Montana
Medicaid rate increases important for Montana providers, but challenges remain
HELENA — The Hannaford Group Home in Helena, operated by Many Rivers Whole Health, is currently housing eight clients receiving behavioral health services – 100% of its capacity. But earlier this year, it was only housing four, due to a need for more staff. Leaders say the difference now is thanks in part to an increase in the state’s Medicaid provider reimbursement rates, approved by the Montana Legislature earlier this year.
“In that big picture, it was definitely a sigh of relief, and pleased, and with a lot of gratitude – because without that, this would be a very different conversation,” said Dr. Jen Preble, the licensed residential supervisor for Many Rivers’ Helena group homes.
During the 2023 legislative session, provider rates were a major topic of debate throughout the budgeting process. For clients on Medicaid, the reimbursement rate determines how much the state will pay providers for giving them services like behavioral health, senior and long-term care and care for people with disabilities.
Advocates have talked for a long time about the growing costs of providing these services – and the challenges of recruiting and retaining workers if reimbursement rates didn’t keep up. Providers aren’t able to simply raise prices for Medicaid patients to account for things like inflation.
Jonathon Ambarian
Preble says Many Rivers had been dealing with acute staffing challenges for about a year. She said, as other industries in need of workers kept raising wages, it became almost impossible for them to compete in that market.
“I think for us the reduction in residential beds was moving towards closure – so if we didn’t get more staff, then we were no longer going to be able to fully occupy the group home,” she said.
Having four fewer beds available at the Hannaford Home had a ripple effect, taking up additional space at their Sleeping Giant Group Home, which houses 12 clients. MTN spoke to one client, remaining anonymous, who said she had to wait six months for a spot to open up when she was ready to leave the Montana State Hospital.
“If Hannaford was not open, I would still be waiting to discharge,” she said.
Jonathon Ambarian
BethAnn Rivers’ brother is a current group home client, and she called it “a miracle” when he found a place with Many Rivers, as he had been seriously struggling before getting a community placement. She said their family had real concerns about what would happen if the group homes went through additional reductions and he was at risk of losing of losing his place.
“It is a home-like environment; my brother loves it there,” she said. “He loves the community that he has there, the family bonds that they form there. He has people to go to and to talk to, and he feels safe, and he feels at home. All of us need that family. None of us deserve to be alone and on the street and forgotten.”
Altogether, Preble says Many Rivers’ residential program had reduced its capacity to around 40 earlier this year. After the rate increases took effect, they were able to raise salaries for group home workers to $16.50 an hour. Now, with more staff in place, they’re serving about 50 clients.
Jonathon Ambarian
Despite the increase, Preble says their challenges aren’t over. She noted that the rate increases were largely in response to a study that analyzed providers’ actual costs – but that study is already two years old.
“It’s bare minimum, right?” she said. “It’s allowing us to stay open, and that’s allowing us to continue providing the service, but we certainly aren’t going above and beyond.”
Jonathon Ambarian
For Youth Dynamics, which provides children’s mental health services across Montana, the provider rate increase didn’t lead directly to higher salaries. CEO Dennis Sulser told MTN they had seen the staffing challenges building for a long time – losing nearly 50 full-time staff since 2021. He said leaders decided they had to offer higher pay immediately to be competitive – even before the state approved additional reimbursement. He said the increases were a big help, but it’s still hard for them to find any margin in their budget.
“The challenge for us is our rates are set outside of us, our rates are set by our Medicaid program partners,” Sulser said. “We are truly thankful for additional rates; it’s keeping us in the game – but yet still very challenging.”
Sulser said the rate increase was particularly helpful in bolstering their family support program, which provides therapists and social workers to engage with kids and their families, both in the community and in their youth group homes.
“The Home Support Service is truly designed to keep the family intact, and we truly believe that children in the family, that engagement with the family is our best fundamental result,” he said.
