Annual Report

The Montana Healthcare Foundation’s 2021 Annual Report provides an overview of our work over the past year. The important work summarized in this report is a testament to our talented staff and the dedicated, tireless work of committed partners all over Montana.

We actively partner with nonprofits, government agencies, Native nations, and other organizations to address our state's most significant health challenges. We listen to communities to understand their needs and goals and work together to identify and pilot solutions.

Beyond making grants, our staff provides leadership, convenes and facilitates discussions among stakeholders, provides technical assistance, researches promising solutions, and fosters new partnerships to improve the health of all Montanans.

Learn more about the Montana Healthcare Foundation, including our history, staff, and board of trustees.

Grantmaking Overview

Since we began our programming work in 2015, we have:

56 counties
Reached each of Montana's 56 counties and every Native nation and urban Indian health center.
528 grants
Funded 528 grants and contracts with $33 million.
$91 Million
Leveraged our resources to bring $91 million of federal and private funds into the state.

Annual Charitable Funding Amount

American Indian Health

We support Native-led solutions to improving the quality and availability of health care. The principle of self-determination guides our work: we build our strategy and programs in partnership with Native nations, urban Indian health centers, and Native-led organizations.

Since 2015, we have funded 138 projects in Indian Country with $6 million. We have also leveraged our resources to help secure $29 million in federal and private funds to support the Native nations in Montana.

Our work focuses on strengthening health services, supporting governance and leadership, and reducing health disparities.

projects since 2015
funded in Indian Country
in federal and private funds leveraged

Strengthening American Indian Health Services

Expanding access to stable, high-quality, Native-led public health and health care.

We support Native nations and urban Indian health centers to build effective health care and public health programs. To ensure these projects endure and provide lasting benefits to the communities they serve, we provide funding and technical assistance to help build strong business operations and stable revenue sources. Some of the highlights of this work include:

Northern Cheyenne Tribe

A $25,000 Montana Healthcare Foundation planning grant followed a year later by a $150,000 implementation grant fostered a partnership among the Northern Cheyenne Indian Health Service, Northern Cheyenne Tribal Behavioral Health, and St. Vincent Healthcare. This partnership provides midwifery services for pregnant women living on the Northern Cheyenne Indian Reservation. Previously, women traveled to Billings – over 100 miles from home – for each prenatal visit. The initial collaboration led to a five-year contract, signed in 2021, to continue providing these essential services for women and families.

Little Shell Tribe of Chippewa Indians

In 2018, we sponsored the tribe’s leaders to travel to Alaska to visit the Southcentral Foundation and learn about its award-winning NUKA Nuka System of Care. In 2021, the Little Shell Tribe completed renovations on a new clinic designed to deliver patient-centered, trauma-informed, and culturally-centered NUKA Care. We provided grants to support the strategic planning efforts and partnership with Southcentral Foundation.

Fort Belknap Indian Community

With an early Montana Healthcare Foundation grant, the Fort Belknap Indian Community established a diabetes care clinic. By the end of 2021, the clinic provided diabetic care services at over 500 visits. We also helped the community apply for a planning grant to take over the operation of its behavioral health services from the Indian Health Service. After more than five years of planning, the Fort Belknap Indian Community assumed control and management of its behavioral health services in 2021.

Blackfeet Tribe

With a $13,300 contract, we supported the Southern Piegan Health Clinic’s application for an Indian Health Service Small Ambulatory Grant. In 2021, the clinic was awarded $2 million to remodel and expand its facilities.

Supporting American Indian Health Governance & Leadership

Providing a platform for collaboration among American Indian health leaders to build a strong and Native-led health system.

We support the American Indian Health Leaders, a dynamic group of leaders from the Native American health departments and the urban Indian health centers. At their request, we have organized quarterly meetings since 2016.

A highlight in 2021 was the group’s decision to pursue the development of a regional treatment center for people with substance use disorders. The treatment center would provide culturally appropriate in-patient treatment and out-patient services for Native American people in Montana. With no such program currently available, many people must be sent out of state for treatment, resulting in challenges for patients and their families, high costs, and fragmented care.

The Rocky Mountain Tribal Leaders Council and five tribal health departments have passed resolutions supporting continued planning efforts.

