As a new system to deal with paying for school mental health treatment for Montana students with serious emotional problems “is about to be implemented,” school districts across the state say it’s not viable.
The School and Community Comprehensive Therapy Program connects licensed or supervised practitioners from a mental health center and behavioral health aides with children who can access services at school, in their homes, or in the community.
Earlier this year, the state legislature moved the program to the Office of Public Education, citing frustration with the way the state’s Department of Public Health and Human Services has weathered past funding hurdles.
School districts have always been obligated to pay one-third of the cost of a program that is part of Montana Medicaid. But historically they have done so through in-kind matches such as providing physical space for therapy or laptops – not cash. After first raising concerns about this in-kind approach in 2013, the federal government finally stopped allowing it last year.
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The state health department stepped in to cover the cost, arguing that it didn’t want to get mental health care from students in the middle of the coronavirus pandemic. But earlier this year, the state legislature vetoed Department of Health spending without lawmakers’ approval and halted that approach.
Instead, lawmakers set aside about $2.2 million in temporary funds to pay schools’ share of the costs while the state health department returned to the federal government with a plan where schools would bear a third of the cost. Nearly $1.3 million in bridge money has already been paid out, and more claims could be pending.
While counties have said since this summer that it will be difficult to find cash for a third of their costs, officials on Thursday told an interim legislative committee that other requirements the OPI is trying to establish are not applicable. Officials also called for better communication from the OPI.
However, leadership at the OPI told the committee that it had made significant efforts to meet with schools and third-party mental health providers.
One major point of contention is the Memorandum of Understanding (MOU) that the OPI says schools must sign to get the money they spend from the federal government. This process is called intergovernmental transfer and was streamlined by a single legislature where schools sent the federal government $1 to get $3 in return for paying for mental health services.
“We have advised our legal counsel not to sign the MOU because there are concerns about (the language of the MOU) and we have asked to address but not have asked,” Kalispell Public Schools Director Michael Hill told a temporary legislative committee on Wednesday.
An OPI spokesperson said late Wednesday that the memorandum form originated with the federal government.
“We understand that this was the thinnest model to fit the requirements, because we didn’t want to overburden our schools,” wrote Brian O’Leary.
O’Leary said OPI sent the form to the Association of Montana School Boards and the legal entities that serve schools for review. The OPI then submitted the changes to the state health department, which added its own changes before sending them to the federal government for approval. After Medicare and Medicaid signed the memo, the memo went to school districts for their own review.
Mike Waterman, executive director of business services for Bozeman Public Schools, said AA’s school districts, the largest in the state, “agreed not to be comfortable with the proposed structure and on our legal counsel’s advice, we do not intend to adhere to it as it currently exists.”
Waterman said one area of AA has already withdrawn from the CSCT program because of its complexities. He said that this may be one of the reasons for the decline in the services provided.
The deputy superintendent, Sharyl Allen, presented the committee with figures showing a decline in the number of students receiving mental health treatment. The number of students served by the program has exceeded 5,000 since 2015, but decreased in 2020 to 4,556, when many children were not in school in person, and then to 3,827 this year after legislative measures caused many areas to change how services are provided. .
Dennis Williams, executive director of the Montana Association of School Business Administrators, said the committee’s schools are concerned about additional reporting requirements. What OPI plans to order, she said, goes beyond what the federal government is asking for. She said she had sent OPI suggestions on how to eliminate what she described as duplicate reports but had not yet seen those suggestions in place.
Waterman said that schools are already preparing adequate financial reports and that what the OPI has proposed is “very complex and labour-intensive” and will require hiring additional staff.
Quinn Holzer, assistant director of the legislative finance division, said OPI’s record-keeping requirements are “more complex” than similar arrangements with county nursing homes.
Mary Windecker, executive director of the Behavioral Health Alliance in Montana, said mental health service organizations she represented are willing to offer mental health treatment, but school districts are not comfortable signing the memo to secure money to pay for those services.
“It’s about six o’clock on December 15,” Windker told the committee when she testified on Wednesday. “(The new plan) is supposed to come into effect on January 1st…Service providers are not withdrawing, they are there and ready to provide services. School districts do not feel comfortable signing a very complex MOU regarding a match.”
Part of the problem, Windecker said, is that navigating Medicaid is a complex process that the OPI is not familiar with.
“The bottom line is that after January 1 when schools return, thousands of children will not receive CSCT services, not because providers do not want to provide them, not because schools do not want them in schools, but simply because schools do not feel comfortable signing contracts.”
Waterman said a joint meeting between the OPI and the state’s health department, schools and providers is “very much needed.”
“At this point, the proposed solution is not widely understood at the school level and is also impractical,” Waterman said.
Allen pointed to a prospectus provided to the legislative committee showing that the OPI has held 14 virtual meetings, 17 individual meetings with regions and with third parties such as legislative subcommittees and education advocates. She said these were in addition to meetings between the FBI and the state health department.
“We have worked very hard together to reach out to our counties and our third-party providers,” Allen said.
Jay Phillips, senior director of Central Services, said OPI has also been talking with schools about other options.
This could include setting up a mental health center that he will run. Phillips noted comments from rural schools about the decline of third-party providers due to staffing issues such as the challenge the schools face.
Phillips said a return to an in-kind match might be a viable option, although it would take a year and a half or more and still need approval from the federal government.
Going back to this setting, it would take at least a year to document the rates charged by providers and provide that information to the federal government, Megan Bell, chief of the Office of Child Mental Health, said. The plan will still need to get federal approval after that.
Towards the end of the meeting, state Republican Representative David Pedy of Hamilton said the program had never been made into law and was only administratively created. He proposed legislation to put the program into practice, which he said would be the “best long-term way to ensure the program’s continuity.”