Jonathon Ambarian
Youth Dynamics has four group homes on its Alternative Youth Adventures campus in Boulder, four in Billings, one in Great Falls and one in Helena – but some remain closed because of staffing needs. Sulser said two years ago, they had about 80 children placed in those homes, and they’re now down to about 45.
Sulser said they have to look to things like community and philanthropic support to allow them to remain competitive in attracting workers.
“We’re all going to have to be a little creative about how we go into the future, and changes are absolutely necessary in our ongoing business model, if you will, no matter what that looks like,” he said.
Jonathon Ambarian
The reimbursement rate is only part of the picture these providers are facing. Many also identify needs to repair, update or expand their facilities in order to keep up with the needs for service.
Sulser said he’s excited about a $10 million program, recommended by a state commission and signed off on by Gov. Greg Gianforte this week, that will provide one-time grants to cover some of the costs of repairing existing residential care facilities, opening or reopening new ones or training new staff.
Jonathon Ambarian
Youth Dynamics broke ground this week on a new group home building at the Boulder campus, one of two they’re planning to build to replace the current aging facilities. Sulser said it will be valuable to have a building designed specifically for the type of youth care they provide.
“The facilities have been challenging at best, and we’re working to improve that,” he said.
They’re also in the process of moving their Helena group home into the former Florence Crittenton facility on Harris Street.
Jonathon Ambarian
Preble says Many Rivers is also looking at what needs to be done to facilities like the Hannaford home.
“I mean, homes require new window coverings, they require new flooring, new cabinetry, especially in high use areas like a kitchen, for example,” she said. “When you’re talking about eight or nine people, counting staff, in or out of a house every day, that’s far more use and wear on a home.”
Despite the ongoing challenges, the successes so far have been good news for people like the Many Rivers client MTN spoke to. She said she’s grateful for the calming environment at the group home, the support she gets from staff, the skills she’s developing and the activities she’s able to enjoy.
“I think it’s huge that these people care enough to keep trying and keep pushing forward and keep trying to get funding for Many Rivers to have more stuff – to have more fun stuff like the river, like going to the farm, therapeutic things that are very helpful to mental illness,” she said.
The client told MTN, in her time at the home, she hopes to be a role model for those going through mental health challenges.
“I am here to set an example that you can recover and heal with every step you take on your journey through mental illness,” she said. “You just have to be stronger than the storm and rise with all you’ve got.”
On a frosty morning in late December, Marce Hoffman backs two huge draft horses out of a barn at the historic 320 Ranch south of Big Sky.
“Step up, step up,” Hoffman instructs the horses as he maneuvers them toward a waiting sled. It’s time to take the animals out for a turn on a trail they’ll know well by the end of the winter season. They’ll tread the path up to seven days a week during the holidays and five days a week after that. The animals strain in their harnesses, eager to pull and run.
“They’re fresh. They won’t be fresh come New Year’s, though; they’ll be all muscled up, ready to go,” said Hoffman.
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The 320 has a long history. It was homesteaded as two separate ranches more than 125 years ago.
“1912 they combined them to form 320 acres That’s how the ranch became known as the 320,” explained Hoffman as he practiced the history lesson he gives while narrating the ride through the high, narrow valley the ranch is nestled in, just outside the boundary of Yellowstone National Park.
In 1936, Bozeman doctor Carolyn McGill purchased the ranch.
Hoffman said, “She fell in love with this area on different hunting trips, trips down into the Yellowstone Park.”
You might recognize McGill’s name from somewhere else.
“Caroline started the Museum of the Rockies in Bozeman; was actually called the McGill Museum when it first opened up,” said Hoffman.
Current owner Dave Bass purchased the ranch in 1985.
Hoffman explained that’s when the ranch really began to grow into a tourist Mecca. He said, “He (Bass) bought it up from a 20 gust capacity over 200 that we have today.” He pointed to cabins that drifted by, framed by the mountains and the Gallatin River. It’s the view guests get as they take a one-hour trail ride in the sleighs. Hoffman ticked off the sights: “You get to see Cinnamon Mountain, Burnt Top Mountain. We’ll be able to see the Spanish Peaks when we go along the Gallatin here. Looking back you’ve got a view of Monument.”
