Montana’s Medicaid program is embedded in several Department of Public Health and Human Services (DPHHS) divisions and programs. A new Montana (MT) Medicaid Director was hired in May 2022. The MT Medicaid Director oversees three Medicaid Divisions: Health Resources Division (HRD), Senior and Long Term Care Division, and the newly formed Behavioral Health and Developmental Disabilities Division.
The Medicaid Division Administrator in HRD is the Title XIX signatory. The Title V MCHBG (MCHBG) signatory is the Early Childhood Family Support Division (ECFSD) Administrator, where the MCHBG 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 MT. This is the most recent data available, due to disruptions to data collection in 2020.
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 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 (CFS) leadership to support training mental health professionals in Parent Child Interactive Therapy (PCIT). CSHS has trained two cohorts of mental health professionals across the state to increase capacity for this service, and ensure access for CFS clients. A Train-the-Trainer cohort begin instruction in September 2022.
- CSHS convened 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. CSHS has recently expanded the participants to include: the Head Start Director; Part C staff; the Children’s Trust Fund Supervisor; CFS Program Managers; and the Prevention Bureau Chief, who is embedded in Medicaid and oversees the Mental Health and Substance Use Prevention Block Grants.
- Monthly meetings are held with the Meadowlark Initiative leadership to discuss efforts around the sustainability of Project ECHO clinics, and the psychiatric consultation access line. This group includes the Medicaid Bureau Chief responsible for primary care and medical home services. 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 Health Resources & Services Administration (HRSA) Perinatal Behavioral Health Grant, which was awarded to DPHHS in 2017.
- The Children & Youth with Special Health Care Needs (CYSHCN) Director is co-leading the MT 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 MT Rural Institute for Inclusive Communities, and family leaders.
- The MT Access to Pediatric Psychiatry Network (MAPP-Net) advisory committee, and the MAPP-Net Symposium planning committee, include Medicaid staff representation for children’s mental health services.
- CSHS participates in the Community Health Worker (CHW) Taskforce. and recruited Medicaid’s participation to support identifying a sustainable funding source for CHWs. The goal is to advance equitable systems of care.
- CSHS has participated in conversations with Medicaid Bureau Chiefs regarding sustainable funding sources for family peer support specialists.
The Special 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. MT WIC met with Medicaid in June 2022 to discuss this topic and other program updates. The meeting included CSHS to discuss the eligibility and payer distinctions for formula coverage and reimbursement between Medicaid, WIC and CSHS’s financial assistance program. MT 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 their website to ensure participants are aware of how to contact and apply for Medicaid, especially for minors eligible for Early Periodic Screening Diagnosis and Treatment (EPSDT).
In September 2020, the Oral Health Program (OHP) began collaborating with HRD to determine if the MT 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 MT Healthcare Program members under the standing orders of a supervising physician. This project is temporarily on hold, due to staff turnover. An OHP and HRD collaboration on a potential project, to increase the number of preventative oral health services provided to members under 36 months of age by Medicaid enrolled physicians, physician assistants, and nurse practitioners, was met with similar challenges for updating the PHC fee schedule.
MT Obstetric and Maternal Support (MOMS) Program
Medicaid Behavioral Health and Developmental Disabilities Division (BHDD) and HRD staff continue to meet monthly to share updates on their programs. They also endevour: to look for opportunities for collaboration and coordination; to maximize funds; and to capitalize on resources which support their shared population of perinatal providers and patients. These staff oversee the HRSA funded Perinatal Behavioral Health Initiative (PBHI), and the Substance Abuse and Mental Health Services Administration (SAMHSA) funded Strengthening Families Initiative for Pregnant and Postpartum Women (SFI-PPW). These meetings include regular participation from: the HRD Administrator, the Medicaid Member Health Management Bureau Chief who oversees the PBHI, the SFI-PPW Program Manager and her supervisor, and the MOMS Program Specialist and her supervisor (Title V Director).
The group has initiated discussions to work toward a common definition of care coordination across all DPHHS programs. This is essential for potential Medicaid reimbursement for care coordination for perinatal patients and sustainability for the three programs. They are collaborating on a shared document that includes each program’s definition, and/or job descriptions of those who serve in that role.
The MOMS and the PBHI programs have been sponsors of the Perinatal Mental Health Conference. They have offered scholarships for conference registration, and training for Perinatal Mental Health-Certification (PMH-C) through the conference. The next conference is in November 2022.
Additionally, the MOMS and PBHI staff were co-leads of the Center for Medicare and Medicaid Services (CMS) sponsored Postpartum Care Affinity Group (PCAG), and received technical assistance from Mathematica. As one of nine teams from other states, MT learned from quality improvement (QI) advisors and subject matter experts on how to improve postpartum care. The goal of this effort is to improve postpartum care visits among Medicaid and Children’s Health Insurance Program beneficiaries.
The anticipated outcome is for MT to identify and advance innovative strategies on public insurance financing of home visiting services, and how Medicaid could support home visiting sustainability. Out of this technical assistance, an internal workgroup with representation from Medicaid, CFS, Asthma Home Visiting, and MIECHV was formed to discuss the options available in MT.
HMF refers all families to needed services, including referrals to Medicaid. For the 2021 performance year, HMF reported to HRSA the following:
- 72.4% of caregivers in MIECHV funded services had Medicaid as their insurance source;
- 78% of children enrolled in MIECHV funded services had Medicaid as their insurance source.
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