” Tobol said.

The organization went from 153 employees in 2020 to 128 today. The staffing shortage means employees now focus mainly on making sure clients have the basics — medications and meals — instead of providing additional community integration and activity support services.

At Florence Crittenton in Helena, where moms 18 to 35 with substance use disorders can live with their young kids while undergoing treatment, a mom entered the kitchen where women are taught life skills like learning to cook dinner. The woman told a staff member she was making juice for her child.

“This is where life happens,” said , Florence Crittenton’s clinical and residential services director.

Executive Director said the organization’s two main sources of revenue are Medicaid reimbursements and fundraising. Fundraising, which used to account for 30% of revenue, now makes up between 60% and 70% of the money coming in.

“It’s the reason we’re still open,” Krepps said.

At any given time, an average of 15 to 18 of Florence Crittenton’s 50 staff positions are vacant. If Medicaid rates don’t increase, she said, the organization will have to consider if it can continue operating the recovery home at its current capacity.

“The full rates would just barely cover where we are today,” Krepps said of raising Medicaid reimbursement rates to benchmark levels.

In 2021, Florence Crittenton closed a youth maternity home for pregnant youths and young moms ages 12 to 15, the only home in the state that took teens under 16. Krepps said Florence Crittenton didn’t take Medicaid fees there because the rates were too low.

“It’s heartbreaking,” Champer said. “It’s like clockwork on Monday morning. I come in and see the inquiries and referrals about moms who need treatment and we can’t function at full capacity because we don’t have staff.”

, the CEO of Youth Dynamics, which provides home support, case management, and community-based psychiatric rehabilitation across the state, said his organization is paying its staff more than it can afford. Even with the rate increase, he said, they’d only break even.

In the past three years, Youth Dynamics has lost 56 full-time employees. The covid-19 pandemic made people realize they could find other jobs that paid more and even allowed them to stay home, Sulser said.

Two years ago, the entry-level pay for Youth Dynamics was $10.70 per hour, and it now averages $13.70. Still, staffing shortages led to the closure of a group home in Boulder and one in Billings, shrinking the organization’s capacity from 80 to 64 beds statewide.

Ashley Santos, program manager for the organization’s three remaining group homes in Boulder, said she is trying to figure out how to attract enough staff to reopen the closed home there. An increase in pay supported by the provider rate increase could give her flexibility to provide extra incentives, she said.

But it’s hard to attract workers when Hardee’s has a starting wage of $18 per hour compared with Youth Dynamics’ $16, she said. And fast-food jobs don’t come with the emotional toll of working with kids who have a severe emotional disturbance diagnosis like PTSD or depression.

Back in Helena, Johnson made his last stop of the day for Family Outreach. He sat next to a client on the couch at the house where the client lives with his mom. Johnson called the number on the back of his client’s debit card to see how much money was left on it before they went out to run errands.

Johnson and the client then headed to a local supermarket. Trips like these give his client a chance to interact with other people, while his mom gets some time to herself.

“You look nice,” Johnson said to the client as they got into the car, the folksy music of Dougie Poole, the choice of Johnson’s previous client, playing in the background.

Keely Larson is the KHN fellow for the UM Legislative News Service, a partnership of the University of Montana School of Journalism, the Montana Newspaper Association, and Kaiser Health News. Larson is a graduate student in environmental and natural resources journalism at the University of Montana.

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

Horning, 51, was diagnosed in 2014 with acute myeloid leukemia, an aggressive cancer — the five-year survival rate for those . Horning had been through chemotherapy and a stem cell transplant, which severely weakened her immune system. Because the MMR vaccine contains live virus, she couldn’t get the vaccine herself and had to temporarily avoid her vaccinated daughter.

Now, Horning is worried about Montana legislation that could further compromise her and other immunocompromised people by making it easier for more people to opt out of routine vaccinations.

“If they do allow this, and a significant amount of people don’t vaccinate their kids, then there could be community spread,” Horning said. “And then I’m really in danger, the same as a newborn is in danger.”