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As he drives onto a flat, straight stretch of the trail, the horses get frisky. “These guys are gonna air out right here,” he cautioned, just as the horses break into a run. It demonstrated the challenge of managing big Percheron horses around guests.
“Our number one priority is keeping everybody safe. So we always have to be constantly looking at the equipment. As far as the people, probably the hardest part is herding them up and getting them on the sleighs,” Hoffman laughed as he allowed that it is probably harder to manage the passengers than the animals.
Sitting next to him, Head Wrangler Logan McDaniel said she enjoyed working at the ranch.
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“I like, of course, to drive and work with the horses but also meeting people from all around the world. You get to meet people from all different parts of life, all kind of different places,” she said. “They’re here for vacation. You get to kind of realize a little bit of people’s life story. It’s pretty cool just to meet different people.”
And the horses?
Hoffman said, “We’re looking for good disposition, you know. We’re not looking for heavy pullers we’re just looking for horses that are pretty docile and easy-going horses. They’re not gonna win any pulling competitions here.”
But these workhorses are no slouches.
“We’ll pull 18 people no problem and these guys are big horses,” said Hoffman.
He said that translates to about 18 hands and nearly 2,000 pounds each. As the horses cool down after their workout, Hoffman wiped them down and explained how these animals cope with the harsh winters at the ranch.
“You know those horses are on hay, you know free choice grass hay and water. They do pretty well. We’ve got a lean-to for them to get out of the wind. But for the most part, you know, they’re pretty hearty animals,” he said.
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By late afternoon, as dusk descends on the ranch, guests begin to wander toward a pair of the big sleighs. They board the blanket covered seats for a ride out to the other end of the valley where a wood-floored canvass tent awaits. It’s heated and features a bar serving snacks, hot cocoa, cider, and more. A fire crackles in a pit surrounded by seats outside. After a bit of rest, the passengers will climb back into the sleds for a ride back to the ranch restaurant.
Taking in the view around them, Hoffman and McDaniel reflected on their jobs. Hoffman said, “There’s a lot of people that never seen a horse or been around horses, so it’s a good opportunity to you know, to introduce them to the horses.”
McDaniel added, “It’s cool watching people fall in love with the horses. That’s why I kind of do this. It’s to see people fall in love with horses like I do.”
MISSOULA — Montana State’s path to Frisco, Texas, for the FCS national championship has been built by Treasure State natives.
For Rylan Ortt, Adam Jones and Zac Crews, that road started with the decision to become Bobcats — and spurn the hometown Montana Grizzlies — after playing high school football at Missoula Sentinel.
Tom Wylie / MTN Sports
“Rylan was the first guy to grow up a Griz fan and make that jump over to Bozeman for a lot of different reasons,” Sentinel football coach Dane Oliver told MTN Sports. “And so that kind of laid the foundation. And I know Zac and Adam both looked up to Rylan.
“You know how recruiting works, if they’re having a positive experience wherever they’re at, it helps when they hear from a kid that they trust and know.”
Ortt joined Montana State in 2019 after a stellar Sentinel career playing quarterback and throwing the javelin. As the Spartans’ QB, Ortt threw for 2,098 yards and rushed for 750 yards as a senior in 2018.
In the javelin, he won the 2019 Class AA state championship with a throw of 208 feet, 8 inches.
Once in Bozeman, Ortt transitioned to safety. He redshirted in 2019, and the 2020 season was canceled due to the COVID-19 pandemic. In the four years since, he has emerged as one of the leaders on a defense full of Montana guys.
This season, he leads the Bobcats with 75 total tackles. He’s also caught one interception and forced and recovered a fumble.
“He sacrificed a lot for our (Sentinel) program just having to play quarterback,” said Oliver, who played for the Grizzlies and was a member of their last national title team in 2001. “And hopefully that’s helped him being a safety, and maybe the knowledge you gain from the quarterback perspective has allowed him to have success at that level.”
