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ebruary 2000


[1/Vf 1 2000

3 0864 0016 2579

Department oTPublic Health & Human Services

February 2000

17* A T1\/f TT Changes Considered for
r AliVl 111 State Public Assistance

In planning for the 2001 Legislature, the state human
services agency is asking the public for ideas on how to
better serve public assistance recipients — those who rely
on benefits like Food Stamps, cash assistance and
childcare assistance, for example.

A series of 25 town meetings in 18 different communities
began Jan. 13 in Billings and concludes Feb. 11 in Bozeman.
Meeting information is available at each County Office of
Public Assistance, and letters encouraging participation have
been mailed to interested parties. The meetings, coordinated
by Kim Brown and Patty Guiberson of DPHHS, will provide
the public with information about areas that can be changed
under federal guidelines, those areas that cannot be
changed, and most importantly will serve as a gathering point
for brainstorming.

"This is an opportunity for all interested parties to share
their observations," said Hank Hudson, administrator of the
Human and Community Services Division in the
Department of Public Health and Human Services. "We
have perceptions on strengths and weaknesses in the
system, but we need to expand them by hearing more
from the public. We know sanctions are a concern, and
there are barriers to employment and issues to address
with Native Americans — these are the types of issues we
want to explore."

In 1996 Montana initiated its present public assistance
system — FAIM, or Families Achieving Independence in
Montana. The program was intended to be flexible and
evolve, and in that vein Phase II of the FAIM program is now
being drafted to bring before lawmakers. "Our draft plan for
Phase II will be determined in large part by the comments we
receive from the public," Hudson said. He added that recent
changes in federal program regulations give states flexibility
in areas where little or none existed.

Residents who want to share comments can write: FAIM
Phase II, Kim Brown and Patty Guiberson, Public
Assistance Bureau, DPHHS, Box 202952, Helena, MT
59604-2952. Comments will also be accepted
electronically by using the DPHHS website
( under What's Hot, FAIM II) or by
directly e-mailing ([email protected]).

(continued on Page 8)


American Heart Month
Low Vision Awareness Month

February 8

State Advisory Council on Food and Nutrition
10 a.m. to noon — Cogswell BIdg Rm C209B
Contact: Crystelle Fogle 444-2672

February 9

Health Now HMO Status Meeting
8:30 - 1 1 a.m. — Great Falls Clinic
Contact: Amy Solich, 444-4148

February 11

Dental Access Coalition

Legislative Preparation Meeting

10 a.m. to 2 p.m. — Cogswell BIdg Rm C209B

Contact: Cheri Seed 444-0276

February 14

8 p.m. - PBS Broadcast on Financial Planning
Contact: 1-800-332-2272

February 15

9 a.m. to noon

Nursing Facility Reimbursement Work Group
Cavanaugh's Colonial Inn, Helena
Contact: Betty Lattin 1591

February 15-17

Meeting of Public Assistance County Directors
Jorgenson's Holiday Motel, Helena
Contact: John Gardner 751-5900

February 21

HOLIDAY— President's Day

February 22-23

Native American Advisory Council — Helena
Contact: Kathy Deserly 406 444-9748

February 23

Tobacco Prevention Advisory Council

10 a.m. to 3 p.m. — Colonial Inn, Helena
Contact: Jan Mclnerney 444-7408


A Message From the Director: BUDGET TALK

Laurie Ekanger
DPHHS Director

You may be aware that the DPHHS
budget was the subject of discussion
during a recent legislative interim
committee meeting on mental health.
The question: Did the 1999
Legislature appropriate enough
money to meet DPHHS program
obligations for this year?

The honest answer is — we don't
know for sure, and here is the reason
why: We don't know how much
health care costs will inflate. I've
been involved for over a decade in
trying to predict health care costs, first with our state
employee group benefit plan and now with the Medicaid
health plan. Generally we've done as good a job or better
than anyone else, but it is not possible to precisely predict
the future. And keep in mind, with the Medicaid program,
a 1 -percent variance equals $1 million in state general
fund money because the program costs about $100
million in state funds per year (and another $280 million in
federal funds).

Our budget for this biennium was built on projections
made a year ago. If our projections are 98 percent
accurate, we could have $2 million extra state funds this
year. But if costs are 1 02 percent of projections, we are
short $2 million. Right now it is too close to call.