In 2021, Montana passed — — which prohibited discrimination based on vaccine status in settings like employment, education, and health care. In effect, it banned private businesses and local governments from requiring employees to be vaccinated, not just against covid-19 but any disease. A federal judge in health care settings in a lawsuit filed by hospitals, medical providers, and nurses. Two other lawsuits challenging HB 702, one by are pending.

This year, lawmakers have introduced proposals to expand vaccine exemptions in schools and change criteria in the workplace and the legal system.

Proponents of the school-related measures include mothers advocating for their parental rights over whether to vaccinate their children; a nurse who maintained that medical choices should be private; and a day care instructor concerned about the connection between vaccines and autism, a .

Some experts say those bills, like HB 702 from two years ago, are an overreaction to the fear and anger surrounding the covid pandemic.

Those who promote vaccine exemptions on the grounds of parental rights and individual freedom should be honest about the consequences, said Cason Schmit, an assistant professor at Texas A&M University School of Public Health. Those consequences could include more people sick and dead from preventable diseases, he said.

“We know what the outcomes of these types of laws are,” Schmit said.

According to a nonmedical vaccine exemptions have increased over the past two decades in the U.S.

Medical exemptions for vaccines are granted for conditions that could result in adverse reactions to a vaccine, such as a cancer patient undergoing chemotherapy. The nonmedical type comprise religious — based on a sincerely held religious belief — and conscience exemptions — based on personal or moral beliefs.

According to Lauren Wilson, president of the Montana Chapter of the American Academy of Pediatrics, no state in the last 20 years has implemented a conscience exemption for childhood vaccines. The reports philosophical exemptions in 15 states.

Currently, Montana allows exemptions based on religion but not conscience for K-12 school vaccinations, and the religious exemption must be provided on a notarized affidavit. A medical exemption must be signed by a licensed health care provider.

That would change under , sponsored by Republican Sen. Daniel Emrich, which would require schools, employers, health care providers, state agencies, and other entities to accept “without question or malice” religious or conscience exemptions pertaining to certain medications, including vaccines. Any entity that doesn’t comply would lose state funding.

Religious or conscience exemptions could be used for any of the immunizations required in the : varicella, diphtheria, pertussis, tetanus, poliomyelitis, rubella, mumps, and measles for attendance in primary schools, and influenza B before starting preschool.

SB 450 also would remove the requirement that an exemption be given on a notarized affidavit and allows that a signed letter or statement is sufficient.

Supporters say SB 450 would preserve parental rights as well as the right to choose what goes into one’s body, and provide a justification to refuse vaccination if someone is not particularly religious.

Opponents, including Montana Families for Vaccines, the Montana Medical Association, and Wilson, said states with conscience exemptions have the lowest vaccination rates.

“I think part of the problem is that vaccines have been victims of their own success,” Wilson said. “There have been many childhood illnesses that have been eliminated for more than a generation, and people don’t remember.”

Another measure, , would require schools to inform parents which exemptions are available through whatever communication they already provide to students about vaccines. It initially added a conscience exemption for schools, too, but that was taken out of the bill.

Republican Rep. Jennifer Carlson, the sponsor of both HB 715 and 2021’s HB 702, cast doubt on whether HB 715 would significantly affect vaccination rates. She said during a legislative hearing on Feb. 27 that the state has a 95%-97% vaccination rate despite its existing medical and religious exemptions.

In the , 96% of Montana’s kindergartners were vaccinated against measles, mumps, and rubella, while 3% were excused under religious exemptions, according to the state’s public health department. According to the, the share dropped to nearly 93% of Montana kindergartners in the 2020-21 school year.

Nationally, about receive two recommended doses of MMR vaccine and 2% remain unvaccinated because of nonmedical exemptions.

Carlson emphasized that HB 715 wasn’t about covid, and that she isn’t opposed to vaccinations, saying at the hearing that she and her five children have all had their childhood vaccines.

“This bill is not a debate about the efficacy of vaccines,” Carlson said.

