The state health department has announced a new $2.8 million contract with a nonprofit to provide targeted case management to about 2,500 Montanans with developmental disabilities.
At the end of last year, a few days before Christmas, the Department of Public Health and Human Services told four organizations that held contracts to provide targeted case management around the state that those contracts would end March 31.
The elimination of the contracts led to those organizations — A.W.A.R.E. Inc., Opportunity Resources, Helena Industries and Central Montana Medical Center — to lay off about 70 case managers. Helena Industries has since closed, citing in part the loss of the contract as a reason why it wasn’t financially viable to continue operations.
A.W.A.R.E., which has services for children and adults with developmental disabilities around the state, was awarded the new contract in May. It starts June 1 and runs 13 months, and can be extended a year at a time for up to five years.
Targeted case managers work with people age 16 and up who have developmental disabilities, helping them get necessary services and care. They serve as advocates, for example, as people get and keep jobs, transition to independent living and find doctors and therapists.
When it announced the cuts, the health department said it would be able to absorb the 2,100 clients previously served by the nonprofits with its existing targeted case managers who worked in addition to those case managers employed by the nonprofits. At the time, the state estimated it would provide services for a total of 2,700 Montanans who need targeted case management.
The elimination of contracts is the result of budget cuts made in November during a special session of the Legislature called to address a $227 million budget shortfall brought on by revenues lower than projected and the most expensive fire season in Montana’s history.
People with developmental disabilities and their families filled auditoriums in Helena during hearings on the cuts to protest the reductions, saying there was no way state case managers could meet their needs with such high workloads.
"I am very pleased that a new statewide case management contract for individuals with disabilities has been awarded,” health department director Sheila Hogan said this week. “I know how important this service is to the thousands of Montanans who receive it, and I’m excited to move forward with a contract in place.”
Having one organization provide targeted case management instead of four means there's an "economy of scale" and savings for A.W.A.R.E., Hogan said. A.W.A.R.E. was the only one of the previous four providers that had an existing network of services statewide.
The contract covers 2,572 people a month, meaning the state will still provide targeted case management to some people. The state still expects to have increased workloads for its case managers, said department spokesman Jon Ebelt.
The contract was announced this week. Its value of $2.8 million includes state and federal money. The health department projects it will save the state an expected $980,000 through the end of the biennium compared to the previous contract.
Pat Noonan, A.W.A.R.E.’s public policy officer, said his organization will hire 40 case managers to provide services.
“We’re excited,” Noonan said. “Even (organizations) that didn’t get the contract are glad it stayed with community providers because it does keep the door open so that maybe things can go back to the way they were. The fear is that if the state took this over, we would never get it back.”
While the new contract represents about a 60 percent reduction in what the nonprofit is reimbursed for the services it provides, there are other changes that lessen the administrative time burden on employees.
Case managers used to be required to bill for their time in 15-minute increments, leading to a lot of time spent on paperwork. Under the new contract, workers can bill once a month for patients.
“The department to their credit did listen to the providers on some of the things that needed to be changed to be able to provide the service (at a lower rate),” Noonan said. “This is much less of an administrative burden on our staff so that they could have higher caseloads and still be able to provide the service.”