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, Medical Home Portal
• 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 waitlists 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-transferrable. When moving to Montana, your child will need to sign up for the waitlists 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.

Introduction

Montana has many services that exist to support your family. When applying for services, know that many different agencies establish their own regulations and eligibility requirements. A recommendation from Montana family leaders is to apply for as many services as early as possible. Using these supports can help your family thrive in Montana!

The following resources have been highlighted by families as the most important in their family’s journey; however, it is by no means an exhaustive list of everything available in Montana or nationally. If you need assistance or a resource that is not found below, you can contact the Family-to-Family center and speak to a resource navigator, or contact the Children’s Special Health Services Hotline.

Government Programs

• Food, Medical, or Cash assistance: The Department of Public Health and Human Services has an online portal where you can apply for food, medical, and cash assistance on one application. These programs include the Supplemental Nutrition Assistance Program (SNAP), which was formerly food stamps; Temporary Assistance for Needy Families (TANF), or cash assistance; and Health Coverage Assistance, including Medicaid, Healthy Montana Kids, health insurance assistance, and tax credits for insurance.
• Special Supplemental Nutrition Program for Women, Infants, and Children (WIC): WIC offers nutritional and breastfeeding support and counseling to families with children 5 and under, and expecting parents.
• Montana Milestones Part C: The Montana Milestones Program provides early intervention services and supports for families who have infants or toddlers, from birth through three, who have significant developmental delays or disabilities or have been diagnosed with an established condition associated with significant delays. These services include therapies and interventions that can help your child thrive and support their healthy development. To be eligible for the services, a child must have a diagnosis of an established condition from a physician or psychologist that is likely to result in developmental delay or disability; or two or more 25% delays or one 50% delay in physical, social, cognitive, communicative, or adaptive development. If you have questions about this service, you can visit their website or call 406-444-5647 for more information.

Grant Programs

• Genetics Financial Assistance: The genetic testing financial assistance program can be used when your child requires a genetic test that is not covered by your insurance, or if a child is uninsured. The test must be confirmed necessary by a physician, and for Medicaid patients it must be documented that Medicaid and EPSDT both do not cover this request.
• Financial Assistance Program: The Children’s Special Health Services Financial Assistance Program supports families in purchasing treatment and enabling services requested by medical providers. Its policies and status are maintained on its website.

• MonTECH: MonTECH provides technology, support, and services that improve the quality of life for Montanans with disabilities. MonTECH provides assistive technology devices and services, either as a loan or through a community buy-sell network.
• Jadyn Fred Foundation: The Jadyn Fred Foundation provides direct financial support to families with children with special health needs. Families must submit an application, referral from a doctor, nurse, or social worker, and a consent form.
• The Cerner Charitable Trust: The Cerner Charitable Trust provides funding for expenses such as treatment, equipment, displacement, and vehicle modification. Check out their website to see if you qualify for this funding.
• The Marshall and Mary Brondum Special Assistance Foundation: This organization exists to help individuals whose needs are not or cannot be met by existing charities and/or agencies. These needs include medical, adaptive lifestyle, and financial.
• The Dental Program: This program offers free dental care for children with many disabilities that may lead to increased need for dental services, such as Cerebral Palsy, Muscular Dystrophy, Intellectual Disabilities (including Downs Syndrome), and organ transplants. However, this program is not open to Medicaid patients. In Montana, it is located in Great Falls, but families from around the state can travel for these services.
• NORD PKU: For patients with Phenylketonuria (PKU), the NORD PKU assistance program offers support for out-of-pocket health care.

Where to find out more

We recognize that the services listed here are not a comprehensive list of supports for your family. If you are looking for more supports, you can contact the Children’s Special Health Services hotline at (800)-762-9891 or cshs@mt.gov. Our staff will be happy to direct you to further service options.

Introduction

Accessing resources is extremely important to families that are moving to Montana with one or more child(ren) with a special health care need.  A child's diagnosis not only impacts that individual, but the family as a whole unit. Listed below are organizations for parents and family members that offer support, resources and networking connections throughout Montana.