The state employee health plan can maintain a reserve
fund to allow for these variances because the premiums it
collects are employee money. Private insurance programs
have the same flexibility. The Medicaid program is not
allowed such a reserve.

Legislators and the Governor's Budget Office naturally try
to cut projections close. Because there are so many
demands for state money, they do not want to tie up
unnecessary funds in the Medicaid budget. The
predictions are based on the best information and models
we have, but they are still a gamble every session. No
one on earth knows for sure what will happen with health
care costs. A variety of factors contribute to the cost —

Electronic Distribution Beginning

Starting this month, an Internet link to DPHHS newsletter
articles will be electronically mailed to state employees who
are on our distribution list. Readers outside state
government who wish to receive newsletter articles by
computer can send their e-mail address to Ken Pekoe
([email protected]).

To help coordinate the transition, the February edition will be
circulated both electronically and on paper to DPHHS
employees. Employees who have e-mail but did not receive the
newsletter electronically should contact Pekoe via Outlook or at
444-2596. Employees without Outlook and those who prefer
paper newsletters can still receive the traditional version.

Again, the electronic mailing will contain an Internet link that will
take users to the newsletter articles on the DPHHS website.
This method is quick and takes up minimal system resources.
Moving to the electronic system will better assure that all
employees are directly receiving access to the newsletter, and
we estimate significant savings in annual postage and printing.

new medicines, new diseases, new treatments, the ebb
and flow of illnesses and health care price fluctuations to
name a few.

So far this year the cost of prescription drugs is running
much higher than we projected. This is a national trend/
problem. Also, last fall the federal government cut federal
funding in Title XX of the Social Security Act by $1 .3
million; this money was for our Developmental Disabili-
ties Program. We had alerted the 1999 Legislature to this
possibility and they inserted language in House Bill 2
directing us to "backfill" any Title XX cuts from our state
Medicaid funding (counting on projections being at least
1 percent too high). In addition, our cost for Department
of Administration computer services, including the new
accounting system, was under-funded by almost $1

During fiscal years 1983 through 1995, Medicaid benefit
costs grew annually at rates ranging from a low of 6.3
percent to a high of 20.6 percent, averaging 11.8 percent.
Then in fiscal 1996 growth slowed to 4.4 percent and
then to historic lows of 0.5 percent in FY97 and 1 .5
percent in FY98. This generally reflects national trends,
but the significant slowing in cost escalation in Montana
is also the result of cost control measures made by our
Medicaid experts and the success of Montana's welfare
reform. I honestly never thought I'd live to see such small
health care inflation in any program! For this biennium
Montana's projected grow/th rates are 2.45 percent for
FY2000 and 3.25 percent for FY2001 , although national
projections have been about 7 percent per year.

We are still hoping that we are accurate. We only have
six months of Medicaid claims data available to project
costs for this fiscal year, and health care providers have
up to 12 months to bill us. So, as you can see, too many
variables remain to confidently know how our budget will
look in the end.

But rest assured: DPHHS will continue to run high-quality
programs in the most cost-conscious way.

Be Wise In Use Of Internet

As a reminder to employees, inappropriate use of the Internet is

an increasing problem.

According to Lynne Pizzini, state network security officer, several

agencies are experiencing system problems due to heavy Internet

use. Some state employees are downloading Internet programs

with such things as radio programs or screen savers that

automatically update.

According to state policy, such use of the Internet is not

appropriate. These types of uses can slow the network down,

cause degradation of service, and in some cases lose complete

connectivity for legitimate state business, such as email and

mainframe applications.

DPHHS does allow personal use of the Internet during lunch and

break times, with the exception of gambling or anything that is

inappropriate (i.e. sexual, violent, etc.) or not reasonable due to

system resource limitations.

If you are in violation of this privilege, please refrain from doing

so to allow all employees the benefits of quicker service for

network applications.

If you have any questions about this, contact Pizzini at 4444510.

Public Meetings IHighlight Tobacco Prevention Efforts

The state Advisory Council on Tobacco Use
Prevention recently held statewide public
meetings to present and discuss Montana's draft
comprehensive plan designed to diminish
tobacco use.

