Montana Department of Public Health and Human Services director Charlie Brereton, center, appears with staff members before lawmakers on Thursday, Jan. 5, 2023. Credit: Mara Silvers / MTFP

Lawmakers on a key budget committee heard requests Thursday from health department officials and consultants that they say will help stabilize the struggling Montana State Hospital and other public facilities that care for veterans, seniors and people with intellectual disabilities and substance-use disorders. 

Department of Public Health and Human Services director Charlie Brereton told legislators on the bipartisan and bicameral budget subcommittee that the department is requesting at least $300 million, spread across a variety of bills, to fund ongoing investments in the state psychiatric hospital, other public health care centers and growing the state’s behavioral health network.

Brereton said some specific price tags are essential for the Montana State Hospital to eventually regain accreditation from the Centers for Medicare and Medicaid, which the federal agency pulled from the hospital in 2022 after investigations of patient falls, COVID-19 outbreaks and deaths.

“It’s an investment up front,” Brereton told the committee Thursday. “We don’t believe, we know that these improvements must be made in order to achieve CMS recertification,” Brereton said.

If approved by legislators, Brereton said, the department would also shift funds to close down the Spratt Unit at Warm Springs for older adults with dementia and aim to move those patients to community facilities or the Montana Mental Health Nursing Care Center in Lewistown. The proposal comes after months of criticism from lawmakers about substandard conditions at Spratt.

“Assuming that we secure the needed funding that’s proposed to you here, [we’d] like to eventually shutter the Spratt Unit or significantly downsize it and move patients when appropriate to our facility in Lewistown … as well seek to secure alternative placements in community settings,” Brereton said. 

While some requests will fit under the health department’s umbrella in House Bill 2, the state’s primary budget bill, the department said it will also try to insert funding in other parts of the budget to cover long-term investments in infrastructure and technology, including upgrading roofs and implementing electronic health records and billing. 

Many of the department’s budget requests echoed the recommendations from Alvarez & Marsal LLC, a New York-based firm that holds a roughly $7 million contract to oversee the state’s public health facilities. Consultants from the group also presented their recommendations to the committee of lawmakers on Tuesday, emphasizing the need to recruit and train qualified staff to help fill hundreds of vacancies and decrease the state’s reliance on expensive contracts for traveling medical professionals. 

The consulting group also recommended that the state invest in the creation of “two new, regional, private behavioral health care settings” to offset the pressure on Warm Springs and other public facilities. The department echoed that recommendation in its budget presentation, asking for $113 million to put toward expanding the network of behavioral health facilities in areas with large populations. The initiative, the department said, “will improve MSH’s long-term delivery of care, reduce MSH reliance on contract staff, increase access to behavioral health services, and increase access to inpatient beds across the state.”

With the first week of the session coming to a close, Brereton said that the health agency does not have all of its budget details or bill drafts finalized. But he committed to maintaining transparency and communication with the committee in the months ahead. 

Sen. Bob Keenan, R-Bigfork, who chairs the health and human services budget subcommittee, said Thursday that it’s also too early to know which funding requests lawmakers will decide to prioritize or scuttle. The idea for building new brick-and-mortar facilities, for example, isn’t something he’s immediately ready to agree to, citing workforce shortage and expensive operational costs.

“I want to know the details of that. Where are we going to put them? How are we going to staff them, and where are they going to go,” Keenan said.

With the new proposals, health care staffing shortages, and layers of departmental reorganizations and bureaucracy, Keenan said the upcoming biennium is “the most challenging budget” he’s seen in nine sessions on the health and human services subcommittee. 

“There’s just so many pieces that need to be put together,” he said.

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Mara writes about health and human services stories happening in local communities, the Montana statehouse and the court system. She also produces the Shared State podcast in collaboration with MTPR and YPR. Before joining Montana Free Press, Mara worked in podcast and radio production at Slate and WNYC. She was born and raised in Helena, MT and graduated from Seattle University in 2016.