Healing and Ending Addiction through Recovery and Treatment (HEART)

Montana faces a drug crisis that is harming families and devastating our communities. Governor Greg Gianforte and DPHHS Director Charlie Brereton are committed to addressing this issue through the HEART Fund, which the governor introduced in his first week in office.

With $6 million in new funds and a federal match, HEART invests $25 million a year to provide for a full continuum of behavioral health and treatment programs for communities.   

The 2021 Legislature voted to approve, and Governor Gianforte signed into law, HB 701 to approve HEART.   

On October 1, 2021, DPHHS submitted a Medicaid waiver to the Centers for Medicare and Medicaid Services (CMS) requesting federal approval for various components of the HEART Waiver. A Medicaid waiver asks for federal approval to use Medicaid funds for services that aren’t usually allowed.   

On July 1, 2022, DPHHS received federal approval of a portion of the waiver request that will significantly increase access to SUD treatment for Montana Medicaid members.  Since this time, hundreds of Montanas have received serves under this newly approved Medicaid benefit.

The rest of the waiver asks for federal approval of Medicaid coverage for additional critical programmatic improvements including contingency management, tenancy supports, coverage for inmates 30 days prior to release, and mobile crisis. DPHHS and CMS continue to work toward approval of these components of the waiver application.

Progress report (last updated 2-6-23)

Progress to date

DPHHS continues to make significant progress filling in current gaps in Montana’s full behavioral health continuum of care. These efforts are increasing services to Medicaid clients and bolstering services in communities.  

HEART accomplishments at-a-glance:

  • About 350 Montanans were served from July 2022 to January 2023 under newly approved Medicaid benefits as a result of HEART Waiver approval and state plan amendment changes. These numbers will continue to increase as more Montanans are served.
  • Adult Medicaid members of all ages can now receive inpatient and residential chemical dependency services.
  • Montana Medicaid updated its substance abuse treatment coverage to align with ASAM criteria, supporting quality clinical care for all members.
  • DPHHS closed the treatment coverage gap by adding three ASAM treatment levels to the Montana Medicaid benefit plan.
  • Over $5 million in funding has been allocated to support HEART-related programs in FY22/23. Part of this funding is a result of new Medicaid-funded services now available in Montana through HEART.
  • Over $1 million has been provided to Tribal Governments in Montana to fill locally identified gaps in prevention, crisis, treatment, and recovery services.
  • Over $2.7 million has been provided to local detention centers to implement jail-based therapeutic services, certified behavioral health peer support services, care coordination and other services. 

Progress details:

  • Grants to Tribal Nations: To date, $1,000,000 has been distributed to Tribal Nations through the HEART Fund in SFY22-23. Each of the eight Tribes received $125,000. HEART allocates $500,000 annually to Tribal governments to fill locally identified gaps in substance use disorder prevention, mental health promotion and mental health crisis, treatment, and recovery services. The first report of how these funds were utilized will be available soon.
  • Medicaid waiver approved: On July 6, 2022 Governor Gianforte and DPHHS announced federal approval to significantly increase access to substance use disorder (SUD) treatment for Montana Medicaid members. The federal approval, made possible through the governor’s HEART Fund, allows larger licensed SUD treatment providers to receive Medicaid reimbursement for short-term acute inpatient and residential stays at facilities that meet the definition of an institution for mental disease (IMD). Since July 2022, hundreds of Medicaid recipients have been served in substance use disorder IMD facilities through this newly approved Medicaid benefit.

The approval has paved the way for more providers to offer this Medicaid benefit as well. Badlands became licensed in September 2022 for 32 total beds to serve Medicaid recipients as part of the SUD IMD waiver approval. In December 2022, a third facility, Recovery Centers of Montana, Cramer Creek, became licensed as an SUD IMD facility for an additional 55 beds. This facility started serving Montanans in January 2023 under the newly approved Medicaid benefit.

  • Funding awarded to local county detention centers: In October 2022, DPHHS awarded $2.7 million in funding to local detention centers to implement jail-based therapeutic services, certified behavioral health peer support services, care coordination and other services. Funding was allocated to Yellowstone, Missoula, Lewis and Clark, Gallatin, Butte Silver-Bow, Cascade and Custer counties.
  • Additional Medicaid services added: DPHHS closed the treatment coverage gap by adding three ASAM treatment levels to the Montana Medicaid benefit plan. These services are now available to Montanans:

ASAM 3.1: Clinically Managed Low Intensity Residential Services. This is a licensed community-based residential facility that functions as a supportive, structured living environment. Members are provided stability and skills building to help prevent or minimize continued substance use.

ASAM 3.2: Clinically Managed Residential Withdrawal Management. This is a clinically managed residential withdrawal programs providing 24-hour structure and support. These services are provided to a member diagnosed with a moderate or severe SUD and whose intoxication/withdrawal signs and symptoms are significant enough to require 24-hour structure and support. Services focus on social support to safely assist a member through withdrawal without the need for medical and nursing services.

ASAM 3.3: Clinically Managed Population-Specific High Intensity Residential Services. This service is for a clinically managed population-specific residential treatment program providing 24-hour structured residential treatment. These services are provided to a member diagnosed with a moderate or severe SUD whose substance related problems have resulted in temporary or permanent cognitive deficits and are unlikely to benefit from other residential levels of care. Services are slower paced, repetitive, and designed to address significant cognitive deficits.

  • PAX Good Behavior Game: DPHHS has continued to expand the implementation of the PAX Good Behavior Game (PAX GBG), an evidence-based prevention program. PAX GBG is a school-based program that enables teachers to utilize classroom strategies that increase children’s self-regulation, improve academic outcomes, and reduce the prevalence of substance use, mental illness, and suicidal ideation throughout a child’s life. Since the HEART Fund launched, 429 additional teachers have been trained to implement PAX GBG. Montana now has 2,389 teachers trained to implement PAX GBG across the state. 
  • Primary Prevention: DPHHS has funded the establishment of 17 additional Prevention Specialists in communities across Montana. Prevention Specialists lead the implementation of primary prevention activities that seek to reduce the rates of underage drinking, adult binge drinking, marijuana and methamphetamine use, and strengthen the local prevention infrastructure. Dedicated prevention specialists now serve 49 of Montana’s counties and 4 federally recognized tribes in Montana. 


The HEART fund utilizes tax revenue from the sale of recreational marijuana to leverage additional Medicaid funding through a federal match. The HEART Fund is used to bolster additional Medicaid services and support community SUD programs. 

Current HEART Fund allocations include:

  • Continuity of Care in County Jails - $2.7 million (biennium)
  • Grants to Tribal Nations – $1 million (biennium)
  • Prevention Activities/ Medicaid Treatment Services - $20 million (biennium). Full availability of this funding is dependent on full approval of the HEART waiver by CMS.