American Indian Health Leaders Meeting Attendees, March 2022.

Reducing American Indian Health Disparities

Improving health and well-being for Native American people in Montana.

Montana’s Medicaid Tribal Health Improvement Program (T-HIP) offers an unprecedented opportunity for Native nations to create wellness and disease prevention programs. Much of our work in this area involves providing grant funding and technical assistance to support the development of these programs and convening program directors.

The pandemic highlighted the fragility of food supply chains on Native American Reservations. In 2021, we started working on new projects focusing on food insecurity, food sovereignty, and distribution.

We funded three Native-led nonprofits (FAST Blackfeet, Arlee Community Development Corporation, and Day Eagle Hope Project) and the Chippewa-Cree Indians of Rocky Boy Reservation to provide relief for food insecurity exacerbated by the pandemic and to develop frameworks for longer-term, sustainable work on food sovereignty.

The four projects distributed over one million pounds of food in the first six months and served between 2,000 and 4,300 families monthly. The longer-term food sovereignty work is ongoing.

Pounds of food in the first six months
2K - 4.3K
Families served per month

FAST Blackfeet, Thanksgiving Food Distribution, 2021

"The ability to purchase locally grown foods, share recipes, provide cooking classes, and support our neighbors is truly making a difference in our community.”

Arlee Food Resource Center
Arlee Community Development Corporation

“I want to express my gratitude for the produce boxes. Any help to provide for my family is always welcomed and greatly appreciated.”

Food Bank Recipient
Day Eagle Hope Project

Behavioral Health

We increase access to effective prevention programs, early diagnosis, and effective treatment options for people with behavioral health issues like mental illness and substance use disorders. Behavioral health is a primary issue for communities throughout Montana, many of which face a longstanding shortage of prevention programs and specialty treatment services – especially in rural areas.

Since 2015, we have increased the availability of prevention and treatment options by funding 242 projects  with $16 million. We have also leveraged our resources to help secure $49 million in federal and private grants. Primary care plays a central role in screening for, diagnosing, and treating mental illness and substance use disorders in Montana and nationally.

We focus on integrating behavioral health into primary and prenatal care to ensure these practices have the resources to provide team-based care and meet the needs of their communities. We also support a range of prevention and specialty behavioral health treatment initiatives.

Projects funded since 2015
Dollars funded since 2015
In federal and private grants

Integrated Behavioral Health

Caring for patients’ physical, behavioral, and mental health needs under one roof.

In Montana, primary care providers serve as the first line of treatment for many people with mental illness and substance use disorders. The integrated care model enables primary care providers to offer screening and prompt, effective care for common issues like depression, anxiety, and substance misuse. More severe problems are referred to a behavioral health specialist so the patient can get the care they need right away.

The pandemic increased the demand for behavioral health services as people experienced social isolation, heightened anxiety, and loss. Montana adults reporting symptoms of anxiety or depressive disorders increased during the pandemic reaching as high as 35% in 2021. For comparison, a national survey in 2019 found that 11% of U.S. adults reported symptoms of anxiety or depression.

Our goal is to ensure people can get many behavioral health needs met by their primary care provider. So far, we have helped integrate behavioral health services into 57 primary care clinics across the state. By the end of 2021, 74% of adult Medicaid patients were seen by primary care clinics offering integrated care.

In 2021, we brought on a team to provide direct technical assistance to our grantees. Our team helps each site manage changes to organizational procedures and workflows to make their programs successful and sustainable. They offer training and education to primary care teams and help sites monitor their data to ensure they provide care that improves patient health.


Barrett Hospital

After a year of planning, the project was ready to start in early 2020, right as the pandemic hit the state. Because of all their groundwork in 2019, in a matter of two weeks, they were able to get a telehealth system in place and begin providing behavioral health services remotely.

Telebehavioral health proved to work exceptionally well in rural Montana. Patients liked that they could connect with a therapist from the privacy of their homes. It made treatment more accessible for people who had challenges traveling long distances to the hospital or managing caretaking schedules. Barrett Hospital continues to provide its patients with telehealth as an option for behavioral health.

