Montana’s Department of Public Health and Human Services (DPHHS) relies on federal funding, which provides a significant number of public health services to the 1.1 million plus citizens living in one of the state’s 56 counties.  In FFY 22, the state’s Title V Maternal & Child Health Block Grant (MCHBG) expended $2,315,433.  This spending provided Direct and Enabling Services to 21,276 pregnant women, infants, children, adolescents, children and youth with special health care needs (CYSHCN) and women of childbearing age (Form 5a).  This number increases to 84,088 for the same group, when including Public Health Services and Systems (Form 5b).   

The MCHBG, housed within the Family and Community Health Bureau (FCHB) in DPHHS, relied on partnerships with private clinics, hospitals, community based-organizations, non-profits, Tribal Health Departments, colleges and universities, high schools, and County Public Health Departments (CPHDs) to serve these Montanans in FFY 22.  These partnerships as well as the FCHB’s other maternal and child health focused programs, focused on addressing Montana’s FFYs 2021-2025 priority needs:

• Access to Public Health Services
• Bullying Prevention
• Family Support & Health Education
• Infant Safe Sleep
• Medical Home
• Children’s Oral Health
• Women’s Preventive Healthcare

Montana’s methodology to ensure that the 30%-30%-10% requirements are met for Preventive and Primary Care for Children; CYSHCN, and administrative expenditures, used the ratios of the total maternal and child population as a factor for determining state-level budget amounts for the demographic categories.  In FFY 22:

• $836,601 (36.13%) was expended on Preventive & Primary Care for Children, which was slightly less than the budgeted amount of $848,546
• $773,939 (33.43%) was expended on Children with Special Health Care Needs, which exceeded the budgeted amount of $736,690
• $231,543 (10%) was expended on Administrative costs, which was greater than budgeted amount of $190,439.  The increase was due to changes in: Administration; organizational structure; and personnel costs.                             

Funds are distributed to the CPHDs using a formula which considers the size of their maternal and child populations, along with oversampling for those who are at or below the federal poverty level. These CPHDs are often the only source for enabling and public health services for their community.  In FFY 22, $975,421 (42%) was distributed to 48 CPHDs to address their selected National/State Performance (N/SPM) as illustrated in the following map:

The CPHDs reported $5,996,450 for their FFY 22 match amount.  With the CPHD’s match, combined with the State’s MCH funds of $2,854,070 and program income of $3,156,546, the MCHBG total match far exceeded the $3 to $4 requirement.  The state match was slightly over 24 times the required 1989 Maintenance of Effort of $485,480.

Estimating the FFY 22 budget relied on financial information and programmatic data previously collected and reported to complete Forms 3a, 3b, 5a, and 5b.   The differences between budgeted and expended amounts were largely created by fluxuations in the numbers per populations served by the CPHDs. 

The CPHDs FFY 22 Financial & Data Reports  stated:

• 31,327 Group Encounters (duplicated count)

In addition to MCHBG funding, the federal and state funds awarded in FFY 22 supported other FCHB programs focused on the maternal and child population.  This is illustrated in the following paragraphs, and reported on Form 2.  Additional details and specifics are in the FFY22 Annual Report N/SPM narratives.

The CSHS Section’s MCHBG FFY 22 expenditures supported these activities for NPM 11: Medical Home:

• Contracted with the HALI Project: Montana Parent Partner Program to provide peer services to 275 families in one of five communities.
• Collaborated with the University of Montana Rural Institute for Inclusive Communities (UMRIIC) to host the Montana team’s participation in the National Care Coordination Academy.
• Butte 4-C’s facilitated the Circle of Parents (COP) peer support meetings in 12 sites, attended by 205 individuals.
• Funded two national COP trainers who offered training to 14 individuals.
• UMRIIC continued to:
  • Provide the Consumer Advisory Council (CAC) with evidence-based transition resources for their quarterly meetings and distribution to the CAC interested parties.
  • Assist with the Montana Youth Transitions Conference.
• Contracted with the University of Utah to maintain and enhance the Montana Medical Home Portal website.
• Collaborated with the Family to Family Health Information Resource Center (F2F) on a resource guide for families of CYSHCN moving to Montana.
• Financial Assistance Program (FAP), which covered items that were not covered by Medicaid, Part C, or private insurance, such as: an adaptive backpack for a child to participate in family outdoor activities; and a mobility harness.

