HELENA — Mark Nay’s first client had lost the van she was living in and was struggling with substance use and medical conditions that had led to multiple emergency room visits.
Nay helped her apply for Medicaid and food assistance and obtain copies of her birth certificate and other identification documents needed to apply for housing assistance. He also advocated for her in the housing process and in the health care system, helping her find a provider and get to appointments.
After a year of “steady engagement,” Nay said, the client has a place to live, is insured, is connected to the health care system, and has the resources needed to “really start to be successful and stable” in her life. Nay is one of two community health workers in a program that St. Peter’s Health of Helena started in 2022, focusing on people experiencing or at risk of homelessness who had five or more ER visits in a year. Nay and his colleague, Colette Murley, link their clients to services to meet basic needs, whether it’s health care, food, housing, or insurance. The goal is to provide stability and, ultimately, to improve health outcomes.
Similar work is done in hospitals, community health centers, and other settings across Montana by people with titles such as case manager, outreach worker, navigator, and care manager. State Rep. Ed Buttrey, a Great Falls Republican, is sponsoring a bill in Montana’s legislative session to put a common title — community health worker — to the type of work they do and define in law what the role entails. The bill also would provide for licensure and allow, but not require, Medicaid to cover the service.
“Health care is just a very difficult system to navigate, especially when you’re trying to sign up for service and you’re trying to get access to coverage for service,” Buttrey said. “So that’s where I see the biggest benefit.” Buttrey’s HB 850 is one of several bills still alive this session that are related to Montana’s health care workforce, which is stretched thin throughout the state, the fourth-largest by land area. According to the U.S. Health Resources and Services Administration, more than one-fourth of the state’s residents live in an area with a shortage of primary care health professionals.
Other pending workforce bills include three interstate compact bills, to recognize licenses issued in other states for physician assistants, psychologists, and respiratory therapists. Then there are bills to prohibit noncompete clauses for physicians and some categories of mid-level practitioners. Other measures would allow more unsupervised activities by certain aides and assistants, let nurses provide low-cost home visits to low-income patients, allow licensure of doulas, and let physician assistants and physical therapists be considered “treating physicians” for workers’ compensation purposes.
State Rep. Jodee Etchart, a Billings Republican and a physician assistant, is sponsoring two of the interstate compact licensure bills and one of the bills to limit noncompete clauses.
Etchart termed the compact bills “a no-brainer” because they allow people to get licensed, get a job, and start working in Montana right away.
In 2023, Etchart sponsored successful bills to allow physician assistants to practice without physician supervision and to expand the scope of practice for direct-entry midwives. Those bills, she said, helped pave the way for the progress this year’s workforce bills have made this session.
“It opened a lot of people’s eyes about how we can increase access to health care all over Montana,” she said. The 2023 bill allowing independent practice by physician assistants drew opposition from physicians, with the Montana Medical Association saying it extended their scope of practice without requiring additional training. This session, the MMA has supported the bills to remove noncompete provisions but opposed bills on expanding the scope of practice for chiropractors and optometrists. MMA CEO Jean Branscum said the group generally believes scope-of-practice changes don’t fix workforce problems if the expanded practice isn’t supported by evidence or training.
Buttrey said this session’s bills to extend unsupervised practice and enact licensure compacts are an acknowledgment of the difficulty that small, rural communities have in attracting doctors. Physician assistants and nurse practitioners have been filling those gaps, he said.
Community health workers fill a different type of gap. They don’t provide direct medical care, instead helping people find the health care and support services they need to become and remain healthy. Many states have already adopted definitions for community health workers and started providing Medicaid reimbursement for their services.
The requests to add to the list of Medicaid-covered services come at a time when Congress is considering significant budget cuts that could affect the amount of funding the federal government contributes to the Medicaid program. Although the legislature this session continued Montana’s Medicaid expansion program for low-income adults without disabilities, some legislators expressed concern about potential federal changes that could lower the amount of federal funds available for the program.
State Sen. Carl Glimm, a Kila Republican, was one of those legislators. He said he has similar concerns about increasing the types of services covered by Medicaid.
“The more stuff we add,” he said, “the more responsibility the state has” if the federal government shifts more of the program’s costs to the states.
Buttrey’s bill would define a community health worker as a “frontline public health worker” who helps people obtain medical and social services, advocates for their health, and educates individuals, providers, and the community about health care needs. Workers could be licensed after completing training and supervision requirements.
Most medical providers don’t have time to delve into all the outside factors influencing a patient’s health, said Cindy Stergar, CEO of the Montana Primary Care Association, which is supporting Buttrey’s bill. Community health workers can assist with that, she said, adding that research shows people with complex needs become healthier faster when their basic nonmedical needs, such as food and housing, are met.
“At the end of the day, the patient is better,” Stergar said. “That’s first and foremost.” The Area Health Education Center at Montana State University has been offering community health worker training since 2018, and the University of Montana’s Center for Children, Families and Workforce Development began a training program in 2023. Together, the programs have trained nearly 500 people in how to identify the medical and social factors influencing a person’s health and in strategies for connecting the person with the right community resources.
“Ideally, what community health workers are doing is getting out of the clinic walls, meeting people where they are, and addressing the priorities of the client to get to the root cause of their health conditions and health needs,” said Mackenzie Petersen, project director for the training program at the University of Montana.
Supporters of the community health worker role say the workers are uniquely positioned to observe, understand, and address the barriers preventing a person from getting and staying healthy.
The barriers might be a lack of transportation or insurance or, for a homeless person, the inability to refrigerate a prescribed medication. A community health worker can arrange rides to appointments, help with insurance applications, or make sure a health care provider prescribes a medication that doesn’t need refrigeration.
Murley, with the St. Peter’s Health program, recalled that one of her clients was making frequent trips to the ER with suicidal ideation. Murley learned that he faced bullying in his apartment building and helped him relocate. The ER visits dropped off.
As Nay put it: “It’s really about helping the people that we work with create a path to their health.” KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
