Moving to Montana

Shawna Hanson, Outreach Coordinator for the Family-to-Family Health Information Center, and the mother of two children with special healthcare needs, shared this note for other families:

“What services are available for my child if we move to Montana?” That’s a question we hear frequently at the Montana Family to Family Health Information Center. More often, the move has already been made and families are struggling to find resources matching those they’ve left behind.

Systems of support for families with disabilities differ from state to state, and parents/caregivers seeking help for their children can find the search intensely frustrating. The team at Children’s Special Health Services recognized this struggle and invited our Center to help shape “Moving to Montana.” This page has been thoughtfully constructed with input from Montana families of children with developmental, physical, and mental-health challenges.

“Moving to Montana” is a launch pad for your search. Here you’ll find links to programs serving a broad range of needs. You’ll also find links to robust directories like Montana’s Medical Home Portal, making it easier to find therapists and providers.

Whether you’re a would-be Montanan considering a move to our state, a recent arrival trying to get familiar with our system, or a long-time resident new to complex care, you’ve found the place to start!

Introduction

When you have a child with special health needs, it can be extremely stressful to transition their healthcare while planning a move. Before moving to Montana, there are steps you can take to prepare for the transition and connect with a medical home (LINK) before coming to the state.

Medical Home

The process of transitioning medical settings may be an overwhelming task for children with complex healthcare needs. Before moving, you can:

• Request a letter from your current doctor or provider explaining your child’s needs and history
• Transfer medical records to your new doctor. You can ask to have all medical records transferred to the new office prior to arrival, or request a copy of them for yourself that you can bring with you to your first appointment. Asking for your own copy of the records may have a cost out of pocket, but is often more reliable than file transfers between offices.
• Talk to your doctor about what they suggest to help create a smooth transition of care
• Reach out to the Family-to-Family center to connect with families in your community

Resources

Though not a comprehensive list of everything available in our state, the following resources were highlighted by families as the most important for healthcare planning:

Providers:

These resources can help to locate medical providers in the state. If you cannot find a specific provider, or would like an opinion on services, you can contact resource navigators at the Family-to-Family Center.

• Primary care provider databases: American Academy of Pediatrics directory, Montana Access to Health Web Portal (Medicaid Providers Only)
• Specialists: Behavioral Health Resource on the Bright App, Genetics Navigator
• For those enrolled in Health Montana Kids, the HMK website has pages to find medical, pharmacy, dental, vision, and transportation services in-network.

Community Services:

• The following databases include resources of providers, services, therapies, and community supports: Montana 211, Healthy Mothers Health Babies
• If you are enrolled in WIC, your WIC counselor can refer your family to resources and services in your community

Specialty Clinics:

Specialty clinics can help to provide specialized healthcare not available everywhere in the state. While this list is not a comprehensive summary of every clinic, it can give you a broad overview of some clinic resources. If you are looking for a specific clinic that you cannot find, you can contact CSHS at (800) 762-9891.

• Montana 211 maintains a resource of pediatric clinics and hospitals.
• Pediatric Specialty clinics:
  • Logan Health Clinics offer various specialty clinics in Kalispell, Great Falls, Missoula, Helena, and Bozeman. Refer to the Logan Health Website to learn about what services are offered at each clinic.
  • Cystic Fibrosis Clinics are run through Billings Clinic and serve patients from all around Montana. They serve both children and adults with CF, and handle all medical needs affiliated with CF in one organized system. To learn more, contact Shawna Sprandel from Billings Clinic at (406) 238-5118.
  • The Seattle Children’s Pediatric Cardiology clinic is located in Great Falls, with outreach clinics located in Bozeman and Helena.
  • Cleft-Craniofacial clinics are run through state government to provide treatments including surgery, consultations, and various therapies. If your child has a cleft-craniofacial need, your primary care provider can refer them to the closest clinic. Clinics are located in Billings, Great Falls, Missoula, and Bozeman. To learn more about these clinics, contact the Children’s Special Health Services Nurse Consultant Katie Sheehy, BSN, RN, at (406) 444-3620 or Katie.Sheehy@mt.gov.
  • The Montana Muscular Dystrophy Association Clinic is run through the Billings Clinic and serves patients from all around Montana and Wyoming. There is a program for children and for adults. To learn more, contact Michelle Kautz from Billings Clinic at (406) 238-5097.
  • The Pediatric Complex Care Program at the Billings Clinic serves patients with multiple complex, chronic medical conditions from Montana, Wyoming, North Dakota. To learn more, contact Michelle Kautz from Billings Clinic at (406) 238-5097.
  • St Vincent Hospital in Billings hosts many pediatric specialists from Primary Children’s Hospital in Utah. Refer to the St Vincent Website for more details.
  • Great Falls Clinic has numerous pediatric specialists. To see what specialties are available and their two locations, refer to the Great Falls pediatrics website.
  • Community Medical Center in Missoula hosts many specialists from Seattle Children’s Hospital and has numerous pediatric specialists living there (ex. GI, Developmental). The Community Medical Center Clinic website details what clinics are available, and when.

