Year In Review: Covering health and human services in 2023

Though it feels like a lifetime ago, the 2023 legislative session was filled with conflict over several high-profile issues, including restrictions on abortion and medical choices for transgender minors seeking gender-affirming treatments. There was also camaraderie over reform-minded policies aimed at other issues, including Montana’s expansive foster care system and efforts to tame the state’s unwieldy mental health and addiction treatment landscape. As is common with thorny policy issues, clear winners and losers have yet to emerge even half a year later.

The Republican-driven law to prohibit transgender youth from receiving gender-affirming medical care was challenged in court by trans teens, their families and health care providers, and eventually blocked by a temporary court order. An effort by House Republicans to censure the most vocal opponent of that bill, freshman transgender lawmaker Rep. Zooey Zephyr, D-Missoula, seems to have accomplished little other than raising Zephyr’s profile. Two other bills targeting LGBTQ+ people and expression have also been challenged in court.

A ban on the most common method for second-trimester abortions briefly went into effect but was later paused by a judge’s order, alongside a stack of other restrictions on reproductive rights. Later in the year, advocates for expanding abortion protections launched the long process of putting a constitutional amendment on the ballot before voters in 2024, encouraged by positive voter responses to similar measures in other states since the fall of Roe v. Wade.

Coalitions and roadblocks formed over other pressing topics. Democrats joined Republican lawmakers to push through transparency and patient reforms for the Montana State Hospital, as well as a law to require state child protection workers to obtain a judicial warrant before removing a child from their home for suspected parental neglect or abuse. The changes to the state hospital were the only 2023 laws to survive vetoes from Gov. Greg Gianforte through the legislative override process. Despite the ultimate failure of the judicial warrant policy, additional strategies for boosting child and parent representation in foster care proceedings — mandatory legal representation for youth, expedited hearing timelines and the Montana Indian Child Welfare Act — became law.

Another issue that prompted bipartisan policymaking this year was a surge in funding for Medicaid provider rates, aka how much state government decides to reimburse health and direct care workers for the services they provide to low-income people, seniors and people with disabilities. Providers, industry groups and health advocates beat the drum about Montana’s chronic underfunding so consistently throughout the session that a significant funding increase overcame multiple legislative hurdles.

It’s been a bumpy process for providers to start actually receiving those updated payments. Some blame the state health department for juggling too many complex projects: the long-anticipated “Medicaid unwinding,” which Montana began in April, has been the first time states can remove enrollees from Medicaid coverage since the beginning of the coronavirus pandemic. So far, more than 100,000 people have lost their Medicaid coverage, the majority of whom were removed because of failure to return required paperwork.

The health department’s newest leader, Charlie Brereton, has continuously refused to pause the ongoing eligibility reviews, saying he believes most of the department’s decisions to end coverage have been appropriate. (About 30% of those who have lost coverage were determined to be ineligible, according to the state’s tracking dashboard, compared to 63% who were removed for lack of timely response). Health advocates fear that many former Medicaid enrollees, including children, will become uninsured or get stuck in the bureaucratic red tape of the reapplication process.

While Medicaid reviews churn on, generating unflattering headlines, the state health department and Gianforte administration have tried to foreground their efforts to overhaul parts of the behavioral health system through the work of a new group, the Behavioral Health System For Future Generations Commission. As of mid-December, the group has authorized up to $17.5 million to help reopen residential treatment beds and, separately, generate community-based evaluations for criminal defendants awaiting assessments at the Montana State Hospital. While neither initiative has yet been approved by the governor, the group has a raft of other short-term and long-term fixes waiting in the wings.

Throughout a year full of newsworthy events, a few articles stand out, at least to me. I wrote about David Gianforte, one of the governor’s children who, as a nonbinary person and member of the LGTBQ+ community, used their platform to lobby their father to veto several anti-trans bills advancing through the Legislature. When the governor signed one of those bills — Senate Bill 99 — into law, I profiled one of the families suing to stop it.

Elsewhere on my beat, I dug into stories about Montana’s addiction treatment ecosystem, including the fight to bring more ethical oversight to recovery residences, how medical providers are struggling to stay sober and employed after the dismantling of a longstanding peer support program, and how health care providers are trying to help patients overcome addiction during pregnancy and childbirth. These stories, perhaps more than any others this year, will stick with me.

Last but not least, I tried to keep one watchdog eye on the state health department. I wrote about the agency’s handling of patient care and staffing at the state hospital, the hiring of New York-based consultants with a hefty price tag, and, of course, the department’s ambitious new leader, Charlie Brereton, who’s set to celebrate his 29th birthday this month.

Reprinted from the Montana Free Press: montanafreepress.org/2023/12/26/montanas-health-and-human-services-headlines-of-2023/