In addition to focusing on NPM 11, CSHS staff administered these Federal (F) and State (S) funded programs:

• Genetics, CSHS Clinic, and Newborn Screening Programs: $1,609,775 (S)
  • Supported Cleft/Craniofacial clinics in four regional locations.
  • Blood spot specimen is collected 24-48 hours from birth and sent to the DPHHS Public Health Laboratory within 3 days.
    • Children and families in need of follow up worked with Shodair Children’s Hospital.
• MAPP-Net: $840,228 (F)
  • Sponsored the third annual Symposium of Pediatric Mental Health.
  • Promoted and facilitated mental and behavioral health screening and follow-up through trainings, resulting in 181 inter-disciplinary providers were trained through MAPP-Net programming.
• Newborn Hearing:  $314,354 (F)
  • Ensured that all newborns had their hearing screened by 1 month, diagnosed by 3 months, and enrolled in early intervention by 6 months.

The MCHC Section ensured that the CPHD’s expended their allocation on their selected N/SPM, and required Fetal, Infant, Child, and Maternal Mortality Review (FICMMR) Program injury prevention activities.  Explained in detail in the Overview of the State, Montana has a “decentralized” system for providing public health services whereby local CPHDs are on the frontline for providing public health services.   

Many CPHDs, especially in the smaller-populated counties and in counties with few social resources, are the initial and/or only source for enabling and public health services.  For example: Petroleum is home to 161 women, infants, children, adolescents, and CYSHCN; whereas Yellowstone is home to 74,273.

The MCHBG and FICMMR Program Specialists (PS), both supported 100% with MCHBG funds, completed data quality reviews of the CPHD’s reports: Quarterly; Annual Compliance & Activities; and Annual Financial & Data.  The CPHDs’ approved reports generated their MCHBG payments, with final authorization by the Title V MCHBG Director/MCHC Supervisor. 

The MCHBG PS: worked directly with the 23 CPHDs that selected SPM 1: Access to Care and Public Health Services, and the 9 CPHDs that selected SPM 2: Family Support and Health Education; provided technical assistance (TA) as needed to all the CPHDs, i.e. completing their required reporting; training on evidence-based/informed activities; and was the Project Manager for the FFY 21 Annual Report & FFY 23 Application.   The FICMMR PS: worked directly with the eight CPHDs that selected NPM 5: Safe Sleep; completed Quality Assurance on the 168 Child Death Review (CDR) reports submitted by the CPHD FICMMR Teams; ensured that the CPHD’s injury prevention activity was evidence based or evidence informed; and throughout the year, provided feedback on their quarterly reports.

In addition to administrative oversight of the MCHBG funding, the Title V MCHBG/ MCHC Section Supervisor supervised staff responsible for the $3,405,327 in federal and state funds that supported the maternal and child population.  These funds created the following programs and focus:

• Montana Obstetrics and Maternal Support (MOMS): $2,172,755 (F)
  • NPM 1: Well Woman Visit TA.
  • Raise and elevate the importance of woman’s health.
  • Innovative approaches for accessing pre/post-natal care and substance abuse treatment for pregnant women.
• Grants to States to Support Oral Health Workforce:  $400,000 (F) & $100,000 (S)
  • NPM 13.2: Children’s Oral Health TA
  • Dental students provided oral health services in Dental Health Professional Shortage Areas (HPSA).
  • Graduate nursing students provided education, screenings, and referrals to American Indian Head Start Programs.
• Maternal Mortality Review and Prevention: $299,279 (F)
  • Data analysis and reporting can be used to support MOMS’s activities and MCHBG 2025 Statewide Needs Assessment priority selection.
• Primary Care Office: $159,003 (F)
  • All the N/SPM.
  • Data analysis determined the Primary Care, Dental, and Mental HPSA designations.
• State Loan Repayment Program:  $174,190 (F) & $100,000 (S)
  • All the N/SPM.
  • Healthcare providers practicing in a HPSA received loan repayment assistance.

