For the past few years, the behavioral health community and providers have testified numerous times about the need for prevention and community-based services to be reinstated after the 2017 Special Session budget cuts. It’s unlikely that there is anyone in the state that doesn’t now see how those cuts disseminated the behavioral health system and impacted our rural communities in a disproportionate manner. Adults, families and children with mental illness or disabilities have been hit with insurmountable difficulties and providers have struggled to keep open the few programs available. As we move into 2020, the Behavioral Health Alliance would like to ask you for assistance on some innovative solutions to the many problems Montana families face. All of these initiatives will require funding in the 2021 Legislature:
- Family First Prevention Services Act: The bill aims to prevent children from
entering foster care by allowing federal reimbursement for mental health services,
substance use treatment, and in-home parenting skill training. It also seeks to improve
the well-being of children already in foster by incentivizing states to reduce placement of
children in congregant care. The Act will be implemented in Montana by October 2021.
The Behavioral Health Alliance is partnering with Children and Family Services (CFS)
and Children’s Mental Health Bureau (CMHB) in order to implement the Act with best
practices and prevention strategies.
The Act was intended to be budget neutral and the savings from reducing the number of
children place in congregant care would pay for prevention programs. In Montana, only
3.7 percent of children are placed in congregant care compared to over 10 percent
nationally. DPHHS will need to fund prevention programs using some other means since
we don’t have an overuse of congregant care beds. For example, when kids are sent out of
state, Montana pays out-of-state agencies a higher day rate, education costs, and room
and board, which it does not pay in-state agencies. If Montana agencies were paid a
higher rate, agencies could afford to take more Montana kids and the savings could be
used for prevention programs such as case management, home support services, and
therapeutic foster care, and adoption services.
- Children and Family Case Management: This program was cut by 58% in January. Since then $23M has been transferred out of Children’s Mental Health Bureau (CMHB) with $10M of that going to CFS to cover the increased costs of foster care. In the 2019 Legislature, $3.5M was allocated by Health and Human Services Committee to reinstate case management for children and adults. To date, none of that money has been used for case management programs. Alliance members and the CMHB created a case management taskforce to create a sustainable Children and Family Case Management Program. As soon as Montana Medicaid approves a higher rate for case management, agencies will be able to begin opening case management programs again. In the 2021 Legislature, funds will need to be reallocated for this very important program that allows many children to stay safely in their homes.
- Children’s Continuum of Care Initiative: Montana Healthcare Foundation has awarded a grant to the Alliance to collaborate with DPHHS to plan a Children’s Continuum of Care Initiative. Children and youth with mental health issues are best supported through a continuum of care that provides ongoing services. The goal of this approach is to use the most appropriate and least restrictive interventions, both in or out of the home, while ensuring that safety issues and needs are addressed. The Continuum of Care Taskforce will include DPHHS Directors, children’s providers, and a national consultant that will create a timeline and plan for implementing a Continuum of Care. A System of Care for children was implemented in Montana in 1999, but since then the legislation has been diluted to the point that no system of care currently exists in Montana.
The first task for the Continuum of Care Taskforce will be to develop an evidence-based model for Home Support Services. Home Support Services provide therapy and case management for at-risk children and families in the home. With the implementation of Family First, it is imperative that Montana again delivers intensive treatment in the home to families and children before they are removed to foster care or therapeutic group homes. Home Support Services and a continuum of care for children will require the continued collaboration with CFS and CMHB as well as input from OPI and other children’s agencies.
Over two years has passed since the 2017 Special Session cuts to Montana’s most vulnerable. Only a few programs have been reinstated with funding. Funding will need to be allocated to these very important programs. Legislators can help the Behavioral Health Alliance and DPHHS bring these projects to fruition so that Montana can relinquish first place for rate of suicides and the need for foster care placements.