The meetings took place Jan. 31 through Feb. 3,
but the Council is accepting public input about
the plan through Feb. 10. Anyone wanting to
provide comments can do so via:

♦ Electronic mail (from the DPHHS
website or to
[email protected])

♦ Postal mail (Tobacco Use
Prevention Plan, Box 202951, Room
C317, Cogswell Building, Helena,
MT 59620-2951)

♦ Facsimile to Jan Mclnerney (406-444-7465)

Public meetings took place in Kalispell, Missoula,
Great Falls, Glendive and Billings. In addition, a
dozen sites were linked to the Kalispell meeting
via interactive videoconference.

"Smoking and spit-tobacco use are high-priority
health concerns to Montanans. Residents need
to be aware of this plan and become involved
with its development," according to Jane Smilie,
who is overseeing the project for the Department
of Public Health and Human Services. "We all
have a great opportunity to make a huge
difference in Montana's future health status."

The draft plan, developed over three months by
DPHHS staff and the 24-member Advisory
Council, was made public Jan. 18. Copies are
available on the Internet (http://
draft_comprehensive_plan.htm) or by calling
DPHHS at 406-444-5508. Summary and full-
length versions are available.

Ultimately, the plan will help advise DPHHS
how to spend nearly $8.5 million in state and
federal funds over the next 18 months. State
funding comes from the national settlement
with tobacco manufacturers, and the federal
portion is from a competitive grant awarded
last summer to Montana from the U.S.
Centers for Disease Control and Prevention.

The plan will guide DPHHS in creating, or in
some cases expanding, programs that focus on
preventing kids from starting to smoke or using
spit tobacco; helping tobacco users quit;
protecting people from secondhand smoke;
restricting tobacco advertising; and eliminating
sales to minors.

Once the draft plan is finalized and enacted —
likely this spring — the Advisory Council will
continue to function in an oversight capacity to
ensure well-coordinated, effective efforts
between state and local programs.

DPHIHS Assisting, Advising in Libby Asbestos Situation

For the past two months, DPHHS has been working closely with other state and federal agencies to
monitor and assess health risks in Libby related to asbestos exposure.

In November, newspapers began reporting about significant instances of disease and death stemming
from exposure to asbestos dust from a vermiculite mine near Libby. The mine was open for several
decades, but closed in 1990.

For DPHHS, the key questions are whether there is a present health exposure risk and whether residents
who never worked at the mine are suffering from illness related to the dust. State Epidemiologist Dr. Todd
Damrow and Medical Director Mike Spence, M.D., are leading the DPHHS efforts.

According to Damrow, DPHHS is involved in two main ways:

♦ Assisting Lincoln County officials and residents in understanding processes and roles, particularly
health officer Dr. Brad Black and staff at St. John's Lutheran Hospital.

♦ Supporting federal involvement in any way. The key federal agencies are the Environmental Protection
Agency and the Agency for Toxic Substances and Disease Registry.

Preliminary results will be available this month to determine whether a present health risk exists.

Damrow mentioned that federal workers in Libby have been impressed with the information and
cooperation they have received from DPHHS, especially in terms of mortality data supplied by the
Vital Statistics Bureau.

Nutrition for babies: What, when and how to feed infants

Feeding babies is one of the most critical jobs that new parents have. Infants need the right balance of

nutrients at the right time so that they can grow and develop into normal, healthy children.

Fortunately, the basic timeline for feeding babies is really quite simple. Throughout the first year of life,

breast milk or iron-fortified infant formula is a baby's most important source of nutrients and calories.

By four to six months, most babies are physically ready to begin solid foods. "Starting solids too early can

be fiiistrating for infants, parents and other caregivers," says Annette Peterson, MS, RD (Registered

Dietitian). "If babies aren't ready, most of the food ends up on laps and clothes rather than in your baby's

tummy. Peterson also cautions against an old myth: Solid foods do not make babies sleep through the night.

In fact, offering solids too soon can stress an infant's immature digestive system and increase the risk of

developing food allergies.

Instead of rushing to begin solids, parents can tell if baby is ready by paying careful attention to

developmental changes. "For safe and successfiil spoon-feeding, infants need to be able to sit up

with only a little support," says Peterson. "They need plenty of tongue coordination, so they can

move food fi-om the fi-ont of the mouth to the back." Doubling of birth weight is another

sign that it may be time for solid food.