The Adolescent Health PS expended $957,332 in federal funds by partnering with high schools, colleges and universities, non-profits, UMRIIC, and Yarrow.  The funding streams were the Pregnancy Risk Education Program (PREP), the Prevention Health Block Grant, and Rape Prevention Education (RPE), and Sexual Risk Avoidance Program (SRAE). The SRAE/PREP PS worked with the two CPHDs that selected NPM 9: Bullying Prevention in FFY 22, and the CPHDs whose FICMMR injury prevention program focused on suicide prevention.

Referrals to, and providing educational materials about, the FCHB’s Montana Healthy Families (MHF) and WIC Programs were often mentioned in the CPHDs’ SPMs 1 and 2 reports.  HMF and WIC also distributed FCHB and ECFSD specific programmatic resources, such as: suicide prevention, safe sleep, bullying prevention, Healthy Montana Mouths, childcare locations, and FAP information to their consumers.  In FFY 22, WIC funding totaled $17,443,433 (F) and $7,627 (S) and HMF received $4,349,780 (F) and $592,329 (S).

The FFY 22 budget referenced the state funds, $499,903, that previously supported the Title X program that was in the FCHB. The competitive Title X grant was awarded to a non-profit clinic that began offering services July 1, 2022.  The Title X staff provided technical assistance to the new awardee and worked with the state contracted CPHDs and clinics during the transition process.  The FFY 22 budget also reflected the FCHB structure at the time, which included the epidemiology section, which was funded with SSDI and PRAMS federal monies.

For FFY 2024, Montana’s Title V MCHBG Program (MCHBG), housed in the Family and Community Health Bureau (FCHB), is requesting $2,323.181. Administrative oversight of the FFY 24 budget is a collaborative effort by the Fiscal Bureau Analyst (FAB), and staff in the Maternal and Child Health Coordination (MCHC) and Children’s Special Health Services (CSHS) Sections. The MCHC and CSHS MCHBG Program Specialists (PS), the Title V MCHBG and CYSHCN Directors, and FAB have monthly budget meetings which ensure the required 30%-30%-10% requirements will be met for: Preventive and Primary Care for Children; CYSHCN; and Administration. The FFY24 budgeted expenditures are as follows:

• Preventive and Primary Care for Children: $898,174 (38.66%)
• Children with Special Health Care Needs: $711,475 (30.63%)
• Title V Administrative Costs: $232,318 (10%)

Montana (MT) has always contributed the 1989 Maintenance of Effort amount of $485,480. The State Legislature establishes the biennial budget support for programs’ state revenues. For FFY20 through FFY24, the state funding average was $3,210,553.  For FFY24, FCHB programs will receive $3,343,153 in state funds. Certain state funds are tied to legislative rules, and are restricted in their expenditure, i.e., can only support state staff or be expended on contracted services. State funds will help support programs administered by FCHB, CSHS, MCHC; Healthy MT Families (HMF); WIC; and Adolescent Health (AH) staff. The state funds, when combined with the estimated $5,996,450 in matching funds from the 50 County Public Health Departments (CPHDs), and $3,076,215 in program income, will exceed the required $1,742,386 needed to meet the $3 match in non-federal funds for every $4 in MCHBG funding. 

