Montana’s Medicaid program is embedded in several Department of Public Health and Human Services (DPHHS) divisions and programs.  The Medicaid Division Administrator in the Health Resources Division (HRD), is the Title XIX signatory.  The Title V signatory is the Early Childhood Family Support Division (ECFSD) Administrator, where the Title V Program is located. In the Overview of the State narrative, specific enrollment data for Medicaid, Medicare, private insurance, and other insurance coverage is included in Table 3: 2019 Estimates of Resident Population by Insurance Coverage Type for Montana. 

Several Family and Community Health Bureau (FCHB) maternal and child health-focused programs have been working on specific projects with Medicaid in the last year.   The 2021 Legislative Session caused a brief halt in progress; but conversations resumed in early June 2021.

The Children’s Special Health Services (CSHS) section has made specific efforts to build collaborative partnerships with Medicaid. Efforts include:

• Partnering with Medicaid and Child and Family Services leadership, and using Montana Access to Pediatric Psychiatry Network (MAPP-Net) funding to support training mental health professionals in Parent Child Interactive Therapy (PCIT). The partnership will train two cohorts of mental health professionals to increase capacity for this service across the state of MT and ensure access for Children and Family Services clients.

• Quarterly collaborative meetings with the Children’s Mental Health Bureau Chief and the Developmental Disabilities Bureau Chief to discuss programs, provide updates and identify partnership opportunities.

• Monthly meetings with the Tribal Health Services and Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Program Section Supervisor to discuss funding for: Cleft Craniofacial services; EPSDT program: and Targeted Case Management for Children and Youth with Special Health Care Needs (CYSHCN). These meetings have ceased since the position became vacant several months ago.

• Monthly meetings with the Meadowlark Initiative leadership, which includes the Medicaid Bureau Chief responsible for primary care and medical home services, to discuss efforts around the sustainability of Project ECHO clinics and the psychiatric consultation access line. Information on state Medicaid policy changes to support Project ECHO clinics has been shared.  The Meadowlark Initiative is the term used to describe the collaborative efforts between the MT Healthcare Foundation and HRD staff administering the HRSA Perinatal Behavioral Health Grant, which was awarded to DPHHS in 2017.
• The CYSHCN Director is co-leading the Montana team participating in the National Care Coordination Academy, which includes participants from various Medicaid divisions. The CYSHCN Director has recruited Medicaid staff to present information on children’s mental health services and medical homes to an audience which includes providers, the University of Montana Rural Institute for Inclusive Communities, and family leaders.

• Medicaid representation for children’s mental health services is on the MAPP-Net advisory committee and the MAPP-Net Symposium planning committee.

• CSHS participates in the Community Health Worker (CHW) taskforce and recruited Medicaid’s participation to support identifying a sustainable funding source for CHW.  The goal is to advance equitable systems of care.

The Supplemental Nutrition for Women, Infants, and Children (WIC) Program is required to meet with Medicaid at least annually to discuss coverage of medical formulas and nutritionals for mutual participants.  Montana WIC met with Medicaid in July 2020 and again in June 2021 to discuss this topic and other program updates.  Montana WIC clinics regularly make referrals to Medicaid for any family that appears to qualify and states they are not enrolled.  Likewise, Medicaid staff may refer families to WIC when appropriate. 

Additionally, WIC added specific language to the general program booklet, the participant cardholder, and the “resources” section of the website to ensure participants are aware of how to contact and apply for Medicaid, especially for minors eligible for EPSDT.  The local WIC agencies referred 3,005 individuals who self-reported as not being enrolled in Medicaid but appeared to qualify.

In September 2020, the Oral Health Program (OHP) began collaborating with HRD to determine if the Montana Healthcare Program Public Health Clinic (PHC) fee schedule can be updated. The goal is to allow PHCs to bill and receive reimbursement when a public health nurse applies fluoride varnish on Montana Healthcare Program members under the standing orders of a supervising physician.  The OHP last met with HRD staff to discuss the decision matrix in January 2021.  According to the latest update received, HRD staff are working on the reimbursement schedule for public health clinics, which will include oral health services.

The OHP is also collaborating with HRD on a potential project to increase the number of preventative oral health services provided.  This specifically targets services for members under 36 months of age delivered by Medicaid enrolled physicians, physician assistants, and nurse practitioners.  If approved, the program would provide enhanced reimbursement for oral health services provided by enrolled primary care providers who have completed the Smiles for Life online curriculum.

The Title X Family Planning Program (FPP) is collaborating with HRD to attempt to increase the reimbursement for family planning clinics located in rural public health departments for women’s reproductive health visits.  In the last year, staff have met twice to identify the issue and begin to discuss solutions. HRD is working on the reimbursement schedule for public health clinics, which will include oral health and family planning.  FPP is also working with HRD to better understand the reimbursement for telehealth visits.

Montana Obstetric and Maternal Support (MOMS) Program, Addictive and Mental Disorders Division (AMDD) staff and HRD staff have initiated discussions to work toward a common definition of care coordination.  These staff oversee the HRSA and private foundation funded Meadowlark Initiative, and the Substance Abuse and Mental Health Services Administration (SAMHSA) funded The Strengthening Families Initiative for Pregnant and Postpartum Women. These three grant-funded programs are exploring sustainability through Medicaid reimbursement for care coordination, which is a component of the three programs. 

Additionally, the MOMS and Meadowlark staff are co-leads of the Center for Medicare and Medicaid Services (CMS) Montana Postpartum Care Affinity Group (PCAG), which is receiving technical assistance from Mathematica. As one of nine teams, Montana will learn from CMS’s quality improvement advisors and subject matter experts in improving postpartum care. The goal of this effort is to improve postpartum care visits and the quality of visits among Medicaid and the Children’s Health Insurance Program beneficiaries.

The year-long learning commitment is anticipated to help guide interventions that could be adapted by the County Public Health Departments (CPHD) that selected NPM 1: Well Woman Visit. The PCAG will reach out to CPHDs and encourage them to choose an intervention supporting NPM 1, which would also align with the goals of the PCAG and MOMS. The MOMS grant could provide supplemental funding in addition to MCHBG funds to support the CPHD’s NPM 1 intervention activity.

The Healthy Montana Families (HMF) Home Visiting program was one of 11 Maternal Infant Early Childhood Home Visiting (MIECHV) funded states to participate on the National Academy for State Health Policy (NASHP) State Policy Institute on Public Insurance Financing of Home Visiting, which convened in January 2021.  The Title V and MIECHV Project Directors, HRD Branch Chief, and ECFSD leadership participated in the three training sessions. Beginning in August 2021 and ending in April 2022, Montana is one of three states participating in the NASHP’s in-depth technical assistance opportunity.  The anticipated outcome is for Montana to identify and advance innovative strategies on public insurance financing of home visiting services and how Medicaid could also be tapped for home visiting sustainability.

HMF refers all families to needed services, including referrals to Medicaid; however, Medicaid referrals are not a required data element for MIECHV reporting purposes.  For the 2020 performance year, HMF reported to HRSA the following: 

• 72.5% of caregivers in MIECHV funded services had Medicaid as their insurance source;
• 78.6% of children enrolled in MIECHV funded services had Medicaid as their insurance source.