Dr. Marian Kummer, a retired pediatrician and Montana Families for Vaccines board member, said she worries that if HB 715 and SB 450 become law, it will leave the state vulnerable.

“The fear is what’s going to happen if they pass the personal exemption — the exemption rate will go up and that is going to put more communities at risk for outbreaks of these diseases,” Kummer said.

To maintain immunity against measles, needs to be fully vaccinated — having both MMR shots — against the disease. Kummer said if there are more exemptions, the state could fall below that threshold.

The 2021 legislature that eliminated the requirement that vaccine rates be reported to Montana’s Department of Public Health and Human Services and local health departments.

Democratic Rep. Ed Stafman has that would boost vaccine and exemption reporting. Stafman said that at some point there will be an increase in outbreaks because of increasing exemptions, and data will be crucial.

“When that outbreak happens here, we’re going to be in deep trouble,” Stafman said.

In the workplace, would require workers’ compensation insurance to cover adverse reactions to employer-mandated vaccines.

And in the courthouse, would prohibit the use of vaccination status as evidence or grounds for decisions in guardianship or custody cases. It also would make it so vaccination status can’t be used as a factor in determining criteria for adoption.

That bill’s sponsor, Republican Rep. Caleb Hinkle, said including vaccination status in evidence could lead to biased decisions because of how politicized vaccinations have become.

But Schmit of Texas A&M said the measure could handicap judges’ ability to rule what is in the best interests of a child.

Keely Larson is the KHN fellow for the UM Legislative News Service, a partnership of the University of Montana School of Journalism, the Montana Newspaper Association, and Kaiser Health News. Larson is a graduate student in environmental and natural resources journalism at the University of Montana.

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

Valley County, with a population of just over 7,500, passed levies to support the nursing home amounting to an estimated $300,000 a year for three years, starting this year. And when the Hi-Line Retirement Center in neighboring Phillips County shut down last year as the covid-19 pandemic brought more stressors to the nursing home industry, Valley View Home took in some of its patients.

Thompson said he foresees more nursing home closures on the horizon as their financial struggles continue. But lawmakers are trying to reduce that risk through measures that would raise and set standards for the Medicaid reimbursement rates that nursing homes depend on for their operations.

A by the last legislative session found that Medicaid providers in Montana were being reimbursed at rates much lower than the cost of care. In his two-year state budget proposal before lawmakers, Republican Gov. Greg Gianforte has to the provider rates that fall short of the study’s recommendations.

Legislators drafting the state health department budget included ’s proposal, but still not enough for nursing homes to cover the cost of providing care. Those rates are subject to change as the state budget bill goes through the months-long legislative process, though majority-Republican lawmakers so far have rejected Democratic lawmakers’ attempts for full funding.

In a separate effort to address the long-term care industry’s long-term viability, a bipartisan bill going through Montana’s legislature, Senate Bill 296, aims to revise how nursing homes and assisted living facilities are funded. The bill would direct health officials to consider inflation, cost-of-living adjustments, and the actual costs of services in setting Medicaid reimbursement rates.

, which received an initial hearing on Feb. 17, has generated conflicting opinions from experts in the long-term care field on whether it does enough to avoid nursing home closures.

Republican Sen. Becky Beard, the bill’s sponsor, said that although the bill comes too late for the nursing homes that have already closed, she sees it as shining a light on a problem that’s not going away.

“We need to stop the attrition,” Beard said.

, a research assistant at the Economic Policy Institute, a nonprofit think tank, said wages for nursing home employees had been extremely low even before the pandemic. He said the focus needs to be on raising Medicaid reimbursement rates beyond inflationary factors.

“Increasing Medicaid rates for inflation is going to have positive effects, but there’s no way that it’s going to compensate for what we’ve experienced in the last several years,” Martinez Hickey said.

Colorado, Illinois, Massachusetts, and North Carolina are among the states that have adopted laws or regulations to since the pandemic began. Michigan, North Carolina, and Ohio adopted increases or one-time bonuses.