In 2021, with the help of our technical assistance team, Barrett Hospital began developing a real-time data dashboard. This dashboard will provide clinic-wide and provider-specific data, allowing providers to see their patients’ screening rates and relevant trends.

Since implementing the program, Barrett Hospital’s leadership has seen a shift in provider engagement. At first, some providers were hesitant to add screening for behavioral health issues to their already busy primary care visits and worried about how patients would respond. But, seeing how open patients were to the screening and how much the behavioral health follow-up helped, providers became more confident and engaged in providing integrated care.

In 2019, Barrett Hospital joined the Integrated Behavioral Health Initiative because what they heard in the community, saw in their emergency department, and learned from their community health assessments told them that access to behavioral health services was a critical need.

"When we started this project, we were seeing a lot of behavioral health crises in our hospital and community. Now, we are still seeing people who have mental illness and substance use issues, but we are identifying and treating them much earlier – far before they reach a crisis stage.”

Amy Wellborn, Barrett Hospital, Behavioral Health Provider

The Meadowlark Initiative®

Integrating prenatal care and behavioral health to improve maternal and neonatal outcomes.

The Meadowlark Initiative brings together clinical and community teams to provide the right care at the right time for women and families, improve health outcomes for mothers and babies, and keep families together and children out of foster care.

The Meadowlark Initiative provides routine screening for mental illness and substance use disorders to all women during prenatal and postpartum appointments as a new standard of pregnancy care. Women with any concerns identified through screening are offered evaluation and treatment options right away.

Of the 10,000 deliveries in Montana each year, Meadowlark care providers now screen more than 6,000 pregnant women for substance misuse, depression, and anxiety. Immediate treatment and support are offered when needed.

The initiative’s goal is to make Meadowlark care available in every Montana community with a delivery hospital. To date, The Meadowlark Initiative is actively supporting women in 19 communities, including 15 of the state’s 25 birthing facilities.


Care Coordination

The care coordinator plays an essential role in The Meadowlark Initiative’s community team. The care coordinator helps women schedule appointments and access available resources in the community, like safe housing, reliable transportation, and nutrition benefits. The care coordinator also acts as a liaison for women should it become necessary for Child and Family Services to become involved in the woman’s case.

The Meadowlark Initiative is a unique public-private partnership between the Montana Healthcare Foundation and the Montana Department of Public Health and Human Services.

Behavioral Health Continuum of Care

Strengthening prevention, early diagnosis, and prompt access to effective behavioral health treatment.

We support a complete continuum of behavioral health care by addressing gaps in the prevention and treatment system. We build practical, statewide approaches to preventing mental illness and substance use disorders. We also help communities respond more effectively to people in crisis, improve community-based care for individuals with behavioral health issues, and help communities implement new partnerships to address the most pressing behavioral health challenges.

The behavioral health continuum includes a range of behavioral health services – from prevention to treatment. This illustration shows the behavioral health continuum of care and how we are working with partners throughout the state to support each area.


Mental Illness & Substance Use Disorder Prevention: We help counties and Native nations implement evidence-based prevention programs like Communities that Care and the PAX Good Behavior Game.

Crisis Intervention

Behavioral Health Crisis Systems: We help communities redesign their crisis systems. By providing timely access to behavioral health services, an effective crisis system improves outcomes and helps avoid unnecessary ER visits and justice system involvement.


Community-Based Treatment: We help communities implement the Program for Assertive Community Treatment which allows people with longstanding, severe, or disabling mental illnesses to live and function safely in their homes and communities rather than being hospitalized.


Health Partnerships: We help develop partnerships between organizations that serve people with behavioral health diagnoses. For example, we support new collaborations between health care providers and the justice system. These partnerships help provide team-based care to people in the justice system, improving health outcomes and reducing recidivism.

We also help social service and health care providers collaborate to support individuals and families with complex health and social needs. For example, we help communities implement recovery-focused interventions like peer support and treatment courts. These interventions collaborate with housing and health systems to provide permanent supportive housing to individuals who frequently use emergency services.

Behavioral Health Policy:
We work on finding and implementing practical policy solutions to support the sustainable development of Montana’s behavioral health system.

Supporting Behavioral Health Organizations:
We support organizations that work to support the behavioral health system, including the Behavioral Health Alliance of Montana and the National Alliance on Mental Illness.

