The following are the 10 recommendations from Governor Gianforte's 2027 biennium budget. The legislature fully funded these proposals, and DPHHS is now implementing them. The recommendations are numbered as they appear in the BHSFG final report (PDF). A summary and an update on each recommendation is below.

Ten recommendations were approved by Governor Gianforte:

This recommendation refines and reconfigures the 0208 Comprehensive Waiver Services rates. It will adjust the rate methodology to better align an individual's support needs with their resources, including increasing Medicaid reimbursement.

Update as of September 2026: DPHHS has finalized the services that will use acuity-based rates and is developing the Supports Intensity Scale (SIS) pilot assessment framework. The Department has finalized a contract with the American Association on Intellectual and Developmental Disabilities (AAIDD) to conduct 500 SIS-A pilot assessments, offered both in person and virtually. Now that the contract is in place, assessment scheduling will begin in the near future.

This recommendation expands the service delivery system to support individuals with complex needs by establishing a more robust continuum of care. It will create a Systemic, Therapeutic, Assessment, Resources, and Treatment (START) certified resource center and clinical team. This team will provide technical assistance and crisis response to existing 0208 Comprehensive Waiver providers. The recommendation also introduces a new residential habilitation service for individuals with complex behavioral and/or medical support needs under the 0208 Comprehensive Waiver.

Update as of September 2026: DPHHS is advancing several initiatives to improve crisis intervention for individuals with Intellectual and Developmental Disabilities (IDD) and complex needs:

  • START Program Pilot: DPHHS is working with the National Center for START Services to launch a certified START program. A revised Clinical Services RFP will be reissued to secure a provider to hire clinical and therapeutic coaching teams and begin certification.
  • Specialized Training: In partnership with IntellectAbility, DPHHS is developing crisis-intervention training for direct care staff, first responders, and other stakeholders.
  • Residential Development: A stakeholder workgroup is refining a pilot for small, intensive, community-based homes for people with complex needs.

This recommendation redefines and reopens E&D clinics to better support families. The clinics will handle intake and eligibility for individuals with developmental disabilities seeking the 0208 Comprehensive Waiver, ensuring more efficient support.

Update as of September 2026: After completing an extensive review of recommendations and best practices from providers, schools, and stakeholders, the Department has submitted a new Request for Proposal (RFP).

  • Current Action: The scope of work has been finalized, and the RFP has been submitted for formal review.
  • Objective: Secure up to three vendors to provide comprehensive E&D services across the state of Montana.
  • Timeline: The RFP is expected to be issued in fall 2026.

This recommendation will enhance Targeted Case Management (TCM) by reassessing the reimbursement model, expanding program availability, and piloting a value-based payment model to incentivize providers for improved outcomes.

Update as of September 2026: Guided by data and stakeholder feedback, DPHHS is implementing Value-Based Payment models for Targeted Case Management (TCM) services for people with developmental disabilities and youth with Serious Emotional Disturbance (SED). Seven TCM Access Grants have been awarded to expand services for youth with SED. Grants for adults with mental health needs will be available this summer, followed by grants for adults with substance use disorders in early 2027.

This recommendation implements a tailored care transitions program, such as Critical Time Intervention (CTI), to help individuals released from institutions. The program will provide intensive, short-term support to help them reintegrate into their communities.

Update as of September 2026: Following a review of provider capacity, the state will operate the Critical Time Intervention (CTI) program through its new Care Transitions Section. The program supervisor began program development in May 2026, and CTI workers began serving people discharged from the Montana State Hospital to Butte-Silver Bow, Yellowstone, and Missoula counties on Aug. 31, 2026. Further expansion of the program is planned in 2027.

This recommendation will launch a public awareness campaign to increase understanding and improve access to the 988 Lifeline and its behavioral health crisis support.

Update as of September 2026: DPHHS collaborated with other state agencies to establish a seven-year master services agreement (MSA) for media services. Most contracts are complete, creating a vendor pool for future state media projects. DPHHS plans to release a Contractor Engagement Proposal (CEP) in fall 2026 for a 988 marketing campaign to increase awareness of the 988 Lifeline.

This recommendation will redesign reimbursement rates for in-state youth residential services by creating a tiered structure. This structure will align resources with clinical needs and reduce reliance on out-of-state placements in psychiatric residential treatment facilities and therapeutic group homes.

Update as of September 2026: With input from the University of Montana and youth behavioral health providers, the Department developed the Intensive Therapeutic Group Homes service, a four-bed, high-acuity residential model for youth with complex needs. The Department also developed Intensive Treatment Services for Psychiatric Residential Treatment Facilities (PRTFs) and Therapeutic Group Homes , which will support increased staffing and specialized services based on youth acuity. Administrative rulemaking is underway, with implementation targeted for Jan. 1, 2027.

Other Key Developments:

  • PRTF Bed Capacity Grant: Shodair Children’s Hospital and Yellowstone Boys and Girls Ranch (YBGR) are using a $618,500 grant to expand PRTF capacity for Montana Medicaid and Healthy Montana Kids  youth with complex needs. Shodair has met its goal of adding at least 10 beds. YBGR is advancing facility improvements, recruitment, retention, and staff training to increase capacity.

The recommendation will invest in school-based behavioral health initiatives by funding programs, expanding universal behavioral health screening, and collaborating with the Montana Office of Public Instruction (OPI) to adopt supportive policies and identify sustainable funding sources.

Update as of September 2026: The Department reviewed Medicaid funding mechanisms for school-based initiatives in other states and is developing an Early Identification System (EIS) framework with input from the National Center for Rural School Mental Health. The Department also has active contracts with the Rural Behavioral Health Institute and the University of Montana’s Center for Children, Families, and Workforce Development.

This recommendation addresses behavioral health (BH) and developmental disabilities (DD) workforce shortages by establishing a tuition reimbursement program for case managers and direct care workers. It will also create dual enrollment programs so Montana high school students can earn tuition-free college credits in these fields.

Update as of September 2026: The Department launched two initiatives in December 2025 to strengthen Montana’s behavioral health (BH) and developmental disabilities (DD) workforce. The Western Interstate Commission for Higher Education (WICHE) is conducting a statewide assessment to identify workforce resources, needs, and gaps. In partnership with the Office of the Commissioner of Higher Education, the Department is also developing dual-enrollment, micro-credential, and student-assistance programs to build the workforce pipeline.

This recommendation expands and sustains Certified Community Behavioral Health Clinics (CCBHCs) to build a more integrated mental health and substance use treatment system with sustainable funding.

Update as of September 2026: Montana was selected as one of 10 states to join the four-year Certified Community Behavioral Health Clinic (CCBHC) Medicaid Demonstration Program. The program will expand access to mental health and substance use services regardless of age, location, or ability to pay, while providing more sustainable Medicaid funding.

The Department, its contractors, and four provisionally certified providers are preparing for an Oct. 1, 2026, launch. Current work includes certification, provider guidance, mobile crisis and crisis-receiving services, enrollment and billing training, system configuration, and cost-report development.

Key dates include:

  • Demonstration award: July 1, 2026
  • CCBHC launch: Oct. 1, 2026
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Approved BHSFG Near-Term Initiatives
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Behavioral Health System for Future Generations
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Commission Materials
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HB 936 Long-Term Sustainability Study Committee