In Maine, a 2020 suggested that Medicaid rates should be high enough to support direct-care worker wages that amount to at least 125% of the minimum wage, . In combination with other goals outlined in the study, there had been modest increases in residential care homes and beds, improved occupancy rates, and nods toward stabilization of the direct-care workforce.

Rose Hughes, executive director of the Montana Health Care Association, which lobbies on behalf of nursing homes and senior issues, said many of the problems plaguing senior care come down to reimbursement rates. There’s not enough money to hire staff, and, if there were, wages would still be too low to attract staff in a competitive marketplace, Hughes said.

“It’s trying to deal with systemic problems that exist in the system so that longer term the reimbursement system can be more stable,” Hughes said.

The governor’s office said Gianforte has been clear that Montana needs to raise its provider rates. For senior and long-term care, Gianforte’s proposed state budget would raise provider rates to 88% of the benchmark recommended by the state-commissioned study. Gianforte’s budget proposal is a starting point for lawmakers, and legislative budget writers have penciled in funding at about 90% of the benchmark rate.

“The governor continues to work with legislators and welcomes their input on his historic provider rate investment,” Gianforte spokesperson Kaitlin Price said.

Democratic Rep. Mary Caferro is sponsoring to fully fund the Medicaid provider rates in accordance with the study.

“What we really, really need is our bill to pass so that it brings providers current with ongoing funding for predictability and stability so they can do the good work of caring for people,” Caferro said at a Feb. 21 press briefing.

But Thompson said that even the reimbursement rate recommended by the study — $279 per patient, per day, compared with the current $208 rate — isn’t high enough to cover Valley View Home’s expenses. He said he’s going to have to have a “heart to heart” with the facility’s board to see what can be done to keep it open if the local tax levies in combination with the new rate aren’t enough to cover the cost of operations.

David Trost, CEO of St. John’s United, an assisted-living facility for seniors in Billings, said the current reimbursement rate is so low that St. John’s uses savings, grants, fundraising revenue, and other investments to make up the difference. He said that while SB 296 looks at factors to cover operating costs, it doesn’t account for other costs, such as repairs and renovations.

“In addition to paying for existing operating costs as desired by SB 296, we also need to look at funding of capital improvements through some loan mechanism to help nursing facilities make improvements to existing environments,” Trost said.

Another component of SB 296 seeks to boost assisted-living services by generating more federal funding.

Additional money could help reduce or eliminate the waiting list for assisted-living homes, which now stands at about 175 people, Hughes said. That waiting list not only signals that some seniors aren’t getting service, but it also results in more people being sent to nursing homes when they may not need that level of care.

SB 296 would also ensure that money appropriated to nursing homes can be used only for nursing homes, and not be available for other programs within the Department of Public Health and Human Services, like dentists, hospitals, or Medicaid expansion. According to Hughes, in 2021 the nursing home budget had a remainder of $29 million, which was transferred to different programs in the division.

If the funding safeguard in SB 296 had been in place at that time, Hughes said, there may have been more money to sustain the nursing homes that closed last year.

Keely Larson is the KHN fellow for the UM Legislative News Service, a partnership of the University of Montana School of Journalism, the Montana Newspaper Association, and Kaiser Health News. Larson is a graduate student in environmental and natural resources journalism at the University of Montana.

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

Nyman said she was afraid to tell her parents she had thoughts of suicide. Looking back, a mental health screening might have helped her to stop hiding her struggles from adults and peers, she said.

“Hard things don’t get better if we don’t talk about them,” Nyman said.

Today, Nyman works with the Rural Behavioral Health Institute, a Livingston, Montana-based organization that aims to reduce youth suicides by improving mental health care in rural places. She recently testified for a bill that has been twice rejected this legislative session by the Montana House to use state money to fund free mental health screenings in schools, like those that Rural Behavioral Health Institute provides.

Montana, which perennially has one of the highest suicide rates in the nation, also has a youth suicide rate twice the national average, released last year by the state Department of Public Health and Human Services. The covid-19 pandemic and the isolation it caused increased many of the risks associated with suicide, experts said.

