After four years helming the state’s largest agency, Charlie Brereton is leaving the Montana Department of Public Health and Human Services for a job in the private sector, the governor’s office announced Tuesday.
He will be replaced by Dr. Doug Harrington, the department’s state medical officer. Brereton’s last day is Oct. 30.
The move marks a significant shift for the department, which has a biennial budget of more than $7 billion and oversees everything from anti-hunger programs to infectious disease tracking. Brereton has steered DPHHS through recent turbulence in the health policy landscape, including the culling of state Medicaid rolls after a pandemic build-up, instability at the state psychiatric hospital, and multiple infusions of state and federal cash aimed at stabilizing behavioral health care services and rural hospitals.
The face of those and other initiatives under Gov. Greg Gianforte’s administration has been Brereton — unruffled, well-prepared and resolved, even when facing scrutiny from lawmakers and criticism by health care advocates.
“It has been a great honor to serve Montanans as director of DPHHS,” Brereton said in a statement provided by the governor’s office. “Few roles offer such an opportunity to make a meaningful difference in people’s lives, and I am proud of the progress our team has made across every aspect of the department and throughout Montana’s health and human services system. I am confident that the dedicated public servants of DPHHS will continue carrying our initiatives forward under Governor Gianforte’s leadership.”
In the announcement of his departure, Gianforte called Brereton a “transformational” leader. Fresh from work as a congressional staffer in Washington, D.C., Brereton originally started in the Gianforte administration as a healthcare policy adviser, and was promoted within a year to chief of staff at DPHHS, a new position. Roughly eight months later, at the age of 28, he was promoted to the directorship after Gianforte’s first pick, Adam Meier, left the job, citing family health issues.
“Under Charlie’s leadership, Montana has made historic investments in our broken behavioral health system, secured significant, transformational funding from the Rural Health Transformation Program, and helped make Montanans more self-sufficient,” Gianforte’s statement said. “I wish Charlie great success in the future and thank him for his service to the State of Montana.”
The release did not say where Brereton would be working after leaving the department. Multiple state lawmakers and health care advocates told Montana Free Press Tuesday they also did not know. A spokesperson for the health department did not respond to an emailed inquiry.
The leadership change comes as the department is in the thick of allocating resources from the Rural Health Transformation Program, a $233 million pot of money in the first year of a five-year grant meant to help Montana stabilize and build up its rural and frontier hospitals. The process — closely watched by health policy insiders and service providers — has already hit snags. In September, the department halted contract negotiations with a Florida-based company, Indelible Health Solutions, LLC, that applied to lead part of Montana’s project over a possible conflict of interest with another company, McKinsey & Company, that helped the state seek the federal grant in the first place, Lee newspapers reported.
In an emailed statement Tuesday, Ed Buttrey, the president and CEO of the Montana Hospital Association, one of the organizations selected to implement aspects of the Rural Health Transformation Program, said he is sure the initiative will stay on track after Brereton’s exit.
“As we look forward to launching the Rural Health Transformation Program in Montana, we have full confidence in the capable team at Montana DPHHS,” Buttrey said. “We also know the many partners in this effort, including the Department of Labor and Industry, the Governor’s office, CMS, and the healthcare providers serving rural Montanans, remain committed to the program’s success.”
Other major initiatives are also ongoing. Montana, like other states, is overhauling how it verifies eligibility for Medicaid, the low-income health insurance program, and the Supplemental Food and Nutrition Program, or SNAP, after changes to work requirements passed by Congress in 2025. The department’s enforcement of Medicaid work requirements is anticipated to begin this fall.
The state’s announcement did not forecast how the agency plans to maintain those initiatives during the leadership transition. Instead, it focused on the impact Brereton has already had, noting, among other highlights, that program enrollments in SNAP, Medicaid and Temporary Assistance for Needy Families have “declined under Brereton’s leadership, as Montanans moved from public assistance programs to self-sufficiency.”
Rep. Jane Gillette, R-Three Forks, who chairs the interim committee that oversees the health department’s budget, said in a text message Tuesday she is not concerned about Brereton’s departure causing disruptions. Brereton’s replacement, Harrington, she said, is “going to be spectacular.”
Still, Gillette indicated that Brereton had been a standout leader for the department.
“Every now and then, you meet someone who shines brightly above the rest. Charlie Brereton is certainly one of those individuals,” Gillette said.
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