While Ortt has been a stalwart in MSU’s secondary, Jones has had a breakout season on offense. He burst onto the scene in the Bobcats’ season-opening come-from-behind win at FBS New Mexico when he rushed for 167 yards, including a 93-yard touchdown that sparked the fourth-quarter comeback.
Jones this season has become the most prolific freshman runner in program history, rushing for 1,134 yards and 14 touchdowns. Against Idaho in the quarterfinals of the FCS playoffs, Jones accounted for 95 yards and four touchdowns with starting running back Scottre Humphrey sidelined.
“He’s got all the traits of what it takes to be great,” Oliver said of Jones. “You know, (Jones is successful) maybe a little earlier than I expected. I think the thing that Adam had going for him (in high school) was he was a three-sport athlete. You know, he was a heck of a baseball player, did hockey and football.
“He was always physical. … He’s got the hockey nature, so he’s not afraid of contact. But he’s put on some weight. He can finish runs, always falls forward, he’s got great vision. He’s got all the qualities of a back.”
Slim Kimmel / MTN Sports
Jones, Crews and fellow Cats Dylan Rollins and J.J. Dolan each played a part in helping Sentinel win Class AA state football championships in 2020 and 2021. Prior to the 2020 title, the Spartans’ last championship came in 1972.
Crews, a sophomore, has turned into a contributor on the defensive line with 24 total tackles and 2.5 sacks.
Dolan is a redshirt freshman, and Rollins, the 2020 Gatorade Montana player of the year and a 2021 Sentinel grad, is a freshman after beginning his college career at BYU and serving an LDS mission.
Now they’re all part of an MSU program aiming to end its own drought and win its first national championship since 1984.
“It’s fun to see them go on to be successful, not just the ones that play college football,” Oliver said. “It’s made me realize why I do this. It takes a lot of time and energy to coach high school football.
“So, just to see them grow into young men and have success and be fulfilled in it, whatever career they choose, and those guys are doing it on a public stage, and so obviously super rewarding for myself and all our staff to see the success they’re having.”
Montana State (15-0) will play North Dakota State (13-2) for the FCS national championship on Jan. 6.
After a thrilling 2024 season, FCS football will crown a champion when North Dakota State and Montana State battle on a Monday night. As the Bison and Bobcats near the pinnacle of the sport, let’s take a look back at their journeys.
North Dakota State
Regular season
North Dakota State finished the regular season 10-2, losing its first game to Colorado out of the FBS and its final game to South Dakota out of the MVFC. The season-ending loss prevented the Bison from winning the MVFC outright, but it didn’t matter as NDSU still got the No. 2 overall seed in the playoffs.
FCS playoffs
North Dakota State fought off an early scare from Abilene Christian in the second round to win by 20 points. In the quarterfinals, the Bison beat Mercer 31-7 in a game they controlled from start to finish.
Semifinal round
In the semifinals, North Dakota State defeated South Dakota State for the second time this year to advance to the championship game. Click or tap here for more on the thrilling finish.
