HELENA – Leaders with the Montana Department of Public Health and Human Services now believe they will be able to maintain targeted case management services for 3,600 Montanans with developmental disabilities.

Four nonprofits – Helena Industries, AWARE, Opportunity Resources and the Central Montana Medical Center – currently receive contracts from the state to provide case management for these Montanans. However, DPHHS announced last month that, because of state budget cuts, it would end the contracts and take over the responsibility itself.

“The service of case management will not change,” said Marie Matthews, the state Medicaid director.

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DPHHS leaders initially announced they would be able to keep providing case management for 2,700 people who receive care through comprehensive Medicaid waivers. But Matthews told reporters Tuesday they now believe they can also serve another 900 to 1,000 who are covered on a state plan or are on a waiting list for a Medicaid waiver.

Matthews said DPHHS will not hire new employees to handle the additional workload. Instead, the agency will shift its quality improvement specialists – who currently work with the contractors – into handling cases directly. That will leave the department with about 50 case managers in all.

DPHHS’s contracts with the nonprofits will run through the end of March. By Apr. 1, Matthews said each client will be connected with a new state case manager.

Case managers work with clients to find and arrange the other services they need to live in the community. They can help with things like living arrangements, medication and paperwork for Medicaid applications.

Department leaders say taking over case management services themselves will save $2.5 million by June 2019. It’s among a number of cost-saving measures DPHHS has had to take over the last year. The agency’s budget was cut by $49 million, as state leaders dealt with the effects of a $227 million projected revenue shortfall.

“None of these are preferred changes to make,” said Matthews. “But in this case, we get to keep case management services for all of these developmentally or intellectually disabled individuals, and that’s a good thing.”

Matthews said there are redundancies in the way services are currently delivered. For example, a contracted case manager and a quality improvement specialist might both need to look at the same report.

“If we undo some of those duplications, we will be able to serve all of these clients with 50 case managers in house,” she said.

Once the transition is over, each state case manager will likely work with between 50 and 60 clients at a time. They will operate from DPHHS’s developmental disabilities offices in Helena, Great Falls, Missoula, Kalispell, Butte, Bozeman, Billings, Miles City and Glasgow. In many cases, Matthews said the newly assigned case managers will be working on cases they previously oversaw as quality improvement specialists.

“These really excellent state staff are going to have to step up and serve clients who are going through a difficult transition,” she said. “So expectations will be, I think, even higher to perform services at the right level.”

Despite the challenges, Matthews said DPHHS leaders are confident the change will be a success.

“It’s going to be difficult, and we’re going to succeed, because this is the mission of this division – to help these clients,” she said.

The end of case management contracts may force the current contractors to make large-scale cutbacks. Leaders with Helena Industries have said they will likely have to close offices in Great Falls, Bozeman, Butte and Anaconda and lay off 26 people who work there.


  1. This is not a reasonable solution. The new case managers do not have same training or contacts. This is just a disaster waiting to happen. There will many many people who will fall through the cracks, because no one individual will really be able to handle that kind of work load. Then there are individuals like my daughter who will completely loose the help of Helena Industries, whom she has worked with for over 23 years. And now she will be left on her own to negotiate the “system”. This change is to drastic for our handicapped individuals in the state. How many of those folks that are forgotten will end up in jail or prison? How much will that save the state?