Students In Limbo With Mental Health Support In Schools

By Keila Szpaller, Daily Montanan

July 5, 2021

Some parents of Montana students received a letter in the mail this month saying the mental health services their children receive in public schools were being suspended.

Funding and services for students are on the line, and school officials are worried. To keep counseling going, they worry they’ll be left with holes in their budgets that total hundreds of thousands of dollars. In the meantime, they’re concerned the mental and behavioral health services children receive are at risk even as students cope with the effects of the coronavirus pandemic.

“That’s what’s at jeopardy,” said Godfrey Saunders, superintendent of the Belgrade School District. “And given the fact that we just came through that pandemic year, and how we don’t know what kind of effect that’s going to have on students, we’re trying to make sure we’ll plan ahead to address those needs. But we know they’ll be there.”

An earlier change to a longstanding federal program that came to light during the 2021 Montana Legislature has left mental and behavioral health services offered in local schools through the Department of Public Health and Human Services in limbo.

Saunders said he hopes this week is the only one students in his district of 3,400 will be without services through the Comprehensive School and Community Treatment program. But he’s also wondering if he’ll need to scrape an unexpected $300,000 out of his budget.

Rob Watson, superintendent of Missoula County Public Schools, said roughly 12 to 24 students in every building in his district use the service, but the small numbers add up, and it’s important for those students. He said educators are preparing to see students return in the fall with emotional stressors.

“If they have somebody on site they can talk to, it really helps them stay in school rather than leave school when they have an emotional crisis,” Watson said.

Across Montana, the CSCT program served 4,535 students in 87 school districts in 2020, according to the Department of Public Health and Human Services. The services are more intensive than ones school counselors can provide.

Rep. Llew Jones, R-Conrad, House Appropriations Committee chairman, said after the issue with CSCT arose, the Legislature directed the state Health Department and the Office of Public Instruction to sort out the matter, and a way out is possible. But he said forward motion has not been quick.

“There are at least two potential solutions where OPI and DPHHS can work with CMS (Centers for Medicare and Medicaid Services) and do this in a manner that gets the needed dollars to the schools,” said Jones. “My disappointment is that has not yet happened, and we risk the students that need this (help) losing service.

Established in 2005, CSCT allows school districts to contract with private mental health centers to provide mental and behavioral services to children billed through Medicaid, according to a program report to the Office of Public Instruction. The OPI report said the total federal budget for CSCT is $34 million a year.

In the past, the Health Department certified that schools were providing an adequate “soft match,” but several years ago, the federal requirement changed, said Lance Melton, head of the Montana School Boards Association.

Initially, Jones said federal authorities requested precise documentation of just how the school districts were providing their “soft match” requirements, but that can be difficult for especially small schools.

And Melton said the state had hoped to continue to operate under the old model by successfully appealing for reconsideration. But the clock ran out last summer.

Instead, the Health Department paid $10 million in a hard match because the money was available at the time, Melton said. He also noted the former Bullock administration requested $20 million in its budget for the biennium.

But Jones said the Legislature and the schools weren’t even aware there was an issue prior to the most recent legislative session. Yet in sorting through it, he said they also learned state agencies can negotiate a waiver.

So it’s possible the problem can be solved without asking Montana property taxpayers to spend that $10 million a year when the money could go toward, say, alleviating drought, he said.

“The administration said, ‘If this can be covered fully by the feds, why would we obligate this?’” Jones said. “Same thing the Legislature said. There’s a lot of needs out there.”

In the meantime, Melton said the Legislature, with leadership from Jones and Rep. David Bedey, R-Hamilton, provided roughly $2 million in a “bridge” fund that’s designed to help pay for the program for two or three months while the Health Department and the Office of Public Instruction figure out a plan. (Melton also said lawmakers and the administration wondered why the issue wasn’t raised in previous sessions.)

But he said there’s no going back to the old model, which he characterized as a “sweetheart deal” for Montana.

“We’ve had a windfall, an advantage, for several years that’s now gone,” he said.

In the current model, school districts contribute a 33 percent match, but Superintendent Saunders said the match could be a physical space, a laptop, a phone, or all three. Now, he said, the “soft match” appears to be off the table.

“Now what we’re being told is that 33 percent match has to be monetary in nature,” Saunders said.