The CPHDs will receive $1M from the MCHBG, distributed per the funding formula as required by MCA Section 501 to 510 [42 U.S.C. 701 to 710]; and ARM 37.57.1001. CPHDs will utilize the funds in accordance with details submitted in their FFY24 Operational Plans (OP). The OP includes activities and evaluation plans to address their chosen National/State Performance Measure (N/SPM). The MCHBG funding also supports the CPHD’s required Fetal, Infant, Child, & Maternal Mortality Review (FICMMR) injury-prevention activity. To ensure that the CPHDs’ fiscal reporting accurately reflects their MCHBG expenditures, the MCHBG PS provides annual fiscal reporting training.   

The Children’s Special Health Services (CSHS) Section will provide services to all children with and without special health care needs, from their FFY24 budget of $3,682,955, which includes these funding streams: MCHBG: $711,475; State funds: $2,036,480; and Federal funds: $935,000.             

The CSHS Section will continue their contractual oversight and partnerships, which provide gap-filling services, such as peer support and resource coordination, to address and ensure that CYSHCN have access to a medical home (NPM 11). In the coming year, MCHBG funding will support:

• Peer Support Services: offered by MT Peer Network (MPN) and the Early Childhood Coalition of Beaverhead County (ECCBC) Canvas Early Learning Center.

• Youth Peer Support: new partnership with the Great Falls Area Chamber of Commerce (GFACC) Leadership High School (LHS) program
• Transitions Project and program evaluation: University MT Rural Institute for Inclusive Communities (UMRIIC).
• Financial Assistance Program: for qualifying families of CYSCHN or foster care child, will provide assistance for services outside the scope of Medicaid, CHIP, or private insurance.
• Title V MCHBG Family Delegate role.
• Purchase of assistive equipment and adaptive technology for Mon-Tech’s lending library
• Sponsorship of the half-day conference organized by the MT Chapter of the American Academy of Pediatrics.

MCHBG funding will support the CSHS PS (100%) and the CSHCN Title V Director/Section Supervisor (75%). In FFY24, these CYSHCN focused programs will receive support from the remaining CSHS state and federal funds. They will receive contract oversight and technical assistance from: the CSHS Nurse Consultant; the MT Access to Pediatric Psychiatry Network (MAPP-Net) PS and the Newborn Hearing Screening (NBHS) PS:

• Cleft/Craniofacial Clinics: An interdisciplinary care team will be selected based on their Request for Proposal (RFP) application to provide services to children and their families.  Anticipated contract to be executed in December 2023.
• MT Statewide Genetics Program: Genetic testing and counseling services, provider consultations, and education on genetic conditions through a contract with Shodair Children’s Hospital.
• Metabolic Services: Shodair Children’s Hospital is contracted to offer metabolic clinics and long term follow-up services for families identified by the Newborn Bloodspot Screening (NBS) program. 
• CSHS and the DPHHS Public Health Laboratory collaborate on ensuring an infant and their family receive additional services based on NBS test results.
• Resource navigation projects, such as a resource tool for families who are considering moving to MT.

• MAPP-Net: Primary care providers and behavioral health specialists will be connected to education and consultation services to meet the mental health needs of the children and youth they serve.
• NBHS: All infants are provided with NBHS and resources, following the 1-3-6 Early Hearing Detection and Intervention guidelines established by the Joint Committee on Infant Hearing.
• The Newborn Screening Committee, which is charged with reviewing the panel of required screenings and recommending any additions or removals.

In FFY24, the MCHC Section will be supported with $200,000 in state, and $3,030,498 in federal funding. The Title V MCHBG Director/MCHC Section Supervisor will oversee the six following programs:

The MCHBG PS serves as the primary contact for the 50 participating CPHDs, which includes: providing training, technical assistance (TA), and resources on: their selected N/SPMs; Operational Plans; Contracts, Semi-Annual Reports; Annual Compliance & Activities Reports; and Annual Financial & Data Reports. The MCHBG PS will be the subject matter expert for 30 CPHD’s working on SPM 1, and 13 CPHD’s SPM 2; and refer the CPHDs to FCHB/MCHC staff who are positioned to address specific inquiries regarding NPMs 1, 5, 9, and 13.2.  In FFY24, the MCHBG PS will schedule approximately 17 CPHD in-person site visits. These visits help to build working relationships, and increase understanding of local environments and challenges.

