Big Sky Times

Montana Gov. Greg Gianforte and the Department of Public Health and Human Services (DPHHS) have obtained federal approval to increase access to SUD treatment for Medicaid members through the HEART Fund, according to a July 6 press release. The move aims to address the state's substance use disorder (SUD) crisis by expanding treatment capacity and reducing waitlists.

“This is a game changer,” said Lenette Kosovich, CEO of the Rimrock Foundation, according to the press release. “Until now, we’ve been limited in the number of Medicaid members that we’ve been able to serve, despite an increased demand for treatment.”

According to the press release, Montana Gov. Gianforte, along with DPHHS Director Adam Meier, announced an expansion of substance use disorder (SUD) treatment for Montana Medicaid members. The initiative, called the Healing and Ending Addiction through Recovery and Treatment (HEART) Fund, aims to provide a comprehensive range of behavioral health and treatment programs for communities.

Under the HEART Fund, larger licensed SUD treatment providers will now be eligible for Medicaid reimbursement for short-term acute inpatient and residential stays at institutions for mental disease (IMD), the release reported. Previously, Medicaid patients had to wait for an available bed at smaller facilities. However, DPHHS successfully obtained a waiver from the Centers for Medicare & Medicaid Services (CMS) to overcome the prohibition known as the "IMD exclusion."

This federal approval is a significant development in addressing Montana's serious SUD crisis, encompassing alcohol abuse, methamphetamine use, and opioid abuse and overdose. According to the press release, by allowing Medicaid payment to IMD facilities with 17 or more beds, the state can increase capacity for SUD treatment and reduce waitlists. The waiver will help stabilize patients before they receive community-based treatment.

Lenette Kosovich, CEO of the Rimrock Foundation, described the approval. "This is a game changer," Kosovich said, noting that it will enable them to serve more Medicaid members who require treatment. The waiver is expected to benefit Rimrock and allow them to scale up their services to accommodate an additional 350 Medicaid members annually, according to the release.

To access treatment in a facility, individuals must first undergo a SUD assessment and receive a clinical determination that inpatient care is necessary, the release reported. Previously, Medicaid patients faced long waits for available beds. The federal approval of the waiver also requires the state to improve community-based outpatient mental health and SUD treatment, ensuring smooth transitions to community-based care after inpatient treatment.

The waiver application also seeks federal approval for Medicaid coverage of additional community-based treatment and recovery services, such as evidence-based stimulant use disorder treatment models, housing supports, and pre-release care management for individuals transitioning from correctional settings. According to the release, DPHHS and CMS are working towards obtaining approval for these components of the waiver application.