Montana Launches Services for Former Inmates’ Riskiest Period

HELENA — Montana has launched a groundbreaking program providing behavioral health services to formerly incarcerated individuals during the critical 30-day period before and after their release from state prison.

Governor Greg Gianforte announced Wednesday the launch of the Healing and Ending Addiction through Recovery and Treatment (HEART) Initiative Reentry Program, following federal approval of a Medicaid waiver that allows the state to overcome longstanding barriers to continuity of care.

The program targets what corrections officials describe as the highest-risk period for overdose, hospitalization, and crisis among formerly incarcerated individuals.

“This initiative represents our continued commitment to ensuring incarcerated Montanans can fully and successfully reintegrate into the community,” Gianforte said. “By offering sustained support to those with behavioral health needs, we are working to give Montanans the help they need to rebuild their lives after exiting the correctional system.”

Until now, federal Medicaid law’s “inmate exclusion” provision prohibited coverage of services for incarcerated individuals except for inpatient hospital care. Montana is among 11 states that have received federal approval to waive this restriction and provide limited Medicaid-covered services to adults in state prisons with behavioral health needs.

The federal Centers for Medicare and Medicaid Services began encouraging states to apply for these waivers in April 2023, representing a significant shift in federal policy toward addressing gaps in care during prison-to-community transitions.

“We know that unmet behavioral health needs contribute to cycles of incarceration, leading to the shared interest from DPHHS and DOC in this initiative,” said Department of Public Health and Human Services Director Charlie Brereton. “This program allows us to proactively connect individuals to care to improve their chances of success post-incarceration.”

The program provides medication-assisted treatment, case management services, community-based clinical consultation, and a 30-day supply of medication upon discharge. Services begin 30 days before release, allowing individuals to establish relationships with community-based providers who continue supporting them after discharge.

“It is our mission to rehabilitate and empower the people under our supervision by providing them with the tools to successfully return to Montana communities,” said Department of Corrections Director Brian Gootkin. “This investment in their overall well-being through the HEART Initiative delivers much-needed support during a critical time as they set the framework for a future beyond the cycle of incarceration.”

The reentry program launches alongside Montana’s broader criminal justice reform efforts. Earlier this year, the Montana Legislature passed House Bill 718, establishing an Office of Reentry Services at the Department of Labor and Industry to coordinate job training, housing assistance, and other support services for formerly incarcerated individuals. The office will play a key role in the governor’s 406 JOBS initiative, which targets more than 100,000 working-age Montanans who have left the workforce entirely despite the state having nearly two job openings for every unemployed person.

The reentry program is part of Montana’s larger HEART Initiative, which includes several controversial components. Montana is also among only three states approved to use Medicaid funds for “contingency management”—a program that provides financial incentives to individuals who test negative for stimulant use.

Research shows contingency management is the most effective treatment for methamphetamine and cocaine addiction during treatment, but long-term success rates remain low, with participants showing only a 22% better chance of staying clean compared to other treatments after payments end.

The state has also invested $2.7 million in grants to seven county detention centers for jail-based therapeutic services in Yellowstone, Missoula, Lewis and Clark, Gallatin, Butte Silver-Bow, Cascade, and Custer counties.

According to federal data, about two-thirds of released prisoners are arrested for new crimes within three years, with the highest risk period occurring in the first days and weeks after release. Montana’s program specifically targets this critical transition period with evidence-based behavioral health interventions.

“This is a smart, preventive investment that will benefit Montana communities,” Brereton said.