Introduction

When moving to a new state, insurance systems, especially state-managed programs like Medicaid and Children’s Health Insurance Program (CHIP), can vary drastically. It is critical to understand how insurance systems may change and what programs will or will not transfer.

Medicaid (Healthy Montana Kids Plus)

Montana Medicaid's program for children is called Healthy Montana Kids Plus (HMK+). Medicaid is a state-controlled program that provides insurance for those who cannot afford private insurance. It is highly recommended to review their information to compare it to services in your home state. It is critical to remember that Medicaid services do not transfer across state lines and coverage may vary. When moving you will have to reapply and join the waitlist for services you may already have in your current state.  You can apply for HMK and learn about income limits and eligibility on the Montana Healthcare programs website.

The Early and Periodic Screening, Diagnosis and Treatment program (EPSDT) is a Medicaid service that provides assessment, check-ups, screening, testing, and treatment of health problems. EPSDT will cover medically necessary treatment for children and youth up through age 20 on a case-by-case; these authorization requests must be submitted by a primary care provider or specialist who determines the child requires the additional services, supplies, or treatment. EPSDT is most relevant when a care provider finds a reason for further treatment or investigation, and EPSDT can cover the results of that investigation.

Healthy Montana Kids (Children’s Health Insurance Program)

Healthy Montana Kids is Montana’s Children’s Health Insurance Program (CHIP). This program offers health insurance coverage for children who do not qualify for Medicaid but whose family still falls within certain income brackets. More detailed information on coverage, eligibility, and services in Healthy Montana Kids can be found in their HMK Member Guide.

Waiver services

Waivers are Medicaid programs that make it possible for individuals to receive Medicaid services in the community, a private home, or group home. This means that those whose needs might usually require institutional care would be able to access the same services in their home and community.

Montana has the following waivers that may support the needs of your children: The Big Sky Medicaid Waiver and the Comprehensive 0208 Waiver. Both waivers have a waitlist that can span years until an individual can access their services. The Big Sky Waiver serves Montanans who have physical disabilities, including those associated with aging, as well as younger individuals who meet the social security definition of disability: “The inability to engage in substantial gainful activity because of medically determinable physical or mental impairment(s) that has lasted or is expected to last for a continuous period of at least 12 months or is expected to result in death”.

The 0208 Waiver is for those with intellectual or developmental disabilities. In order to be placed on the waitlist, you must go through the Developmental Disabilities Program. If a regional specialist determines eligibility for services, then your name can be places on the 0208 waiver waitlist.

 If eligible, your child could be on both waitlist's at the same time while waiting for services. You cannot be on the Big Sky waitlist if you are served by any other waiver, but you can stay on the 0208 waitlist while receiving services through the Big Sky waiver and potentially move onto the 0208 waiver when eligible.

If you have a waiver in your home state, its services will NOT transfer to Montana- you must join the waitlist and begin the process of acquiring services again. The average wait time for families to access waiver services is over 3 years, even if they were already on a waiver in their home state.

When a child is enrolled on a waiver, they become a household of one, meaning that they can receive Medicaid services regardless of income.

To apply for Medicaid contact the Montana Office of Public Assistance . To learn more about waivers, you can contact your regional disability programs specialist, which you can locate on the developmental disabilities program site. If you would like a family perspective on the waiver, you can contact the Family-to-Family Center.

Private insurance

Many Montanans receive health insurance through their employer or other private providers. If you do not qualify for Medicaid and do not receive private insurance, you can purchase insurance coverage on the Montana insurance marketplace . You are eligible for a special enrollment to join a plan at any point when moving to a new home in a new zip code or county. However, you must prove that you had health insurance for one or more of the 60 days leading up to your move. You are eligible for a special enrollment to join a plan at any point when moving to a new home in a new zip code or county. However, you must prove that you had health insurance for one or more of the 60 days leading up to your move.

Frequently Asked Questions:

Will my waiver services transfer from my home state?

No, waiver services are non-transferable. When moving to Montana, your child will need to sign up for the waitlist's again. The DDP/0208 waiver has a current average wait time of 7 years. State waiver programs also differ greatly and there may not be an equivalent waiver in our state. For example, if you are on a 0208 waiver in your current state, the services available to you in your state may be different than the services available to you in Montana AND you will not automatically receive 0208 waiver services in Montana. You must go through the Montana specific process for accessing the 0208 waiver, which includes starting on the waitlist.

If I was on a waiver waitlist in another state, will I get the same spot when I move to Montana?

No. When you move to Montana, you must enroll in the waitlist again and start from the beginning. Even if you were next in line in your home state, the waitlist and waiver processes are independent in every state.

