State health department outlines Medicaid changes, behavioral-health reforms and Montana State Hospital timeline

The Department of Public Health and Human Services told the Montana House Health and Human Services Committee it oversees nearly 3,000 employees, an approximately $7,000,000,000 biennial budget and more than 60 offices statewide, and asked lawmakers to engage with agency staff as the session proceeds.

Director Charlie Brereton said the department is focusing this biennium on behavioral-health and developmental-disability system reform, work prompted by the 2023 Legislature's appropriation of roughly $300,000,000 through House Bill 872 and the BISFID commission that produced a report of more than 20 recommendations presented to the governor in September 2024. "We stand ready to meet with you whenever you would like to meet," Brereton told the committee.

Why it matters: The funding and commission work established in 2023 frame budget and policy choices the agency will ask the Legislature to act on during the 2027 biennium budget process.

Brereton also reviewed the Medicaid "unwinding" or redetermination process that followed the end of the federal COVID-19 public health emergency. He said DPHHS reviewed eligibility for about 330,000 Montanans and that roughly 129,000 people were removed from Medicaid rolls during that effort. He added that by October 2024 Medicaid enrollment had returned to — and in some measures was lower than — pre-pandemic levels. The department emphasized it has implemented provider rate increases adopted in prior legislation to bolster access to care.

Rebecca Decamara, Medicaid and Health Services Management Practice Director, said her branch manages Medicaid's benefits package across behavioral health and developmental disabilities, physical health services (including hospitals, pharmacies and federally qualified health centers) and senior and long-term care programs. She introduced division administrators who will be points of contact throughout the session.

The department described ongoing work at the Montana State Hospital in Warm Springs. Brereton said the hospital lost federal certification in 2022 and the department reclassified the facility administrator role to recruit a physician CEO; he introduced Dr. Kevin Flanagan as the new MSH CEO. Capital and construction work at the Warm Springs facility are underway and estimated to take 12 to 18 months; Brereton said the department expects those projects to position the hospital for an application for recertification by the Centers for Medicare & Medicaid Services once construction and other conditions are met. Staffing shortages remain a challenge, he said, with particular needs for registered nurses and certified nursing assistants.

DPHHS chief information officer Carrie Albro and information-technology staff told the committee the agency manages a large portfolio of systems. Albro said the technology services division supports roughly 190 systems and a statewide service center that fields tens of thousands of calls annually; she identified a Medicaid systems team (sometimes called EMPATH) as operating one of the state's most complex IT systems.

The department also asked committee members to use materials provided, including an organizational chart and a summary of agency functions listing divisional contacts for follow-up. Multiple DPHHS executives offered to provide further breakdowns, including a list of which IT systems are hosted by the Department of Administration's SITSD versus vendor-hosted systems.

Ending: Committee members thanked the agency and asked follow-up questions about IT hosting, a cheat sheet of acronyms for new members, and details about the Montana State Hospital timeline. DPHHS said it would provide updated acronyms and a system-hosting list on request.