Latest news with #MontanaStateHospital
Yahoo
12-05-2025
- Health
- Yahoo
Montana lawmakers approve $124M to revamp behavioral health system
Photo illustration by Getty Images. HELENA— Montana's frayed behavioral health care system, still recovering from the effects of past budget cuts, will get a shot in the arm after state lawmakers approved sweeping changes to upgrade and expand facilities, increase community services, and revise commitment procedures. Lawmakers backed the bulk of Republican Gov. Greg Gianforte's multimillion-dollar vision to bolster and expand the system, which has experienced waitlists for care and has been working in recent years to reverse the loss of community-based mental health services and regain federal certification of the state psychiatric hospital, lost in 2022 after a spate of patient deaths. Legislators then went several steps further to fill what they saw as gaps in the governor's proposals. They agreed to build a new mental health facility in eastern Montana, add more beds at existing state facilities, fund more crisis beds in communities, revise some civil and criminal commitment procedures, and reimburse counties when criminal defendants ordered to state facilities are held in county jails. 'For our families that struggle in these systems, it gives us so much hope,' said Matt Kuntz, executive director of the National Alliance on Mental Illness' Montana chapter, about the legislative action. The state's behavioral health system faced an array of problems going into the 2025 legislative session. They included shortages in community services, particularly in rural areas, created by deep cuts made in 2017 in response to a state budget shortfall, along with a backlog of criminal defendants waiting for evaluations and services at the state-run psychiatric hospital. The prospects of the situation improving seemed dim for a long time, Kuntz said. 'Then you have the governor's office, the legislature, the counties, the county attorneys all working together to bring tangible solutions. And they got the votes.' That support built over time as the state spent money on improvements needed to regain the Montana State Hospital's federal certification and counties came under increasing pressure due to a lack of services and treatment beds. The legislature and governor committed to review the system in 2023. In all, lawmakers approved about $124 million in state spending and as much as $40 million in federal funds during the next two years for behavioral health services, a new state-owned facility, and additional beds in existing facilities. 'The people that need our support, the people that can't take care of themselves, the families that are struggling with their family member that can't take care of themselves at some points in time are going to benefit from what we did,' Republican state Sen. John Esp said in summing up the legislature's work. The spending approved by the legislature goes well beyond the money Gianforte requested for behavioral health changes. He included 10 funding requests in his proposed state budget for the next two years that totaled about $43.5 million in state funds and $42 million in federal funds. The requests were based on recommendations from the Behavioral Health System for Future Generations Commission. Lawmakers created that commission in 2023 to review state-funded services for people with mental illness, substance use disorders, and developmental disabilities. Legislators that year set aside $300 million to be spent in future years on recommendations made by the commission. Even before the start of the session, some legislators questioned whether the governor's budget did enough to address the lack of both community-based crisis services and forensic beds at the Montana State Hospital, which are for people in the criminal justice system. Two bills introduced in January — House Bill 236 and HB 237 — sought to address lengthy jail holds experienced by some people waiting for mental health evaluations or treatment before their trials can proceed. Defendants generally obtain those services at the Montana State Hospital's forensic unit. Both bills failed. But testimony on the measures, as well as on the governor's budget requests, drew attention to the backlog of people waiting in jails across the state. Legislators heard of prolonged delays — some stretching more than a year — that sometimes led to cases being dismissed because of concerns that the delays had violated the defendants' constitutional right to a speedy trial. By April, the legislature was considering possible fixes on several fronts. During an April 15 hearing on Senate Bill 429 to revise criminal commitment procedures, Chad Parker, a state health department attorney, described the measure as 'a very robustly negotiated bill.' Nanette Gilbertson, representing the Montana County Attorneys' Association and the Montana Sheriffs and Peace Officers Association, said it contained elements 'that I know were tough pills to swallow for both the associations I work for and the department.' The bill would allow involuntary medication of defendants in county jails under certain circumstances — an idea state officials initially opposed — and prohibit the filing of a contempt charge if someone isn't admitted to the Montana State Hospital for treatment because a bed isn't available, which was important to the state to include. Gilbertson told the House Judiciary Committee the bill was just one of several that, 'taken in a package, are going to create immense change in the mental health and behavioral health system in the state of Montana.' They include bills to reimburse counties for the costs of holding people waiting for state mental health services, allow short-term mental health holds in the community, improve delivery and payment for community services, and create more beds in state facilities for people committed through both criminal and civil procedures. Legislators also approved money for a new mental health facility, expected to be built in eastern Montana, that will include more forensic beds. Gianforte spokesperson Kaitlin Price said Gianforte would carefully consider the bills passed in addition to his proposals. The governor's original budget request focused primarily on community services. Legislators approved all but one, which would have created an electronic bed registry. The approved requests will revise reimbursement rates for developmental disability services, residential youth psychiatric treatment, and crisis and outpatient behavioral health services. They also will reopen clinics for early diagnosis of developmental disabilities in children, provide workforce incentives, and seek to improve delivery of services to people with developmental disabilities who have complex needs. Esp, who served on the behavioral health commission and sponsored several of the bills, cautioned that the success of this year's efforts will depend on whether future legislatures and governors spend the money needed to continue the new services. 'The problem we've always had around here is we look at things in two-year increments and towards the next election instead of looking at what's the best policy for the state of Montana, long term,' he said. This article first appeared on KFF Health News and is republished here under a Creative Commons license.
