Attracting out-of-state professionals is just the first step in solving Montana’s health worker shortage

Kelly Larson Kaiser Health News

Gina Eisenhart spent nearly six years as a licensed therapist in Colorado before deciding to move to a place where her services were greater. She has researched rural states facing a shortage of behavioral health providers and accepted a position as a clinical senior therapist at Chauder Children’s Hospital in Helena, Montana, in January 2018.

But she couldn’t start her new job right away because state officials denied her application for a license to practice in Montana on the grounds that her master’s degree program required only 48 credit hours to complete instead of 60.

Eisenhart spent nearly $7,000 to earn an additional 12 credits to meet the requirements, something she acknowledged that not every provider would be able or willing to do.

“I come here as a licensed therapist to provide services that Montana needs so desperately, and you say, no, you’re undereducated, when in reality that’s not true,” said Eisenhart, now director of clinical services at Shodair. “It kind of made me feel unwanted.”

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The difficulties Eisenhart faces are an example of the problems health professionals can face in obtaining a license from the state of Montana to practice. State lawmakers are considering proposals to make it easier for out-of-state licensed professionals to work in Montana. The need to attract more workers is especially heightened amid the national mental health crisis and worker shortage, both of which have been exacerbated by the COVID-19 pandemic. But lawmakers, behavioral health advocates and providers say the need is so great, they doubt that reducing barriers to out-of-state practitioners will be enough.

One measure, House Bill 101, sponsored by Republican Rep. Jane Gillett and drafted by the Interim Committee on Children, Family, and Health and Human Services, covers social workers, occupational counselors, addiction counselors, marriage and family therapists, and peer support specialists in behavioral health. It would allow the Department of Labor and Industry to automatically license service providers in Montana if they meet certain requirements, such as having been actively licensed from another state for at least one year and having appropriate educational credentials.

If the bill were to take effect in 2018, Eisenhart said, she wouldn’t have to jump through so many hoops to work in Montana.

Another, House Bill 152 sponsored by Republican Rep. Bill Mercer and requested by the state Department of Labor and Industry as part of Governor Greg Gianforte’s “Red Tape Relief” initiative, aims to streamline the licensing process for all professions the department regulates, from nurses to real estate appraisers.

HB 152 is designed to streamline the process for licensing more than 50 occupations and 150 types of licensing under the Department of Labor, Eric Strauss, director of the department’s Employment Standards division, said at a Jan. 18 committee hearing on the bill. .

Last year, the department received more than 21,300 licensing applications across professions, and half of those were from out-of-state professionals, said Dave Cook, the department’s deputy director for professional licensing. He said health care-related licenses have a higher proportion of out-of-state applicants — 60%.

Department officials said HB 152 would improve licensing mobility by creating a standard that the department uses across occupations to determine whether out-of-state license holders are eligible to work in Montana. It will also set a 30-day timeline for the agency to issue a license after receiving the completed application.

“This helps an engineer, psychologist, social worker or cosmetologist who has practiced for 20 years obtain a license without having to obtain additional education or take an exam,” said department spokeswoman Jessica Nelson.

Although the two bills have the same goal, Labor Department officials have criticized Gillette’s behavioral health worker licensing bill as insufficient to remove barriers to out-of-state workers.

HB 101 “creates additional burdens for licensing, including requiring residency and the requirement to take a specific licensing exam,” Nelson wrote in an email. “These are the issues HB 152 is trying to fix.”

Gillette said she doesn’t think her or Gianforte’s bill alone will solve the healthcare workforce problem. To make a fundamental change, Gillette said, reimbursement rates for Medicaid providers would need to be higher.

“It’s going to do something but it’s not going to fix it in any way,” Gillette said, referring to the streamlining of the licensing process.

A 2021 legislature-commissioned study found that Medicaid provider rates in Montana were too low to cover the cost of many of those who work with seniors, people with disabilities, and children and adults with mental illnesses.

The study found that state Medicaid now pays, on average, 85% of the actual cost of care for adult behavioral health services, for example. Gianforte’s proposed budget would boost that funding next year to 94% of costs, on average, before cutting it again to 91%. The budget proposal is before lawmakers, and to fully fund the services, providers are asking them to raise rates higher than the governor proposes.

Mary Wendecker, executive director of the Montana Behavioral Health Coalition, which strives to make community services more accessible to patients, said her organization recommended the interim committee come up with what became HB 101, but HB 152 goes further than it can. Hopes.

Windecker said every agency her organization represents is understaffed by 25% to 30%. Up to 90% of coalition members’ income comes from Medicaid payments, she said, which isn’t enough. She said accelerating the licensing process and raising Medicaid provider rates according to a study by the Montana Department of Public Health and Human Services are the key strategies needed to meet demand for behavioral health services.

“We have to get people here to work,” Wendecker said. “We have a huge labor shortage and with Medicaid reimbursements so low, we’re having a real hard time hiring people.”

According to the Council on Behavioral Health, there were 5,126 active behavioral health providers in Montana as of this past April. The Montana chapter of the National Alliance on Mental Illness reports that 163,000 adults in Montana have a mental health condition.

Kaiser Health News is a national newsroom that produces in-depth journalism on health issues.

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