HELENA — The Gianforte administration says they’ve reached an agreement that will make it easier for Medicaid members in Montana to access substance use disorder treatment.
“This is a huge milestone for us,” said Charlie Brereton, chief of staff at the Montana Department of Public Health and Human Services.
On Wednesday, the state announced a new waiver, approved by the federal government, will allow larger substance use treatment facilities to get Medicaid reimbursement when people come in for short-term inpatient or residential treatment.
State leaders say there haven’t been enough available beds in Montana for Medicaid patients to receive this treatment, and they believe the agreement will clear one of the major hurdles.
“Access to treatment is vital, and now hundreds more Medicaid recipients will be able to receive this critical service,” said DPHHS Director Adam Meier in a statement.
Federal law prohibits “institutions for mental disease,” or IMDs, with more than 16 beds from receiving Medicaid payments for those services. That meant Medicaid patients might have to wait for treatment until they could get a bed at a smaller facility.
However, in December 2021, DPHHS asked for an exemption to the IMD rule. Now, the Centers for Medicare and Medicaid Services, or CMS, have granted it.
“It’s exciting for those needing help right now,” said Lenette Kosovich, CEO of Rimrock, a treatment center in Billings, licensed for 40 beds. “It is a game-changer.”
Because of the IMD rule, Rimrock hasn’t been able to put Medicaid patients in beds at their main facility. Instead, they’ve had to redirect them to smaller facilities around the community.
Kosovich says, on an average day, they may have 20 to 30 open beds in the main facility.
“You want to talk about really start piling up a waiting list – which is a travesty, because we have the opportunity to treat these people, and we have the beds, but there was no payment mechanism,” she said.
Kosovich says, after Montana implemented Medicaid expansion, Rimrock is now serving roughly twice as many patients on Medicaid. To send those patients to smaller facilities, they’ve needed additional staff to manage them, vehicles to transport them and other added expenditures. She said it’s been especially challenging in light of the ongoing workforce shortage.
“Having these community-based homes is so inefficient,” she said.
Kosovich says other facilities around the state have reorganized themselves into separate 16-bed locations to get around the rule. Rimrock left an option for doing the same as it constructs a new campus.
DPHHS leaders say Rimrock will be the first facility to immediately benefit from the change, but they hope it won’t be the last.
“I think what we’re really interested in is, as we make this available, there will probably be more providers who come to the table and are interested in providing this type of service,” said Rebecca de Camara, administrator of the department’s Behavioral Health and Developmental Disabilities Division.
To Kosovich, the exemption is an important step – to make sure people can get the same care regardless of their insurance situation.
“It is a patient access issue,” she said. “All the stars aligned, and I can’t give enough credit to the people at the state who really helped this happen.”
This waiver is just part of a larger waiver the state asked for from the federal government, as part of Gov. Greg Gianforte’s HEART Initiative. Leaders say they have been waiting for federal approval for some time, and they asked CMS to consider the IMD exemption separately in hopes of getting it done quicker.
“We were fairly certain that we would get easy approval from CMS for that IMD exclusion, because it had already been broadly implemented in states across the country,” de Camara said.
The other aspects of the waiver request are still under consideration. The state is seeking Medicaid coverage for housing support services, pre-release care management for inmates and an evidence-based substance use treatment model.
The HEART Fund was one of Gianforte’s first budget priorities when he took office in 2021. The fund takes state marijuana tax revenue, money from Montana’s tobacco settlement and federal Medicaid match funding and uses it to address gaps in behavioral health and substance use treatment.
The Montana Department of Revenue says they’ll likely make the first transfer of marijuana tax revenue into the HEART Fund later this month. The fund will receive $6 million of that money.