For a common sense guide to feeding kids of all ages, check out a copy of How to

Get Your Kid to Eat... But Not Too Much, by Ellyn Satter at your local library or

bookstore. The Montana WIC Program also provides information on infant feeding at 1-800-433-4298.

IRON: How to pump up your intake

Infants, children, teens and women are more likely to have low iron intakes than other people. Breast milk, iron-
fortified formula, and iron-fortified cereal are the best iron sources for babies. Here are some ways for children and
adults to get the iron they need.

Take supplements recommended by your
health provider.

Your doctor or nurse may suggest vitamins with iron. In some
cases, they may also prescribe a separate iron supplement. If
these pills seem to cause stomach upset or constipation, talk to
your provider about ways to minimize problems.

Eruoy plenty of tasty high- iron foods,
including fortified products.

Food is also an important way to get the iron you need.
Check out the list on the right - find foods you enjoy for
breakfast, lunch and dinner.

Eat sources of heme iron (animal foods) &
non-heme iron together.

You can increase the amount of iron your body absorbs by
eating heme and non-heme iron foods at the same meal
(see list for sources of both).

Combine vitamin C-rich foods with iron
foods and supplements.

Vitamin C foods can also help iron get into your body Take
vitamins with a glass of orange juice; slice a few strawberries
into your bowl of iron-fortified cereal; or enjoy a piece of
cantaloupe with your peanut butter sandwich.

Use cost iron cookware if possible.

You can get more iron into food by using cast iron pots and
pans - especially for foods that are acidic (like tomato
sauce) and simmer for a while.

Counting Up IRON in Food

FOOD Approximate IRON (mgs.)


Beef liver, braised (3 ozs.) 5.8

Lean beef sirloin, broiled (3 ozs.) 2.9

Tuna, light canned (3 ozs.) 2.7

Lean ground beef, broiled (3 ozs.) 1 .8

Lean pork tenderloin, roasted (3 ozs.) 1.3

Skinless chicken breast, roasted (3 ozs.) 1.0

Salmon, canned with bone (3 ozs.) 0.7

Cod, broiled (3 ozs.) 0.4

Fortified breakfast cereal (1 cup) 4.5 - 18.0

(Amount varies, read Nutrition Facts label)

Pumpkin seeds (I oz.) 4.2

Soybean nuts, toasted (1/2 cup) 4.0

Blackstrap molasses (1 tablespoon) 3.5

Spinach, cooked (1/2 cup) 3.2

Kidney ijeans, cooked (1/2 cup) 2.6

Lima beans, cooked (1/2 cup) 2.5

Prune juice (3/4 cup) 2.3

Pretzels, enriched (1 oz.) 1-3

Rice, enriched cooked (1/2 cup) 1-2

Raisins, seedless (1/3 cup) 1-1
Prunes, dried (5) 1-1

Whole wheat bread, enriched (1 slice) 0.9

Green beans, cooked (1/2 cup) 0.8

White bread, enriched (1 slice) 0.7

Egg yolk, large cooked ( 1 ) 0.7

Peanut butter, chunky (2 tablespoons) 0.6
SOURCE: The American Dietetic Association 's Complete Food and
Nutrition Guide (1996)

Outreach Coordinator Helps Boost Children's Health

The DPHHS Children's Health Insurance Plan
(CHIP) recently added Ernie Saxman as Its
Outreach Coordinator, allowing the program
to begin a focus of securing health insurance
for thousands of uninsured Montana children
in 2000.

Many of the eligible children are from
working families that might not realize their
children qualify for CHIP or other free, or low-
cost, insurance programs. There are also families
that no longer qualify for public assistance, but may
qualify for health programs for their children.

"Our outreach efforts will focus on these families,
and others, in order to reduce the cost of health care
for children and to make the outreach efforts as
efficient and successful as possible," Saxman said.

Outreach for CHIP is taking place in two main
ways through community-based groups located
throughout Montana. First, a contract with Healthy
Mothers-Healthy Babies has utilized 14 "Covering
Kids" advocates, and second, 29 additional

contractors are doing combined outreach. The
work is being tailored to the specific needs of each

CHIP is a health insurance plan that provides
coverage to Montana children who do not qualify
for Medicaid due to income or resource limitations.
Depending on family income, CHIP is offered
either free or at low cost. CHIP provides health
insurance that is purchased from private health
insurers, such as BlueCHIP from Blue Cross and
Blue Shield of Montana. Children may be eligible
for CHIP if they are from families with income up to
1 50 percent of the federal poverty level and are not
Medicaid eligible.