The MCHBG PS, who is 100% MCHBG-funded, will be the Project Manager for the FFY25 Application & FFY23 Annual Report.  The PS is also the MCHBG 2025 Statewide Needs Assessment contract liaison with UMRIIC. The MCHBG and FICMMR PSs will provide their contractually required Annual MCHBG and Quarterly FICMMR Trainings, and offer new CPHD staff trainings on an as-needed basis.

The FICMMR PS will ensure that the required CPHDs’ annual FICMMR injury-prevention activity has an evidence-based or informed foundation, and their Semi-Annual Reports and Annual Compliance & Activities Reports reflect their stated activity and evaluation plan. In FFY24, the FICMMR PS, who is 100% MCHBG-funded, will: be the subject matter expert to the seven CPHDs that opted for NPM 5; collaborate with the Department of Justice’s Coroner Liaison upcoming local coroner’s infant safe sleep training; and be a resource to the Maternal Mortality Review Program Nurse Consultant/Grant Administrator.

The Oral Health (OH) Program is funded by HRSA’s Grants to States to Support the Oral Health Workforce Activities and supports NPM 13.2.  The funding supports the OH PS, who is the contract liaison with these partners: University School of Washington/School of Dentistry; MT State University/College of Nursing; MT Office of Rural Health/Area Health Education Center; WIM; and Yarrow, LLC.  MCHBG funds will support the 3rd Grade Basic Screening Surveillance in the 2023-2024 school year. The OH PS will provide technical assistance to the one CPHD that selected NPM 13.2, and the seven CPHDs that are focusing on oral health activities for SPM 1. WIM is conducting an OH Workforce Needs Assessment, to be completed in March 2024. WIM’s needs assessment will also help inform the priority areas and N/SPM selections for the MCHBG 2025 Statewide Needs Assessment.

The MT Obstetric and Maternal Support (MOMS) Program is entering its fifth year, focusing on raising awareness about the importance of maternal health. The program’s aim is to decrease the state’s maternal mortality and severe maternal morbidity rates, by implementing and evaluating maternal health innovations. The funding supports the MOMS PS, who will provide: TA to the one CPHD that selected NPM 1, and two CPHDs that are focusing on women’s preventive healthcare activities for SPM 1; and will continue to collaborate with the Public Health and Safety Division STD/HIV/Viral Hepatitis Section’s effort to increase awareness on how to prevent syphilis. MOMS will continue to contract with the UMRIIC staff to conduct evaluation analysis of the Billings Clinic’s (BC) MOMS-funded programs. In FFY24, BC will continue to offer ECHO clinics; Empaths Perinatal Substance Treatment System; and Cuddling Cubs, a virtual postpartum support group.

The Primary Care Office (PCO) and State Loan Repayment Program (SLRP) PS supports all the N/SPMs which, at their core, require a healthcare provider.  The PCO PS ensures accurate data is used to determine a county’s Health Professional Shortage Area (HPSA) designation. The HPSA score is critical for determining if a healthcare provider is eligible for federal or state loan repayment assistance to practice in the county. 

The MT Maternal Mortality Review and Prevention (MMRP) Program, funded by the CDC Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE MM) Initiative, is recruiting for the Nurse Consultant/Grant Director position which became vacant on July 7, 2023.  The previous Nurse Consultant completed abstracting all the available records for the Calendar Year 2020 maternal deaths. The MT Maternal Mortality Review Committee (MMRC) has discussed and provided prevention recommendations for nine of the 11 maternal deaths.  The MMRC results have been documented in the CDC MMRIA data system.

UMRIIC’s contract, to provide MMRC meeting facilitation and technical assistance, will be amended to include completing family member interviews, to further gauge the preventability of the maternal death. UMRIIC will analyze the 2020 MMRIA data and draft a report on the prevention recommendations. This additional tool will raise awareness on the importance and contributing effects social determinants of health have on optimal maternal health.