The Family-to-Family Health Information Center

The Family-to-Family Health Information Center is a family-led organization within the University of Montana Rural Institute. The center’s mission is to amplify the strength of children and youth with health care challenges by building relationships with providers and programs, connecting families to meaningful supports, and providing them opportunities to learn and to share their experience. Their staff can help you locate local providers explain state resources, identify community support, and help families network with each other.

Family Peer Support

Family Peer Support is a peer-support program where a fellow parent of a child with special healthcare needs can provide direct, one-on-one support. You can contact Jim at Montana's Peer Network with questions, concerns, or needs you may have. Beyond guiding you to resources, a Family Peer Supporter is an individual who is there to listen, offer support, and walk alongside you on your family’s journey. This a great resource for parents who may be feeling isolated, overwhelmed, or need a helping hand.

Support Groups

• Circle of Parents: Circle of parents is a support group run by parent leaders to foster an open exchange of ideas, supports, and resources. Circle of Parents meetings are always free and often have childcare available for the meeting time.
• NAMI: The National Alliance on Mental Illness (NAMI) offers support groups for those impacted by severe mental illness and for those affected by a loved one’s mental illness. They offer multiple groups on different topics, and virtual group options as well.
• Montana Hands and Voices: Montana Hands and Voices provides information, support, and referral to families at any point in their journey with their child who is deaf or hard of hearing, but especially for those families starting on this journey.
• Montana Deaf-Blind Project: The Montana Deaf-Blind project serves individuals birth-21 who are impacted by both vision and hearing loss. This project works to build capacity and improve services and increase resources and expertise throughout the state. They follow national initiatives, including early identification and referral, family engagement, assessment and instruction planning, transition, professional development, and national child count.

Respite Care

Respite care is planned or emergency care provided to an individual with need for support and supervision in order to provide temporary relief to the primary caregiver of that individual. The Lifespan Respite Coalition’s mission is to establish a statewide coordinated system of easily accessible, quality, and affordable respite care services for Montana’s family caregivers or individuals regardless of special needs.

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.

Introduction

Finding support in your community is one way to make the move into Montana more positive. Neighbors, friends, coworkers, and faith-based communities all offer opportunities to build your network and support system in your new hometown.

Home visiting

Healthy Montana Families is a state-run home visiting service that serves pregnant women, infants, and children with disabilities and special healthcare needs. It is a voluntary, family-centered program conducted by a trained home visitor, that provides service coordination and improves health. This program services pregnant individuals and parents with a child under the age of 5, who meet at least one criterion, such as disability, developmental delays, low income, being pregnant under the age of 21, history of interaction with child welfare, substance or tobacco use, low student achievement, or current or former armed forces members.

Centers for Independent Living

Centers for Independent Living (CILs) provide services to anyone with a disability in Montana. They are not places to live; instead, they offer information and referral, independent living skills training, peer mentoring, individual and systems advocacy, transitions, accessibility, adaptive equipment, and housing support. These centers vary by community.

Adaptive Recreation

Children with disabilities deserve to access and enjoy the many opportunities for recreation in Montana. Adaptive recreation organizations include:

• DREAM Adaptive Recreation: DREAM Adaptive Recreation provides individuals ages 5 to adults with year-round outdoor adaptive recreation opportunities.
• The Montana Special Olympics: Montana Special Olympics is a state-wide non-profit that provides year-round sports training, athletic competition, and healthy-related programming for individuals with intellectual disabilities.
• America the Beautiful: Montana is home to some of the country’s most beautiful natural resources, including National Parks like Glacier and Yellowstone. The America the Beautiful Access Pass is a lifetime free-entrance pass for national parks for anyone with a permanent disability and may provide a 50% discount on certain amenities in parks.

Housing Resources

Housing support in Montana can be found at Resources - Montana Housing (mt.gov). This site offers resources and supports on fair housing, low-income assistance, and services for children and families.