Strengthening the Primary Care System:
We know that most behavioral health services are provided in primary care, so we work to support a robust primary care system through our Integrated Behavioral Health Initiative and The Meadowlark Initiative.


Behavioral Health Alliance of Montana

Some of our earliest work to strengthen Montana’s behavioral health system was by uniting providers. Our goal was to incubate a collaboration that could grow into an independent platform where providers could come together and speak with one voice to guide state policy, implement new initiatives, and promote best practices.

Behavioral health providers face economic, regulatory, and workforce challenges in a rapidly evolving health care environment. They are responsible for treating some of the most vulnerable and complex patients, and they have historically lacked a unifying platform to facilitate collaboration.

With these challenges in mind, in 2016, we convened stakeholders from four behavioral health sectors (mental illness, substance use, child treatment, and adult treatment). Over two years, we facilitated a planning process to establish a new organization where behavioral health providers could meet, learn from each other, and collaborate.
In 2017, we gave the newly established Behavioral Health Alliance of Montana (BHAM) a $150,000 grant to develop a strategic plan, cultivate and grow its membership and revenues, and ensure its long-term sustainability.

BHAM is now a mature, fully independent organization that has become one of the strongest voices for behavioral health providers in the state. Behavioral health disciplines across the state can now collaborate, advocate for themselves effectively, and provide the best care possible for their patients.

Some of their contributions to strengthening the state’s behavioral health system include:

  • Bringing behavioral health providers together to identify and address common issues. For example, BHAM is developing a standard set of patient experience, and quality measures to better help providers understand if their treatment is effective.
  • Advancing the use of peer support by behavioral health providers. BHAM provided clinical supervision, training, and measurement outcomes to the state to support the early implementation of peer support by behavioral health providers.
  • Providing feedback on the adaptation of new rules. BHAM provided unified input as the state worked to implement the federal and state changes to telehealth rules during the early days of the pandemic. BHAM has continued to give feedback to Medicaid, which helps the state determine how the rules should evolve to support providers and patients.

BHAM at work

Medicaid and Health Policy

Analyzing practical policy solutions to crucial health systems challenges.

We provide reliable, high-quality information on critical health issues that impact Montanans. Each year, we produce in-depth research on health programs and timely analysis of proposed policy solutions. We provide this information so Montanans can reach informed decisions on health system issues that may impact them.

Annual Report on Medicaid in Montana

Medicaid provides health coverage to more than 275,000 Montanans. It is the state’s largest health care program and a significant contributor to state expenditures. We provide an independent analysis of the program’s performance and identify improvement opportunities.

In 2021, we released our first annual report on Montana’s Medicaid program. In this report and a companion report focused on the behavioral health system, we found:

Montana’s Medicaid program has helped thousands access preventive care annually.

In 2019, 69,000 people went to wellness exams, 65,000 got vaccines, 138,000 visited the dentist, and thousands received cancer screenings.

Medicaid expansion has supported significant improvements in the state’s behavioral health system

including increasing the system’s capacity to prevent and treat mental illness and substance use disorders. In 2020 alone, 8,600 adults participated in psychotherapy, and 3,300 received treatment for substance use disorders.

Medicaid expansion supports the economy and adds jobs.

Annually the program brings $650 million into the economy, supporting 6,000 new jobs and $400 million in personal income.  

Timely Analysis of Proposed Health Policy Changes

In addition to producing in-depth research and analysis – projects that can take a long time to produce – we also work quickly when the need arises.

For example, during the 2021 Montana State Legislative Session, Senate Bill 100 proposed to end 12-month continuous eligibility for people enrolled in Medicaid and the Children’s Health Insurance Plan (CHIP). One potential risk of this change was that some people who still meet eligibility requirements might be disenrolled if they failed to receive or respond to re-verification notices. This risk could be highest for Medicaid enrollees with severe health and social issues for whom health coverage is essential – for example, people who are homeless and those with complex medical and behavioral health conditions.

To better assess these risks, we asked national Medicaid eligibility experts at George Washington University to analyze the bill's potential impact on Montanans. Their rapid analysis estimated that about 22,000 Medicaid and CHIP beneficiaries could lose coverage because of the proposed change, among them many people who still met the criteria for enrollment.

