Montana State Legislature

Department of Public Health & Human Services

The Department of Public Health & Human Services (DPHHS) mission is: Improving and protecting the health, well-being and self-reliance of all Montanans.

Services administered by DPHHS include: public assistance, Medicaid, child welfare, foster care and adoption, nursing home licensing, long term care, aging services, alcohol and drug abuse programs, mental health services, vocational rehabilitation, disability services, child support enforcement activities, and public health functions (such as communicable disease control and preservation of public health through chronic disease prevention).

The department is also responsible for all state facilities except correctional institutions. DPHHS facilities include: Montana State Hospital, Warm Springs; Montana Mental Health Nursing Care Center, Lewistown; Montana Chemical Dependency Center, Butte; Eastern Montana Veterans' Home, Glendive; Montana Veterans' Home, Columbia Falls; and the Montana Developmental Center, Boulder.

DPHHS administers programs by contracting with providers and in some cases through direct provision of services. Most Medicaid, Healthy Montana Kids (HMK), child care, and other services that directly benefit low income individuals are delivered by contractors enrolled in provider networks with DPHHS. Other services, such as low-income energy assistance, out-of-home foster care, and development and maintenance of larger computer systems, are provided by businesses that contract with the department.

Foster care services are largely provided by families who contract with DPHHS. Some DPHHS programs employ staff who provide services directly to clients/consumers including: child and adult protective services; eligibility determination; child support enforcement and collection; and some case management functions. In addition, DPHHS operates six state facilities that provide medical care to individuals.

Below is an organizational chart of the branch, including full-time employee (FTE) numbers, HB 2 base general fund appropriations, and the total of all funds. Unless otherwise noted all phone extensions are preceded by (406) 444.

This report includes a series of charts that compare expenditure growth to the growth in the economy and growth in inflation adjusted for population. Montana statute, 17-8-106, MCA, recommends using growth in personal income for comparison purposes. Personal income is a measure for growth in the economy.

Comparing growth allows financial planners to consider past and future demands in services or changes in revenues.

 

The following policy actions and caseload shifts contributed to significant changes in DPHHS expenditures in the 2002-2018 period:

1999: The Children’s’ Health Insurance Program (CHIP) is adopted in Montana, leading to increased HB 2 spending which becomes especially noticeable beginning in 2004

2004: I-149, or the Tobacco Sales Tax Initiative passes. This policy change contributes to state special revenue growth and expanded programming in DPHHS

2006: HB 2 includes provider rate and direct care worker wage increases

2008: Medicaid caseload increases while the state’s FMAP decreases. CHIP continues to expand, along with Big Sky Rx, which adds to the state special revenue growth. SNAP spending increases with the onset of the Great Recession

2009: The American Recovery and Reinvestment Act of 2009 (ARRA) dramatically enhances FMAP. Enhanced federal funding continues through 2011

2011: Caseload in the Child and Family Services Division (CFSD) for foster care and related programs starts to climb

2012: ARRA funding ends and the state share of Medicaid increases. Growth in state special revenue expenditures due to children’s mental health services

2013: Medicaid exhibits increased spending on hospital and pharmacy services. Caseload in CFSD continues to rise.

2016: The HELP act increases federal expenditures in the second half of 2016

2017: The vocational rehabilitation program entitlement, HELP expenditures, and CFSD caseload drive higher general fund spending. HELP enrollment exceeds estimates, leading to elevated federal fund expenditures

2018: Special session reductions reduce general fund expenditures, but HELP enrollment continues to drive higher federal fund spending. Enrollment in HELP begins to stabilize in the 95,000 range.

2020-2021: Higher state special revenue expenditures are anticipated due to changes to the Medicaid expansion program.