Yahoo
15-04-2025
- Health
- Yahoo
Committee tables bill to split health department
Montana State Hospital. Credit Keith Schubert Admonishing the Montana Legislature for being the 'enabler' of a 'pampered' and 'dysfunctional' health department, Rep. John Fitzpatrick said Monday it's time to break up the largest bureaucracy in the state. The Republican from Anaconda said legislators have been forking over tens of millions of dollars to the Department of Public Health and Human Services and excusing it from accountability, and it's time for a structural change. 'The problem with DPHHS is it's too big, it's inefficient, and the service quality declines,' Fitzpatrick said. Fitzpatrick made his remarks in support of House Bill 851, which he said would transfer administration of state healthcare institutions and community-based programs to a new department of health services. But his arguments didn't fly with the Senate Public Health, Welfare and Safety Committee, which unanimously tabled his bill the same day. The health department has experienced major and high-profile challenges, most notably the Montana State Hospital's loss of federal funds and decertification by the Centers for Medicare and Medicaid Services in 2022. However, during the hearing, members of the health community said the department is making progress, and a change would disrupt that trajectory. Douglas Harrington, state medical officer, said in testimony regarding the confirmation of the health department director, Charlie Brereton, nearly 50 different groups expressed support not only for the director but for the path on which he has set the agency. Additionally, Harrington said all seven health department facilities have stable leadership. For the first time in years, nursing vacancies have been reduced by 30%, and the agency is recruiting roughly one new nurse a week, he said. Except for one-on-one visits, he said patient costs are down 25%. 'The bill is highly problematic for us at a time when significant momentum has been achieved,' Harrington said. The health department annual plan for the current fiscal year — which ends June 30 — said the agency aims to implement 100% of required CMS recertification reforms at the state hospital in Warm Springs. DPHHS did not respond to a question about whether the hospital will reach that goal this year. Echoing the comments from many opponents of the bill, Sen. Carl Glimm, R-Kila, said the idea to split the agency is so massive, it would need to be studied first. Additionally, Glimm said, the state is starting to see positive results. 'Frankly, I think if you rip it in two right now, I think that starts to tear apart some of the effect of what we have going on there,' Glimm said. Sen. Daniel Emrich, R-Great Falls, said he agreed. Emrich said the bill wasn't fully baked, essentially directing the governor to issue executive orders to finish it, and he moved to table it, which the committee supported on an 11-0 vote. Even if legislators resurrect the bill, it may meet a hurdle in the Governor's Office. At a press conference last week, Gov. Greg Gianforte said he would not comment on the specific bill, but he said generally, his administration is opposed to bigger government. He said splitting up an agency means two separate executive teams and potential silos that would make government less efficient. 'Those are principles that matter to our administration,' Gianforte said. The House had supported the bill on an 82-15 vote, and Fitzpatrick was unrelenting in his criticism of the agency in committee. He said the state hospital is not in his district, but it's close, and he gets frequent complaints about it. Fitzpatrick also said the health department has spent profligately because it has failed to properly recruit, and legislators have been complicit in 'shoveling the public's money out like water going over the dam.' 'DPHHS has burned through $71 million to pay for traveling health care staff,' Fitzpatrick said. 'That's $97,000 a day.' Most of the people who testified, though, said the bill would have negative consequences for the people the department is serving, although some said they appreciated the sponsor's hunt for efficiencies and his care for Montanans. Kali Wicks, with national mental health advocacy organization Inseparable, thanked Fitzpatrick for his interest in the topic, but said the bill had the potential to stop progress 'in its tracks' and 'create some issues with continuity of care.' Wicks agreed it might be time for a study bill if time allowed. Mike Chavers, representing the Yellowstone Boys and Girls Ranch and the Behavioral Health Alliance of Montana, said change is hard, and progress in public systems can feel 'painfully slow,' but HB 851 would derail momentum. 'We must oppose this bill, not because we're resistant to reform, but because we started to see the fruits of our hard work,' Chavers said. The agency's chief legal counsel, Paula Stannard, said the bill could raise a 'significant legal issue' depending on the way Montana broke up the department. Stannard said federal rules require a single state agency to administer the state Medicaid plan, and a split could risk federal funds if it created separate points of contact.