Bison schedule
| Opponent | Win/Loss | Score | Record | Ranking (AFCA) |
|---|---|---|---|---|
| at Colorado | L | 31-26 | 0-1 | No. 2 |
| vs. Tennessee State | W | 52-3 | 1-1 | No. 2 |
| at ETSU | W | 38-5 | 2-1 | No. 2 |
| vs. Towson | W | 41-24 | 3-1 | No. 2 |
| at No. 15 Illinois State | W | 42-10 | 4-1 | No. 2 |
| vs. No. 6 North Dakota | W | 41-17 | 5-1 | No. 2 |
| at Southern Illinois | W | 24-3 | 6-1 | No. 2 |
| vs. No. 1 South Dakota State | W | 13-9 | 7-1 | No. 2 |
| at Murray State | W | 59-6 | 8-1 | No. 1 |
| vs. Northern Iowa | W | 42-19 | 9-1 | No. 1 |
| vs. No. 14 Missouri State | W | 59-21 | 10-1 | No. 1 |
| at No. 4 South Dakota | L | 29-28 | 10-2 | No. 1 |
| vs. (15) Abilene Christian | W | 51-31 | 11-2 | No. 4 |
| vs. (7) Mercer | W | 31-7 | 12-2 | No. 4 |
| vs. (3) South Dakota State | W | 28-21 | 13-2 | No. 4 |
Key players this season
- QB Cam Miller
- RB CharMar Brown
- RB TK Marshall
- WR Bryce Lance
- WR Braylon Henderson
- TE Joe Stoffel
- OL Mason Miller
- OL Grey Zabel
- DL Eli Mostaert
- DL Kody Huisman
- DL Loshiaka Roques
- LB Logan Kopp
- DB Darius Givance
- K Griffin Crosa
North Dakota State has a reloaded roster under first-year head coach Tim Polasek. The Bison have the Jerry Rice Award winner CharMar Brown in the backfield along top-three Walter Payton Award finalist Cam Miller. The trenches are stout yet again with NFL prospect Grey Zabel on offense and All-American Eli Mostaert on defense.
Montana State
Regular season
Montana State finished the regular season 12-0 with the longest regular-season win streak in the FCS. Only two Bobcat games — an FBS win over New Mexico State and a Big Sky win over UC Davis — were within one possession.
FCS playoffs
Montana State’s dominance continued in the playoffs. The Bobcats didn’t play a close game in the first two rounds, averaging 50.5 points scored and a 32.5 margin of victory.
Semifinal round
In the semifinals, Montana State held off South Dakota to advance to the championship game. Tommy Mellott led the way offensively with 134 passing yards and a touchdown plus 125 rushing yards and two touchdowns. Click or tap here for more from the game.
Bobcat schedule
| Opponent | Win/Loss | Score | Record | Ranking (AFCA) |
|---|---|---|---|---|
| at New Mexico | W | 35-31 | 1-0 | No. 4 |
| at Utah Tech | W | 31-7 | 2-0 | No. 3 |
| vs. Maine | W | 41-24 | 3-0 | No. 3 |
| vs. Mercyhurst | W | 52-13 | 4-0 | No. 3 |
| at Idaho State | W | 37-17 | 5-0 | No. 3 |
| vs. Northern Colorado | W | 55-17 | 6-0 | No. 3 |
| vs. No. 8 Idaho | W | 38-7 | 7-0 | No. 3 |
| Portland State | W | 44-14 | 8-0 | No. 3 |
| at Eastern Washington | W | 42-28 | 9-0 | No. 2 |
| vs. Sacramento State | W | 49-7 | 10-0 | No. 2 |
| at No. 4 UC Davis | W | 30-28 | 11-0 | No. 2 |
| vs. No. 10 Montana | W | 34-11 | 12-0 | No. 2 |
| vs. UT Martin | W | 49-17 | 13-0 | No. 1 |
| vs. Idaho | W | 52-19 | 14-0 | No. 1 |
| vs. South Dakota | W | 31-17 | 15-0 | No. 1 |
Key players this season
- QB Tommy Mellott
- RB Scottre Humphrey
- RB Adam Jones
- WR Taco Dowler
- WR Ty McCullouch
- TE Rohan Jones
- OL Marcus Wehr
- OL Conner Moore
- OL Titan Fleischmann
- OL Cole Sain
- DL Brody Grebe
- DL Paul Brott
- LB McCade O’Reilly
- LB Danny Uluilakepa
- DB Andrew Powdrell
- DB Rylan Ortt
- P Brendan Hall
Montana State is an experienced group with a mix of young talent. Adam Jones was the runner-up for the Jerry Rice Award while senior Tommy Mellott is a top-three Walter Payton Award finalist. Brody Grebe leads the defense; he finished ninth in Buck Buchanan Award voting.
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