One in 5 students will develop a significant mental health problem during their school years, and roughly 7 in 10 students who need mental health treatment will not get appropriate care, Screening for behavioral and mental health issues has become more prevalent in schools and can help identify students at risk or in need of intervention, according to SAMHSA.

But lawmakers in the state House of Representatives rejected the school screening measure, , sponsored by Democratic Rep. Jonathan Karlen, saying the state already has a suicide prevention program and a statewide coordinator.

During a Feb. 2 House floor debate on a separate bill on suicide prevention, Republican Rep. Bob Keenan said suicide prevention has developed into an industry with no results to show for it.

“We’re still here talking about it, and the numbers continue to go up,” Keenan said.

On Feb. 15, Republican Gov. Greg Gianforte announced a $2.1 million grant to the Rural Behavioral Health Institute to essentially fund what HB 252 proposed — free optional mental health and substance abuse screenings for all schools statewide and same-day care for students flagged as being at high risk for suicide. The money will come from the program, which is funded by federal covid relief aid — and can be spent without legislative approval.

Keenan said he supports the governor’s plan. However, he said, he still thinks the state has spent too much money on suicide prevention and would like to see more community-based peer-support programs.

The health department report showed the state’s highest rate of suicide between 2011 and 2020 was among Native Americans — 32 people out of 100,000 — though Native Americans make up only 6% of the state’s population. by the Centers for Disease Control and Prevention in 2021 showed that 16% of Native American and Alaska Native high schoolers had attempted suicide over the prior year.

Tribal leaders on rural reservations, such as Fort Peck in northeastern Montana, worried the pandemic would lead to a spike in child suicide deaths.

Other data from the CDC that the Rural Behavioral Health Institute shared with lawmakers last year shows that suicide is the second-leading cause of death for people ages 10 to 44 in Montana. Most recently, northwestern Montana’s Flathead Valley.

The initiative announced by Gianforte would build on a pilot project by the Rural Behavioral Health Institute called , which screened more than 1,000 students in 10 Montana schools from 2020 to 2022. Janet Lindow, executive director of the institute, said screenings are a key component in identifying students who may be at risk of dying by suicide.

“This is a way to find those kids who are basically suffering in silence,” Lindow said.

At least one student who was on nobody’s radar has been identified as needing help in each school where the program has operated, she said.

Shawna Hite-Jones, a suicide prevention specialist with the Suicide Prevention Resource Center at the University of Oklahoma, said it’s important to use screenings as part of a comprehensive approach that includes training teachers to recognize suicide risk, teaching students about healthy coping strategies, following up with at-risk students, and making sure students can connect with their peers and trusted adults.

“Screenings are a tool that can be helpful for schools if they have the capacity and relationships with mental health providers to make them useful,” Hite-Jones said.

shows suicide rates have been increasing over the past decade. The covid pandemic exacerbated many of the risk factors for suicide, like social isolation, financial insecurity, or lacking a trusted support group, Hite-Jones said. The pandemic also prompted new discussions around mental health and suicide, she said.

Jennifer Preble advocates for suicide prevention education and legislation with the Montana Chapter of the American Foundation for Suicide Prevention. Because suicide is complex, she said, it’s important to look at the bigger picture.

“There’s no one reason for suicide, and there’s also no one solution for suicide,” Preble said.

If you are in crisis, please call the at 988 or contact the by texting HOME to 741741.

Keely Larson is the KHN fellow for the UM Legislative News Service, a partnership of the University of Montana School of Journalism, the Montana Newspaper Association, and Kaiser Health News. Larson is a graduate student in environmental and natural resources journalism at the University of Montana.

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

That’s because Zawacki was hired to work with a doctor who specialized in addiction medicine, but that doctor did not join St. Peter’s until three months after Zawacki was hired, and it was another three months before he became her supervisor. , physician assistants must be supervised by a licensed physician, with a supervision agreement filed with the state Board of Medical Examiners.

