CMS Approves Montana’s Reentry Services, Contingency Management, and Tenancy Supports 1115 Waiver

Health Highlights

On February 26, 2024, Montana received Centers for Medicare and Medicaid Services (CMS) approval to provide contingency management, tenancy supports, and Reentry Initiative services under its Section 1115 Healing and Ending Addiction through Recovery and Treatment (HEART) Demonstration. This amendment approval builds on the existing HEART Demonstration which provides the State expenditure authority to cover short-term stays at institutions for mental disease (IMDs) for individuals diagnosed with a substance use disorder (SUD). The HEART Demonstration is effective through June 30, 2027.

The HEART Demonstration is a critical component of Montana Governor Greg Gianforte’s HEART Fund, which invests $25 million annually to advance the full continuum of behavioral health and treatment programs for Montana communities. The approved services and supports under the HEART Demonstration include the following:

  • Reentry Initiative Services for Justice-Involved Individuals. Montana is the third state in the country to receive expenditure authority to operate a Reentry Initiative, following California and Washington. The HEART Demonstration will provide a targeted set of Medicaid services to adults with mental illness and/or a substance use disorder who are in Montana’s state prisons. In the 30 days prior to release into the community, eligible individuals may receive pre-release case management, in-reach physical and behavioral health clinical consultation, Medication Assisted Treatment (MAT), and a 30‐day supply of medication to have in-hand. In addition to these approved benefits, Montana received expenditure authority to provide $2.3 million in planning and implementation funds to support efforts between the state prison system and state Medicaid agency and to build community-based provider capacity. Montana plans to implement the Reentry Initiative no sooner than September 2025.
  • Contingency Management Services. Montana is also the third state to receive CMS approval to provide contingency management for Medicaid members, following California and Washington. Contingency management is an evidence-based treatment for individuals with stimulant use disorders (e.g., cocaine, methamphetamine) that provides monetary incentives to beneficiaries for the nonuse of stimulants. This incentive is part of a structured treatment program to reinforce behavioral change. With this Demonstration amendment approval, Montana will be able to build on its successful contingency management Treatment of Users of Stimulants (TRUST) pilot program by expanding coverage for and access to contingency management across the state. The TRUST program has demonstrated strong benefits for contingency management, including treatment retention. The State plans to implement this benefit in October 2024.
  • Tenancy Support Services. Montana joins a number of other states in offering tenancy supports to assist Medicaid enrollees with behavioral health needs who are experiencing homelessness or frequent housing instability. Under the approved demonstration, Medicaid enrolled adults who meet certain needs-based criteria and risk factors are eligible to receive pre‐tenancy supports and tenancy sustaining services to support an individual’s ability to prepare for and transition to housing, as well as to assist in maintaining services once housing is secured. Pre-tenancy services include assistance with the development of a housing plan and assistance with finding housing and moving-in supports. Tenancy support services include providing assistance in working with landlords or property owners, implementing housing goals, and providing additional tenant educational support. Montana also received authority for one-time transition and moving costs, such as security deposits and application fees.

In addition to planning for the implementation of the approved amendments to the HEART Demonstration, Montana Department of Public Health and Human Services is seeking an additional amendment to cover youth in Qualified Residential Treatment Programs with serious emotional disturbance. The federal public comment period is open through March 25, 2024.

CMS’s approval of Montana’s Demonstration request highlights the agency’s continued support of state investments in improving behavioral health outcomes for Medicaid enrollees. As Montana begins to implement the Demonstration, it will serve as a model to other states, including those that are rural and have relatively smaller numbers of Medicaid enrollees, interested in pursuing innovative reentry initiative, contingency management, and tenancy support pilot programs.

1 The following states have pending Section 1115 Reentry Initiative Demonstrations: Arizona, Arkansas, Hawaii, Illinois, Kentucky, Massachusetts, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Oregon, Pennsylvania, Rhode Island, Utah, Vermont, and West Virginia.

2 Montana initially launched the Treatment of Users of Stimulants (TRUST) program in 2021, a two-year pilot that offers access to contingency management at specific sites in the state.



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