The analysis received statewide news coverage and was cited in legislative hearings.


Sharing Resources with Montanans

When we produce a study or analysis on a health topic that impacts Montanans, we work hard to get that information out as broadly as possible. We do this by sharing our reports with the news media, other organizations who work in the health and policy arena, and all our stakeholders. Our goal is for Montanans to have access to all the facts so they can make up their minds on issues that could impact them. 

In 2021, our reports earned 16 different stories and were covered by print, radio, and TV outlets statewide.

Strengthening Public Health

Strengthening Montana's public health system by supporting Native American and county health departments.

Public health plays a vital role in protecting and improving the health and well-being of Montana communities. We work to strengthen the public health system by funding local and tribal health departments, public healthwork force initiatives, and supporting Confluence Public Health and the Montana Public Health Institute.  


Montana Public Health Institute

The Montana Public Health Institute (MTPHI) is a new organization working to strengthen the state’s public health system through collaboration, leadership, and the advancement of health equity.

Spurred by the pandemic’s demand on local health departments, we supported the launch of MTPHI – the state’s first public health institute – in 2020 after an intensive two-year planning process. Nationally, independent, nonprofit public health institutes work closely with public health agencies and private sector stakeholders to provide a range of capacity-building services, including technical assistance, evaluation, policy analysis, and programming.

2021 was MTPHI’s first full year of operation. It hired its first CEO, Matt Kelley, and two additional full-time staff. With a team that has extensive experience in leading public health departments and deep relationships in the community, MTPHI quickly developed its capacity and began providing support to local and state public health departments.

Over the past year, MTPHI played a significant role in the state’s pandemic recovery efforts by analyzing the needs of local health departments and addressing critical technical assistance needs. It also looked beyond COVID-19 to other community needs where public health could play a role.

Some of the specific ways MTPHI is working to support and strengthen the public health system include:

Behavioral Health

Mental health and substance use disorders quickly emerged as a significant focus for MTPHI, driven by community health assessments that found these to be top priorities in all areas of the state. MTPHI is working to enable county and tribal public health departments to lead in building community resilience and responding to mental illness and substance misuse.  

During the pandemic, MTPHI helped local health departments deploy federal emergency funds to address mental health crises in their communities. With our support, MTPHI is doing an environmental scan of behavioral health interventions.

Environmental scans identify the interventions that would work best in the community. The scan focuses on working upstream from behavioral health crisis and treatment, shifting resources and emphasis toward building resilient communities and preventing people from needing emergency services.

Public Health Leaders

The pandemic resulted in considerable local public health staff turnover. As a result, many counties and tribes now have health officials who are new to public health and need education and support as they grow into their positions.

MTPHI staff have extensive experience running local public health departments. They are applying their skills statewide to help new leaders learn the skills needed to run an effective public health program. MTPHI also works to support more experienced public health officials, many of whom have weathered the difficult days of the pandemic, with communities of practice, technical assistance, and direct consultation as they work to rebuild and transform our public health system.

Public Health Communications

During the pandemic, local health officials faced a sometimes-overwhelming demand for timely, accurate information on a rapidly evolving crisis. After completing over 30 reviews of local public health departments’ COVID-19 response, MTPHI saw a clear need for communications training and capacity. So, it began providing resources to help local public health departments clearly and effectively communicate about the things their communities need to know.
To help meet this challenge, MTPHI is hosting temporary staff detailed by the CDC Foundation to work with local health departments to design communications strategies and build staff skills. The staff person also worked with the University of Montana to create communications coursework for the School of Public and Community Health Sciences so that future public health leaders can get the training they need.

MTPHI serves as the connective tissue of our public health system. It connects resources and expertise at the local level with local and tribal health departments and at the state level with universities and the Montana Department of Public Health and Human Services. It is doing the work to help local and state agencies collaborate and work together for a common goal so that the state’s entire public health system is stronger.

School-Based Health Initiative

Improving health and academic outcomes for students by supporting new partnerships between schools and healthcare providers.