Zawacki had an interim agreement that allowed her to begin work, but she needed that supervision agreement to prescribe Suboxone. While Zawacki was waiting, the only way her patients could get Suboxone was in the emergency room, where it costs more and comes in only a three-day supply. Zawacki said a three-day supply is meant to get a patient through withdrawal, but months of treatment are needed to end substance use.

“Any time that you’re limiting access to care, you’re putting patients at risk,” Zawacki said.

As Montana grapples with a health care provider shortage, state lawmakers are trying to find ways to increase access to care. One proposal up for debate is to give physician assistants like Zawacki more independence to practice unsupervised. Republican Rep. Jodee Etchart is sponsoring , which would let physician assistants practice without a supervision agreement. The bill is similar to laws in neighboring North Dakota and Wyoming.

Many physicians oppose the measure. Jean Branscum, CEO of the Montana Medical Association, said the bill expands a physician assistant’s scope of practice with no added training requirements.

“They can be in any area with no supervision,” Branscum said.

Yiqun Chen, an assistant professor of economics at the University of Illinois in Chicago, said physician assistants can play a valuable role in augmenting the supply of health care providers, but not as substitutes for physicians.

Chen co-authored a that found patient outcomes were worse when care was given by a nurse practitioner instead of a physician, and she said she believes those findings could relate to physician assistants, too.

Instead of thinking of nurse practitioners or physician assistants as substitutes for doctors, Chen said, they should be integrated as part of a patient’s collaborative care team.

According to the American Academy of PAs, more than 750 physician assistants practice in Montana, 95.5% of them in rural areas.

Etchart has been a physician assistant herself for 20 years. At the first hearing for her bill in the House Business and Labor Committee on Feb. 3, she said it would allow physician assistants to perform the work they are trained to do without the limitations of direct supervision.

“This is not practicing out of our scope,” Etchart said. “Our scope of practice is already set at the practice level.”

Travis Booke, president of the North Dakota Academy of Physician Assistants, said his state passed in 2019 with little opposition. Booke said the law removed an administrative burden but didn’t let physician assistants expand their practice without extra training or licensure requirements.

It doesn’t give physician assistants more authority to practice, Booke said, “it’s just taking away some of the red tape to do it.”

There has been no increase in formal disciplinary actions against physician assistants in North Dakota under the new law, according to Sandra DePountis, executive director of the North Dakota Board of Medicine.

Wyoming’s law . Eric Boley, president of the Wyoming Hospital Association, said it helped fill the void left by many retiring physicians, particularly in family practice and primary care.

“This is a good option for us to be able to provide that primary care in rural communities,” Boley said.

The Wyoming bill drew some of the same opposition HB 313 has seen in Montana — primarily physicians worried about training and education. But Boley said he wasn’t aware of any bad results with physician assistants having more independence.

Branscum said her group would be amenable to letting physician assistants practice independently, with proper training and education. She said she worries that without a supervisor there to show physician assistants the ropes, patients might get inferior care.

Etchart said she would consider amending the bill to require physician assistants to work under supervision for two years before practicing independently, if they didn’t already have two years of experience after completing school.

Keely Larson is the KHN fellow for the UM Legislative News Service, a partnership of the University of Montana School of Journalism, the Montana Newspaper Association, and Kaiser Health News. Larson is a graduate student in environmental and natural resources journalism at the University of Montana.

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .

Now, the Republican governor wants to put more state money into the initiative, but lawmakers and mental health advocates are asking for more accountability and clarity on how the money is spent.

Republican Rep. Jennifer Carlson, chair of the Human Services Committee of the Montana House of Representatives, said her committee has heard bill proposals seeking to use HEART money for child care and suicide prevention programs, among others. She is sponsoring a bill to increase HEART initiative reporting requirements.

“You really have to think, is that what that money is for, or is that just what’s convenient?” said Carlson.

Matt Kuntz, executive director of the Montana chapter of the National Alliance on Mental Illness, said a lot of questions have been floating around about the initiative this legislative session.

“Nobody really knows exactly how this is being spent or the process of how to get it,” Kuntz said.

