Montana Lawmakers Request More Information About Governor’s HEART Fund

The fund, created by Governor Greg Gianforte to fill gaps in Montana’s addiction and behavioral health programs, has spent $5.2 million since last year as the state awaits an additional $19 million in federal funding.

Now the Republican governor wants to put more public money into the Heal and End Addiction Through Recovery and Treatment initiative, but lawmakers and mental health advocates are demanding more accountability and clarity about how money is spent.

Republican Rep. Jennifer Carlson, chair of the Montana House Human Services Committee, said her committee heard proposals for a bill that would use HEART money for child care and suicide prevention programs, among other things. She is a sponsor of the HEART initiative’s increased reporting requirements bill.

“You really have to consider if this is what the money is for, or is it just convenient?” Carlson said.

Matt Koontz, executive director of the Montana chapter of the National Alliance for Mental Illness, said there were many questions in this legislative session about the initiative.

“No one knows exactly how they are spent or how to get them,” Koontz said.

The legislature passed Gianforte’s HEART initiative shortly after he took office. It uses revenue primarily from recreational marijuana taxes for the state’s $6 million annual share of drug and mental health programs.

The federal agreement will increase the total fund to $25 million, but the state is awaiting full approval of its Medicaid waiver application from the Centers for Medicare and Medicaid Services. The federal agency approved part of the waiver last year.

“Until CMS approves a full phase-out of HEART, the state is limited in what we can do,” said John Ebelt, spokesman for the state Department of Public Health and Human Services.

The Department of Health submits a report to the CMS four times a year. Agency officials did not respond to KHN’s request for a recent report. The Department must receive reports from tribal nations on how their funds have been used. He did not specify whether he received them.

Carlson House Bill 310 requires the department to report annually on HEART initiative spending to the Interim Committee on Children, Families, Health and Human Services. Carlson said this reporting will let lawmakers know what the money has already been spent on and if there is a better way to spend it.

When Gianforte introduced the HEART initiative during his 2021 State of the Union address, he said it was designed to help directly local communities who know their own needs best.

“This is not a bigger government,” the governor said at the time.

HEART money is distributed through grants and Medicaid-funded services. Of the $5.2 million distributed since 2022, $1.5 million has gone to Medicaid for services such as inpatient and inpatient chemical dependency services, Ebelt said.

Eight Indigenous Tribes received $1 million for FY 2022, the fund’s first year, and FY 2023, which ends June 30. These grants went to substance use prevention; mental health promotion; mental health crisis, treatment and recovery services; and tobacco cessation and prevention.

The seven county detention centers received a total of $2.7 million in HEART funds through a competitive grant process to provide mental health services at these facilities.

Missoula County hired a therapist, a prison care coordinator, and a mental illness transportation officer for their share. Gallatin County hired a counselor and two social workers, while Lewis and Clark County hired a therapist, clerk, and education and transportation manager.

Jackie Kerry Lemon, director of program and facilities at the Gallatin County Detention Center, said the money was to be used for mental health and drug treatment. “Our population is often in crisis when they come to us, so being able to see them in a therapist really helps with their anxiety and their needs at the right time,” said Kerry Lemon.

Democratic Rep. Mary Caferro said HEART money could be used to increase Medicaid rates paid to health care providers that a state study found do not cover the cost of care, or mobile crisis response teams that the health department intends to provide Medicaid as a service.

Caferro is sponsoring a bill on behalf of the National Alliance on Mental Illness to add youth suicide prevention to the list of programs eligible for HEART funding.

Mary Windecker, executive director of the Montana Behavioral Health Alliance, said the HEART fund was originally designed to support tribes and county jails, and only recently began funding public substance use and mental health programs after partially approving a Medicaid waiver last year.

This allowed larger substance use disorder treatment centers (over 17 beds) to receive Medicaid reimbursement for short stays in mental health facilities such as Rimrock in Billings and the Badlands Treatment Center in Glendive.

Between July 2022 and January 2023, 276 Medicaid recipients were treated in Rimrock and the Badlands, Ebelt said. The Clinton facility, the Montana Recovery Centers, opened in December and will be licensed for 55 additional beds to serve new Medicaid patients, Ebelt said. Gianforte proposed in his state budget to increase the amount going to the HEART fund by changing the funding formula from $6 million a year to 11% of Montana’s annual recreational marijuana tax revenue.

The Behavioral Health Alliance has recommended the change, but as with many health-related proposals in this legislative session, a major success factor for the HEART initiative will be a sufficient increase in Medicaid provider rates, Windecker said. If the provider’s rates are not covered for the full cost of care, she said, people will not be able to provide the care the initiative promises.

The committee, which is meeting to determine the Department of Health’s budget, will hear a presentation on the HEART initiative on February 9th.

Keely Larson is a KHN Fellow at UM Legislative News Service, a partnership of the University of Montana School of Journalism, the Montana Newspaper Association, and Kaiser Health News. Larson is pursuing a master’s degree in environmental and natural resource journalism from the University of Montana.