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Montana not paying enough to provide in-state mental health services for youth, providers say

Out of Darkness sign

A sign along Harrison Avenue in East Helena encourages participants in Saturday’s third annual Out of Darkness Campus Walk in this IR file photo.

Montana children are being sent out of state for mental health services due in part to the state’s low rate of reimbursement, several of the state’s largest providers said Monday.

And to cover the unpaid costs of providing care for Montana youth, Yellowstone Boys and Girls Ranch CEO Mike Chavers told members of the Children, Families, Health and Human Services Interim Committee, those in-state providers are forced to accept more children with mental health issues from states that pay higher rates.

“Frankly, we do that because we have to,” Chavers said. “Those out-of-state youths subsidize the treatment for in-state Montana youth through those higher rates … sometimes significantly more than Montana’s in-state rates. No one pays less than the Montana rate.”

Meghan Peel, the DPHHS Children’s Mental Health Bureau chief, told the committee that as of last Friday, there were 129 Montana children receiving a high level of care at psychiatric residential treatment facilities. Only 50 of those were receiving those services in Montana.

“That is a problem and it’s unacceptable, and we need to do better,” Peel said.

Chavers and other representatives from youth mental health facilities said they are heavily reliant on Medicaid reimbursements to fund their operations. The state Legislature sets the reimbursement rate for those children, and the lack of sufficient funding means those facilities are unable to staff up enough to provide for the number of children they’re licensed for.

Youth Dynamics provides lower-level mental health care to children across the state, and members of the expert panel told the committee that early intervention is key to helping children before their issues exacerbate and require more intensive — and more expensive — care. Youth Dynamics CEO Dennis Sulser said the organization has a licensed capacity of 80 beds, but can only staff 64 beds due to a shortage of workers who can make more money at fast-food and retail companies. There are between 20 and 50 children on the waitlist, he said.

Admissions at Shodair Children’s Hospital are currently limited to 50% of capacity due to staffing shortages, CEO Craig Aasved said. The hospital recently increased its base wages to $15 an hour while also raising salaries to retain employees, he said, but can’t accept more patients unless they’re coming from states that pay more.

“I fear this trend will continue until our state government recognizes we are in the midst of a statewide mental health crisis,” he said. “It is my opinion that until we see an increase in reimbursement rates we will continue to see a more fractured system with less options for families.”

Peel acknowledged that the choice for many Montana families is between letting their child go without mental health services or sending them out of state to a provider that is willing to accept them. And she said the department’s reimbursement rate to in-state providers is governed by House Bill 2, the Legislature’s main budget bill.

Other panelists noted that the state often pays a higher reimbursement rate to youth mental health providers when Montana children are sent out of state. Out-of-state providers are capped at 133% of the reimbursement rate for in-state providers, but the state only covers their costs if no in-state provider is able to accept the patient.

Chavers said the Yellowstone Boys and Girls Ranch receives an average of $405 per day, per child. Out-of-state providers in some cases get $615 per day, he said.

DPHHS is in the process of preparing a survey for youth mental health providers in the state, Peel said. The survey will collect data in December on the state system’s capacity to serve youth with the most complex needs, including those under 12, acute suicidality, sexual maladaptive behavior, aggression and complex or overlapping medical needs. Follow-up interviews with providers will take place in January, and Peel said the results will be published next spring.

Montana has for decades had one of the highest suicide rates in the nation, and among children aged 11 to 17, the suicide rate is more than double the national average, according to a January report from DPHHS.

Karl Rosston, the state’s suicide prevention coordinator, identified a lack of screening for at-risk youth as one of the biggest issues for preventing those suicides.

“One of the things we know about youth suicide is 86% of parents who lost a child to suicide didn’t even know their kid was depressed because as parents we lose our objectivity,” Rosston said. “It’s hard for us to picture our child wanting to die. So that’s one of the reasons we advocate for universal screening, because we want to give parents the information they need to make the best decision for their child.”

Monday’s panel was the beginning of the interim committee’s study of the state’s children’s mental health system, required under House Joint Resolution 35. The bill was sponsored by Rep. Jennifer Carlson, a Republican from Belgrade.

The committee is also studying the state’s adult mental health system during the first half of the interim. It is expected to finalize its recommendations for the 2023 Legislature next spring.

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