The legislature passed Gianforte’s HEART initiative soon after he took office. It uses revenue primarily from recreational marijuana taxes for the state’s $6 million annual share to be distributed to programs dedicated to treating substance use and mental health disorders.

A federal match would bring the fund total to $25 million, but the state is waiting for full approval of its Medicaid waiver application from the Centers for Medicare & Medicaid Services. The federal agency approved part of the waiver last year.

“Until CMS approves the full HEART waiver, the state is limited in what we can do,” said Jon Ebelt, spokesperson for the state Department of Public Health and Human Services.

The health department submits a report to CMS four times a year. Department officials did not respond to a request by KHN for the latest report. The department is supposed to receive on how their funds were used. It didn’t specify whether it had received any.

Carlson’s would require the department to report HEART initiative spending to the Children, Families, Health, and Human Services Interim Committee each year. That reporting would allow lawmakers to know what the money had already been used for, and if there might be a better way to spend it, Carlson said.

When Gianforte introduced the HEART initiative during his 2021 State of the State speech, he said it was designed to give directly to local communities, which know their own needs best.

“This is not bigger government,” the governor said at the time.

The HEART money is distributed through grants and Medicaid-funded services. Of the $5.2 million distributed since 2022, $1.5 million has gone to Medicaid for services like inpatient and residential chemical dependency services, Ebelt said.

Eight Indigenous have received $1 million covering fiscal year 2022, the first year of the fund, and 2023, the current fiscal year, which ends June 30. Those grants went toward substance use prevention; mental health promotion; mental health crisis, treatment, and recovery services; and tobacco cessation and prevention.

Seven received a total of $2.7 million in HEART money through a competitive grant process to provide behavioral health services at those facilities.

Missoula County hired a therapist, jail care coordinator, and mental health transport officer with its share. Gallatin County hired a counselor and two social workers, and Lewis and Clark County hired a therapist, case manager, and education and transport manager.

Jackie Kerry Lemon, program and facilities director at the Gallatin County Detention Center, said the money had to be used for mental health and addiction services. “Our population is often in crisis when they come to us, so having that ability to have a therapist see them really does help with their anxiety and their needs at a good time,” Kerry Lemon said.

Democratic Rep. Mary Caferro said the HEART money could go toward increases in the Medicaid rates paid to health care providers, which a found fall short of the cost of care, or mobile crisis response teams, which the health as a Medicaid service.

Caferro is on behalf of the National Alliance on Mental Illness to add youth suicide prevention to the list of programs eligible for HEART funding.

Mary Windecker, executive director of the Behavioral Health Alliance of Montana, said the HEART fund initially was meant to support tribes and county jails, and only recently did it start funding community substance use and mental health programs, after last year’s partial approval.

That allowed larger substance use disorder treatment centers (more than 17 beds) to receive Medicaid reimbursement for short-term stays at institutions for mental illness, in Billings and the Badlands Treatment Center in Glendive.

From July 2022 to January 2023, Ebelt said, 276 Medicaid recipients were treated in Rimrock and Badlands. A facility in Clinton, the Recovery Centers of Montana, opened in December and will be licensed for 55 additional beds able to serve patients with the new Medicaid benefit, Ebelt said. Gianforte proposed in his state budget to increase the amount going into the HEART fund by changing the funding formula from $6 million a year to 11% of Montana’s annual recreational marijuana tax revenue.

The Behavioral Health Alliance recommended that change, but, as with many of the health-related proposals in this legislative session, a major factor in the HEART initiative’s success will be whether Medicaid are raised enough, Windecker said. If provider rates aren’t funded at the full cost of care, people won’t be available to provide the care the initiative promises, she said.

The committee that meets to determine the health department’s budget will hear a presentation about the HEART initiative on Feb. 9.

Keely Larson is the KHN fellow for the UM Legislative News Service, a partnership of the University of Montana School of Journalism, the Montana Newspaper Association, and Kaiser Health News. Larson is a graduate student in environmental and natural resources journalism at the University of Montana.

This article first appeared on ºÚÁϳԹÏÍø News and is republished here under a .