 

Legislative Changes

2019 Session

  • Renewed Medicaid expansion with several significant changes, including new taxes on healthcare and a 2025 sunset
  • Reduced total FTE at DPHHS by a net of 99.46 by removing FTE in positions that had been vacant for more than one year
  • Appropriated general fund to provide state match for the Children’s Health Insurance Program (CHIP) due to a phased increase in the state matching rate for CHIP
  • Appropriated general fund to support programs impacted by an anticipated ongoing shortfall in the Tobacco Health and Medicaid Initiative state special revenue fund
  • Created a new reimbursable Medicaid service: peer support services
  • Significant revision of the medical marijuana program, including a tax rate increase and limits on purchase and possession

 

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Legislative Studies

Children, Families, Health and Human Services Interim Committee work

 

Audit Reports

Performance Audit - State Efforts to Mitigate Fraud, Waste & Abuse in the Montana Medicaid Program - June 2018

Performance Audit - Community Benefit and Charity Care Obligations at Montana Nonprofit Hospitals - Sept 2020

Financial Compliance Audit - DPHHS - April 2020

 

Legislation

HR 1, Resolution to support health care workers

HB 25 Clarify funding for education of children in residential treatment

HB 37, Clarify requirements for the Medicaid medically needy program

HB 38, Establish legislative intent for home and community-based services waivers

HB 39, Provide for continued interim review of child protective services matters

HB 57 and fiscal note, Revise requirements related to child protective services congregate care

HB 60, Clarify terminology used in voluntary child protective services process

HB 61, Eliminate sunset for Title X statutory appropriation

HB 70, Revise state suicide prevention program

HB 78, Require certain employees to report suspected child abuse and neglect

HB 90, Create an emergency protective services hearing in child protective service removals

HB 96, Align organ donor awareness SSR fund with administering agency

HB 121, Require elected official approval of local health board and officer actions

HB 123, revising laws related to local boards of health

HB 137 Generally revise vaping and alternative nicotine products laws

HB 140, Requiring provision of information before the performance of an abortion

HB 145, Allow local boards of health and health officers to issue recommendations

HB 167, Referendum to adopt the Montana Born-Alive Infant Protection Act

HB 208, Establishing requirements related to mental health services for birth mothers

HB 209, Generally revise family laws relating to children and parents

HB 216, Allow Medicaid reimbursement for license outdoor behavioral programs

HB 231, revise laws relating to certificate of need

HB 235, Create nutrition incentive program for SNAP

HB 236, Revise local health board & health officer powers, duties, and penalties

HB 249, Revise laws to regulate marijuana advertising

HB 250, Revise immunization requirements for pharmacists

HB 274, Family preservation act for applied behavior analysis for at-risk families

HB 275, Establish uses of Medicaid waiver funds

HB 296, Establish grant program and other uses of DD general fund appropriation

HB 327, Provide default definitions for covenants limiting the use of real property

HB 328, Provide guidelines for assessing language development in deaf children

HB 334, Revise laws on medical exemption from vaccines

HB 337, Constitutional amendment to define person

HB 339, Require child support cooperation for food stamp eligibility

HB 341, Require Medicaid Appropriations be used only for Medicaid expenditures

HB 343, Revise laws related to dentistry and dental hygiene

HB 344, Revising laws relating to designation of public health facilities

HB 356, Prohibit anonymous reporting of child abuse and neglect cases

HB 360, Revise laws regarding medical record fees

HB 364, Require CPS to share limited information with certain reporters upon request

HB 369, Support school-based prevention programs

HB 388, Establish a Montana Health Crisis Preparedness Program

HB 400, Revise laws related to physician assistants

HB 408, Revise mental health laws

HB 601, Establishing requirements for certain long-term care facilities (DPHHS reporting to Child & Families Committee)

SB 16, Allow minors to consent to emergency shelter and services

SB 17, Clarify minor’s ability to disaffirm contracts for housing is restricted

SB 33, Require 30 day notice before termination of participation in HCBS waiver program

SB 43 and fiscal note, Require administrate rulemaking for substantive changes to HCBS programs

SB 100 Provide for the welfare fraud prevention act

SB 101, Provide for the direct patient care safe harbor act

SB 102, Revise behavioral health licensing laws

SB 103, Revise embryo transfer technician licensing laws

SB 104, Uniform Family Law Arbitration Act

SB 108, Authorize elected official approval of city/county health board rules

SB 155, Provide for equal access to anatomical gifts and organ transplantation

SB 166, Generally revise laws related to licensed addition counselors

SB 167, Remove termination date for medical malpractice related portions of the HELP Act

SB 177, Revise laws regarding clergy reporting child abuse and neglect

SB 218, Revise requirements related to reports on the medical marijuana program

SB 236, Provide transparency in health care pricing

SB 244, Require Medicaid coverage of weight-loss reduction procedures


 

Agency profile information provided by the Legislative Fiscal Division.

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