The MMRP and MOMS staff began collaborating with the DPHHS Director of the Office of American Indian Health to establish a formal data sharing agreement with each Tribal Government. A letter signed by the DPHHS Director was sent to the Chairman/woman of each tribe, requesting they ratify a resolution to recognize a partnership in reviewing tribal maternal deaths and sharing recommendations.

The FCHB also includes: Healthy MT Families (HMF) Home Visiting; the Supplemental Nutrition for Women, Infants, and Children (WIC) program; and two Adolescent Health PSs, who are supervised directly the Bureau Chief. 

The Healthy MT Families (HMF) Home Visiting services will support maternal, infant, child, and CYSHCN populations by funding four evidence-based home visiting models:  Parents as Teachers; Nurse-Family Partnership; SafeCare; and Family Spirit. In FFY24, state ($692,980) and federal MIECHV ($5,055,000) funding will support the HMF Supervisor and three PSs. The HMF staff will oversee 18 home visiting programs in 16 counties, three within tribal agencies. 

The WIC Program will have 34 local WIC Agencies, which includes seven Tribal Agencies, and about 120 farmers participating in the WIC Farmer’s Market Program. WIC’s estimated $15M in federal funds, and $9K Farmer’s Market match, also support: the WIC State Director; Nutrition Coordinator; two Public Health Nutritionists, one who is the Breastfeeding Coordinator; Marketing and Continuous Quality Improvement PS; Farmer’s Market PS; Vendor Lead PS; and two Information Technology positions.  Families will have access to WIC’s: nutritional education; food packages; breastfeeding consultations; and fresh fruits and vegetables from Farmer’s Markets.

Adolescent Health (AH) will continue their partnerships with community-based organizations; schools; Tribal Public Health Departments; and colleges. These partners will be contracted to provide services to ensure that Montana youth have optimal physical, mental, social, and reproductive health. Adolescent health is solely funded by federal grants that will total $873,010 in FFY24. The federal grant funds include Title V/Sexual Risk Avoidance Education (SRAE); Rape Prevention and Education (RPE); Personal Responsibility Education Program (PREP); and, by collaborating with the Public Health System Improvement Office, funds from the Prevention Health Block Grant.

As an example of AH partnerships, RPE's contracted partners include: 8 Colleges; 27 Middle Schools; The Montana Coalition Against Sexual and Domestic Violence; 1 non-profit organization (Domestic and Sexual Violence Services); and 2 private for-profit partners (Yarrow and Windfall). Missoula CPHD is a non-contracted partner.

The SRAE PS will support: the one CPHD that selected NPM 9 and two CPHDs that selected a bullying prevention activity for SPM1; and two CPHDs focusing on suicide prevention for their FICMMR activity. The RPE PS serves as the liaison with Yarrow, LLC for completing the Adolescent Health Needs Assessment.

The FCHB will receive $399,999 in state general funds in SFY24. During the June 2023 FCHB Strategic Planning, suggestions were proposed for how this funding could be used to support the FCHB’s: focus on maternal and child health programs; to potentially expand the AH programmatic offerings; and to ease the supervisory burden caused by uneven distribution of programs in the existing sections. Further discussions will ensue at the August 2023 Early Childhood and Family Support Division’s (ECFSD) strategic planning opportunity. 

The new ECFSD structure has moved the State System Data Initiative, and Pregnancy Risk Assessment Monitoring System programs into the Business Systems/Operations Bureau. These programs are crucial for all of FCHB’s federal reporting requirements.  In FFY24, SSDI will receive $100K (federal only) and PRAMS $160,020-federal and $4,694-state special revenue.  

In FFY24, the MCHBG and state partnership will obligate $38,815,317 across all FCHB’s maternal and child health-focused programs. These programs seek to improve the lives of all women, infants, children, CYSHCN, and adolescents living in MT.