What should I do if a service my child needs is not covered by my insurance?

The “Services and Assistance” section of this resource has links for multiple governmental, non-profit, and community resources to help you meet your child’s needs. You can also appeal your insurance claim to try and get it covered, which should be covered in your insurance manual.

Where can I learn more?

The following resources provide more information on the waiver program and health insurance:

• Presentation on Developmental Disabilities Program eligibility: PoP meeting: DDP Updates! - Zoom
• Waiver information from the Family-to-Family Center

Introduction

Like many places in the country, Montana faces a childcare shortage that can impact families’ abilities to find high quality childcare. Montana’s frontier and rural nature impact the geographic availability of childcare. For children with special needs, special considerations for childcare can make this search even more challenging. Use the following resources to help locate high quality childcare for your family!

Childcare Resource and Referral Agencies:

Childcare resource and referral Agencies offer services to help families locate and pay for childcare, offer referrals to licensed and registered facilities, and support childcare quality initiatives throughout the state. These agencies can also help families locate facilities that can support children with special needs appropriately. We recommend contacting your local referral agency to learn about childcare in your region, which you can find on the Resource and Referral Webpage!

Scholarships and support

The Best Beginnings scholarship supports low-income families to afford childcare in licensed facilities. It also has a specific special needs subsidy for children with disabilities to access the level of care and support they need in childcare. You must qualify for the Best Beginnings scholarship in order to receive the additional special needs support, which depends on your family’s income.

Education

Introduction

Your child’s education is a large transition while moving to Montana. Education is locally controlled and can vary between school districts. The special education systems are especially different between districts, and we recommend connecting with the Montana Empowerment Center, who advocate for children of all abilities to obtain high quality educations.

Local Schools

Every school is locally controlled and operates in slightly different ways throughout the state. If your child has specific needs that the school will need to meet, we recommend contacting school districts before choosing a school. For example, some schools do not have any school nurse or only have one for a few hours a week. Some children with complex medical needs may require access to a school nurse. Families of those children should contact the school ahead of enrollment to determine school nurse access and coverage.

Education Rights

Every child in America is entitled to a Free Appropriate Public Education, according to the Individuals with Disabilities Education Act (IDEA). This means that children with disabilities must still be served by local schools and receive an education. The child should be receiving this education in the least restrictive environment, meaning that they should be included with other students and involved to the maximum extent in the environment where they can succeed. IDEA also guarantees caregivers  the rights to access their child’s educational records; participation in all IEP meetings regarding identification, placement, and educational decisions; consultation on transition services when their child reaches 16, and appropriate evaluation for the child. 

The Montana Empowerment Center offers specific online resources and contact information for educational rights.

Special Education

Special education is a crucial right in the life of children with disabilities. Special education requires an IFSP, IEP or 504 form to best understand and address your child’s needs. If your child receives services from Part C, the Part C Program provider and the family will notify the local special education agency and support the child’s transition to Part B services or other services in the community Although it is common in other states, not all school districts offer special education through 21, and many stop educating at 18. These extra years can be critical for transition to adulthood success and family systems. You can contact school districts to understand what age they offer special education through, and what resources they may have that meet your families’ specific needs. While every child is entitled to Free Appropriate Public Education, school resource differences may make that education harder to achieve in certain settings over others.

• IFSP: The Individualized Family Support Plan (IFSP) is required for every child and their family eligible and enrolled in the Part C Program. The IFSP is created by a team including the family, Part C Service Coordinator, and other professionals in the child and family’s life. The plan is implemented by the family and the professionals providing services and supports to the family. Visit the Montana Milestones Part C website and view the video “Let’s Chat About Early Intervention” to learn more.
• IEP: An Individualized Education Program (IEP) is required by the IDEA for every child who is found eligible under state/federal guidelines. The team who creates the IEP includes teachers, administrators, and other student-focused staff members. Parents/guardians are considered equal partners in this group and should feel empowered to advocate for their child’s best interest in their education. To learn more about IEP’s, visit this guide from the Office of Public instruction: Special Education in Montana (mt.gov).
• 504s: A 504 form is a document for children with disabilities or impairments in schools. This form defines an impairment as a physiological disorder or condition, cosmetic disfigurement, or anatomical loss affecting one of more body systems. If your child has an IEP, then that can cover the functions of a 504 instead.

Post-High School Services

When services end for children in school settings, families can struggle with finding meaningful supports to replace the school. Although many school districts in our state have different age cut-offs for education, every child eventually ages out of school services. You can contact your school district to find out at what age they stop offering services, and you can advocate to the local school board to increase this age or offer more support.

The Montana Transition and Employment Project provides support and resources for the process of transitioning out of school services and pediatric care. These resources include trainings/events, groups and councils, and social security and employment information.