Enrollment information is available
through the Montana CHIP office
(1-406-444-6971), Family Health
Line at Healthy Mothers-Healthy Babies (1-800-
421-6667) and the National CHIP Information Line
(1-877-KIDSNOW). If you know someone who
might qualify, please contact one of these


Statewide Breast and Cervical Cancer Screening Services Offered

The state program that coordinates breast and cervical cancer education and screening for uninsured and
low-income women throughout Montana is hoping to provide health services to 2,000 women in 2000.

The Montana Breast and Cervical Health Program oversees statewide services through a dozen
administrative sites in Montana, providing breast and cervical cancer education, clinical breast exams,
mammograms. Pap tests, and diagnostic tests to eligible women. The program also features an American
Indian focus for reservation residents through St. Vincent Hospital in Billings. About 2,500 women have
been screened — but an estimated 7,000 are eligible, according to the Department of Public Health and
Human Services.

The program, funded by a grant from the U.S. Centers for Disease Control and Prevention, is hoping its
community outreach efforts and a statewide provider network will persuade more women to seek services
and reduce the potential for undiagnosed, untreated illnesses.

Throughout its history, program officials have worked to make screening access as easy as possible and
to educate health care providers about the program and its eligibility criteria.

"We have providers enrolled in all areas and they are ready to serve," program manager Sue Miller said.
"Our goal is to screen 2,000 women in 2000, bringing our total services to 4,500 by next year. Of course,
we'd like to serve all eligible women."

Women age 50 through 64 are eligible for services as long as they are uninsured or underinsured and
have a household income at or below 200 percent of the federal poverty level ($16,480 per year for a
single-person household, or $22,120 in combined income for a two-person household). After age 65,
Medicare pays for an annual exam.

Services through the program are available to all eligible Montana women.
1-888-803-9343 or contact the administrative site nearest you:

American Indian Outreach 237-3082
Billings 247-3215 Bozeman 582-3107 Butte 749-5080

Great Falls 454-6950 Havre 265-251 9 Helena 443-2584

Lewistown 538-8811 Missoula 829-4167 Shelby 434-3202

For more information, call

Glasgow 228-3500
Kalispell 758-5733
Sidney 482-2207

Community Cooperation Leads to Record Award for Homelessness

Congratulations to the DPHHS Intergovernmental
Human Services Bureau, Jim Nolan and the
statewide Continuum of Care organization for
securing a record $1.35 million award to provide
services to Montana's homeless residents.

During a Jan. 12 recognition ceremony at
Golden Triangle Community Mental Health
Center in Helena, Gov. Marc Racicot recognized
the achievement alongside Continuum of Care
representatives from Bozeman, Butte, Hamilton,
Helena, and Missoula.

"We know that Montana's communities are only
as strong as their most vulnerable members,"
Racicot said. "The neediest Montanans will have
new resources and opportunities to live
healthier, brighter futures" thanks to the
Continuum of Care efforts.

On Christmas Day, President Clinton announced
Montana's award of $1 .35 million as part of a
national announcement of $750 million in HUD
Homeless Continuum of Care assistance. The
Continuum of Care approach brings together
non-profit groups, the private sector, and local
and state governments in partnership to design
local community programs to help homeless
people become self-sufficient.

DPHHS has taken the lead for the past three
years creating a statewide Continuum of Care
planning process through Montana Human
Resource Development Councils. This effort
linked Montana continuum of care providers,
local governments, banks and other
stakeholders. The goals were to create effective
programs to assist homeless families and
individuals in obtaining self-sufficiency, and to
submit a single, statewide application for
Continuum of Care funding.

Montana is the only state that has a complete
statewide planning process to create, evaluate,
rank, and prioritize homeless programs to fill
gaps in care, all under one funding application.

Montana's approach was recognized in
November 1999 with a national Best Practices
award from US HUD Secretary Andrew Cuomo.
The ability of Montana communities to work
together in a statewide effort contributed to the
record funding for 2000.


Five Montana community programs will
benefit from the $1 .35 million award:

Bozeman: Human Resource Development
Council of District IX, Inc. $77,500 to help
construct Transitional Housing for Families
who are homeless. Contact: Jeff Rupp


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