That means he needs to reserve at least $300,000 that he didn’t know the Belgrade School District needed. And Saunders said he doesn’t know if the district will get the money back.

But Melton said he is optimistic the plan in negotiation will be acceptable to federal authorities because a similar one is already in place in Oregon. (He noted he is not directly involved in the negotiations.)

As planned, school districts would have to provide local dollars instead of a “soft match,” but they’d get the money returned in an “intergovernmental transfer” approved by Medicaid, so it would be just a “paper transfer,” Melton said. The idea is if the feds approve a market rate for services of, say, $100, and providers agree to be paid $67, a district will put in $33, but it gets reimbursed.

Health Department spokesperson Jon Ebelt said the Legislature addressed the CSCT program in two ways in House Bill 2. One was the $2.24 million “bridge” appropriation to OPI, and another was a state special revenue fund to be used by OPI to receive necessary matching funds from school districts seeking reimbursement under Medicaid.

“Effective July 1, 2021, as a result of HB 671 and HB 2, oversight of the CSCT program has responsibilities that fall to both DPHHS and OPI,” Ebelt said in an email.

In Belgrade, though, Saunders said he still doesn’t know if the district will get local match dollars reimbursed, and if it does, whether it will be able to put the dollars back into its general fund. Plus, he said, part of the deal involves providers.

“Are we going to be able to get a provider who will give us that service at a reduced cost so that we can break even?” he said.

Watson said the Missoula district will need to negotiate a new contract with providers by the start of the upcoming school year. He is optimistic that the deal in the works will get approved, but he said it’s difficult to understand how local districts can tap into the bridge funding, and if local money isn’t reimbursed, “that could put us in a pinch.”

“We’re just a little nervous about how that reimbursement is going to work out,” Watson said.

Melton said he isn’t a fan of another option that’s been discussed, which is that districts “hard spend” on the program, but then be subject to an audit and have to repay money if the audit determines their “good faith” idea of how the dollars were spent is off base: “That’s just basically asking for trouble.”

Office of Public Instruction spokesperson Christopher Averill declined to discuss other possible funding scenarios, but he said the agency appreciates the work DPHHS is undertaking to solidify approval from CMS of the new plan establishing provider rates in a timely manner.

“In the meantime, pursuant to HB2 and HB671, the OPI will be utilizing the bridge funding provided by the Legislature, effective July 1, to assist our school districts in covering the non-federal match requirement while DPHHS completes its process with CMS,” Averill said in an email. “It would be inappropriate to discuss hypothetical scenarios beyond this timeframe. That said, we cannot allow previous decisions that led to an untenable fiscal situation to derail our commitment to the 4,800 students in 81 school districts who rely on these critical services, and the OPI is committed to standing up for these families and the districts that serve them.”

Even with federal coronavirus relief, Melton said the stakes are high for school budgets. Still, he said he’s optimistic Medicaid will approve the new funding method, and he believes it could help even more students.

“It should allow continuation of CSCT services in much the way they have been provided in the past and potentially in a way that might gather additional school districts and see an expansion,” Melton said. “The sky is the limit right now.”

In the meantime, Saunders said he doesn’t want children to be without services for long, and he’s been talking to Providence Mental Health about a plan.

“We don’t want to break that continuum of services any longer than we have to, so we’re working on a solution to it, but it affects several kids, quite a few kids actually,” Saunder said.

Based in Bozeman, Providence could not be reached for comment Wednesday or Thursday. However, a June 23 letter from Providence posted on Twitter by a third party and addressed to parents and guardians said state agencies were in discussion, but no decision about funding had been reached yet, and no contract was in place.

“With no contract, this leaves the program in limbo, and due to lack of funding, we have been instructed to stop all CSCT services immediately,” the letter said. “School-based mental health services are uncertain currently. We will reach out with more information when it is available.”

Saunders said he believes OPI and DPHHS are working hard to resolve the issue, but legislation is complex, and the navigation involves state agencies and the federal government. He said he wished he knew when the matter would be settled.

“It’s just going to take some time,” he said. “We will find a way to get this done. Now is not the time to start pointing fingers and laying blame. We just need to stay focused on the main thing, which is our students and our families. So that’s what we need to do. And there’s a way to get it done. Parents shouldn’t lose hope.”

But Jones said time is of the essence: “It is not comforting to me that the (waiver) application is not yet in. But there is a methodology to fix this.”

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