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A ‘step in the right direction’ for CSCT

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A still from video recording of Gov. Greg Gianforte's budget press conference on Nov. 11, 2022.

Governor’s budget proposal includes returning an in-school mental health program to the state health department.

By Alex Sakariassen MONTANA FREE PRESS

A request contained in Gov. Greg Gianforte’s recent budget proposal to state lawmakers would return administration of a program that delivers in-school support to students with serious emotional disturbances to Montana’s Department of Public Health and Human Services.

Over the past year, mental health providers and public education advocates have expressed concern about a series of changes made in the 2021 legislative session to the Comprehensive School and Community Treatment (CSCT) program, which stations mental health professionals from third-party providers directly in schools. One of those changes altered the funding mechanism for the Medicaid-backed program, requiring the state Office of Public Instruction to act as a middleman in collecting and reporting matching funds put up by participating schools to DPHHS.

According to OPI, that particular change was always intended to be temporary. In an emailed response to questions, spokesperson Brian O’Leary wrote that the agency’s involvement was meant to give DPHHS time to resolve “failures” in its administration of the program, and that CSCT has been “an ongoing partnership” between the two agencies since last year. If the governor’s request is approved, O’Leary added, OPI “won’t have any part of the dollar flow of CSCT” moving forward.

“As DPHHS has more expertise in handling the Medicaid dollar flow and now has the capacity, the mutual decision was made to request that CSCT be moved back to DPHHS,” O’Leary wrote.

The change calls for a roughly $37,000 annual reduction in General Fund dollars to OPI for operating expenses and the elimination of a full-time “program services to schools director” position. A request for CSCT funding in the health department’s budget includes one full-time administrative position.

Brooke Stroyke, a spokesperson for Gianforte, wrote via email that DPHHS is developing a transition plan to address outreach and support needs for participating schools, and the agency will use the same process for collecting matching funds that OPI has employed. Stroyke noted that both DPHHS and OPI were involved in discussions about the proposed change.

“DPHHS is committed to working closely with the Office of Public Instruction, school districts, and mental health centers to minimize disruptions in service and administrative burden,” Stroyke added.

Mike Waterman, the director of business services at Bozeman Public Schools who was among the people voicing concerns earlier this year, told Montana Free Press this week that the proposed change “makes sense.” That exact statement was echoed by Aware CEO Matt Bugni, whose nonprofit delivers CSCT services in districts throughout the state. 

But Bugni cautioned that returning administration of the program to DPHHS doesn’t address other hardships facing mental health services for Montana’s youth. A separate change made to CSCT last year requires schools participating in the program to put up a hard match in order to obtain Medicaid funding — money that can’t come from a federal source, raising potential barriers to participation. Meanwhile, reimbursement rates for certain services continue to present financial difficulties for providers, and the state’s workforce shortage has made finding new hires to staff CSCT teams and other positions an ongoing challenge.

“Most of the CSCT providers — not all of them, but most — provide other community-based behavioral health services,” Bugni said. “We look at CSCT as one program of many that we provide. So that entire system of care needs to be sustainable.”

Yellowstone Boys and Girls Ranch CEO Mike Chavers characterized the proposed move as “a step in the right direction.” His organization has increased its CSCT operations throughout the state this year in the wake of CSCT provider Altacare’s quiet departure from the state. Asking OPI to manage a Medicaid-funded program was “like asking me to learn a foreign language,” Chavers said, and he attributes much of the past year’s concern and uncertainty to the communication challenges posed by putting OPI into such a situation.

“They’re experts in educational finances, not Medicaid,” Chavers said. “So this puts it back in the hands of the folks [at DPHHS] who understand the language and reduces some of the unnecessary complexities. And I hope that it encourages some school districts to participate in the program.”

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