The School-Based Health Initiative supports quality, convenient health care for students and their families in a safe, familiar place. We support partnerships between schools and health care providers to create school-based health centers in communities that need them most. Providing health services in school settings helps kids stay in school, leading to better academic outcomes. We launched this initiative in 2020 and have seen it grow rapidly despite the pandemic’s impact on schools and health care providers. So far, we’ve supported seven health providers to plan and start delivering essential health services in 14 of the state’s highest-need schools. To date, the sites have provided services to over 900 patients.

School-based health centers are flexible and can provide services based on the needs of each community. For example, some health centers offer services in the school building, others bring a mobile unit to the school, and some provide telehealth services. The health centers provide a range of health services, including primary care, behavioral health, and dental.


Greater Valley Health Center

Greater Valley Health Center is partnering with Kalispell School District and Evergreen Schools, located in the Flathead Valley. It has school-based health centers set up in the schools and provides primary care and behavioral health services to students, school staff, and the community.

Since opening its doors in June 2020, it has treated over 600 patients.


Alluvion Health

Alluvion Health is partnering with the Vaughn School District K-8 school, located northwest of Great Falls. It provides primary care and behavioral health services at a health center on the school property and dental services through a mobile unit. Its services are available to students, school staff, and the community. Since its operation began in April 2021, it has treated over 150 patients.

Alluvion Health, School-Based Health Center and Mobile Unit

Housing is Health Care

Developing permanent supportive housing projects to improve health outcomes and reduce costs.

We are helping Montana communities develop permanent supportive housing projects for people who are homeless and frequently need emergency services. Supportive housing is unique because, in addition to providing housing, it also offers on-site services such as tenancy support, employment assistance, and medical and behavioral health care. These additional services help people address the issues that may have led to homelessness in the first place.

About 5% of patients account for 50% of health care costs. Many of these people are homeless or have co-occurring mental health issues, substance use disorders, and physical health problems.

A safe place to live paired with supportive services is a cost-effective way to improve health outcomes and reduce the need for high-cost emergency services – like visits to the ER or interactions with law enforcement. An analysis by Boise State University found that supportive housing results in a 50% to 89% reduction in ER use.

Through this initiative, we support permanent supportive housing planning and implementation projects across the state. In 2021, implementation projects provided supportive housing units for 28 people in Missoula, Great Falls, and Bozeman. Communities with projects in process include Helena, Butte, and Billings.

A Montana study of supportive housing programs found that it costs about $500 each month to provide supportive housing services for one person. However, each person successfully housed can lead to over $2,000 each month in Medicaid savings.

Reduction in ER use
28 people
Housed & supported in Missoula, Great Falls, and Bozeman

Cornerstone Supportive Housing Units, Missoula

Tiny Home Village, Bozeman

Grant Application Assistance

Leveraging our resources and expertise to create a greater impact.

We help organizations throughout the state apply for federal, state, and private grants for projects that will advance solutions to high-priority health problems. We use our funds and staff expertise to support grant writers, conduct data analysis, convene potential partners, and develop strategies.

Since we began this work in 2016, we have brought $91 million into the state. We brought in $8 million in 2021 with a return on investment of 5,597%.

Dollars brought since 2016
Dollars brought in 2021
Return on investment in 2021


Eastern Montana Community Mental Health Center

In 2021, the largest grant award received was $3.6 million to the Eastern Montana Community Mental Health Center (EMCMHC) from the Substance Abuse and Mental Health Services Administration. We supported the grant application with a $6,000 contract along with staff time to help with project planning.

With this funding, EMCMHC was able to expand its Montana Assertive Community Treatment (MACT) program to four additional counties in Eastern Montana, support mental health services for adults and children in the region, update its records system, and provide resiliency training to its staff.  

MACT is a behavioral health delivery model explicitly designed for rural and frontier areas. MACT teams are made up of multidisciplinary groups of licensed staff and paraprofessionals available anytime to go out into the community and provide care for people wherever they are.

By providing community-based mental health treatment and connections to other health and social services, MACT helps people with longstanding, severe, or disabling mental illnesses to live and function safely in the community.  

With support from the Behavioral Health Alliance of Montana, the Addictive and Mental Disorders Division, and a $200,000 grant from the Montana Healthcare Foundation, EMCMHC started its MACT program in 2020.

MACT provides community based care.