Government

“Sober Living” Law Aims at Making Effective Solution, Better

17 January 2023
Evelyn Pyburn
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Over time, issues and concerns have been brewing regarding what is commonly referred to as “sober living” residences. With some 37 such facilities located in Billings  – more than any other Montana city –  concerns have grown right along with their increasing number. It is hoped, proposed legislation will deal with the problems.

“Sober living” houses offer a structured environment, for people in recovery who need a safe and substance-free place to live.  They are also commonly known as recovery homes or recovery residences. They do not provide treatment, but a safe, stable place in which to live. In Montana, the state government helps to pay the rent at $500 a month for three months, for those who have been released from correctional facilities, which usually comprise the majority of recovery house residents.

Others in need of a safe and stable place to live may also be referred to a recovery facility and in some cases a facility may specialize in offering shelter for specific categories of individuals, such as mothers with children.

The neighborhoods in which the residences are located often encounter problems— if not by the sheer number of people consuming available parking spaces, to the lack of supervision at a facility, or failure to notify supervising law enforcement officers if a parolee is ejected from a house.

SB-94 has been introduced in the state legislature aimed at tightening up the rules on “Sober Living” residences, which have been operating with very little oversight.  Primary sponsor of the bill is Senator Barry Usher, Billings, who is a member of the Criminal Justice Oversight Council and heads the Legislature’s Judiciary Committee. Also on the committee and a member of the Council, is Kathy Kelker, Billings, who also co-sponsors of the legislation.

Scott Twito, Yellowstone County Attorney, is also a member of the Criminal Justice Oversight Council. As someone who deals with issues of parole violations and recidivism of criminals, Twito believes that without any oversight, a sober living house increases the likelihood that those on probation or parole will reoffend.

The only requirement imposed on a recovery residence, by any entity of government, is to have a business license from the city. There are HUD recommendations that any residence should have only two people to a bedroom but that is in no way monitored.

While Twito understands and appreciates the benefits recovery residences can provide, he has also seen how the poorly-managed facilities can impair any progress an individual might make by putting them into a facility that does not restrict the presence of alcohol and drugs, and with other residents who may be pushing those things.

Billings has experienced an “incredible increase” in the number of sober living homes, points out Twito. The number of houses in Billings has been steadily increasing since 2019.   The next largest number of sober living houses is in Helena, with six.

Twito said that he has heard discussions on the Council and from other state leaders, that places like Missoula and Bozeman don’t have as many residences because they “really pushed against them and did not facilitate their establishment.”

Given the limited requirements on a residence, and a $500 per bed incentive, there is inducement to crowd as many beds into a facility as possible. It has been reported that some owners have put as many as 15 “cots” in a basement.

 The DOC has spent almost $1 million in rent subsidies on the program.

It is also likely that because Billings is a hub for mental health and other treatment programs, that many people in the state who need help, come to Billings.

Twito points out that several owners operate more than one facility. Three owners account for half the residences in Billings.

Among complaints that have been raised about the presence of “sober living” houses is that there is no process of letting the public  know they are being opened in their neighborhoods or what they bring to the neighborhood. The facilities may be housing violent offenders, people on parole for homicide, or convicted rapists.

City planning officials have pointed out that the residents are viewed no differently than any single-family residence. They are not considered boarding houses. Under law the city is not allowed to discriminate, based upon age, disability or handicap, in how they regulate.

Encouraging the implementation of the new law are Richard and Terri Todd, who started one of the first “sober living” homes in Billings, and today oversee four such homes. They, too, are perplexed about how some of the homes function. “What was once an asset to the community is becoming a liability,” said Richard.

The Todds are urging that a “sober living home” be certified with a national organization and to meet their protocols and guidelines.

“Not all sober living homes are really sober living,” said Richard. Many are more like a “work camp.” “There is no structure…without structure residents are likely to go back to drinking and using drugs and have to be removed.”

Both Todds have had their own struggles and have been in prison themselves. It was through their recovery and personal experiences that they recognized what individuals need to successfully reclaim their lives. The Todds say they recognized that “there was a time when it became important that people have a safe place so they can put their recovery first and to help themselves.”

And, they say, recovery “takes someone who can relate to them.”

The Todds started their first “sober living” home in Billings in 2016. Their four residences operate under a non-profit called Ignatius Sober Living. Although they are not affiliated with Alcoholics Anonymous, the Todds’ residences follow the 12 -step emersion program.

The couple quickly learned that they needed help and joined a national organization to become certified. The organization provides direction and training and regular conferences, which they attend, as do the managers in each of the homes.

“If we are not operating within the guidelines, the members have a place to go to report it,” said Terri. Historically, “if you look into ‘sober living’ there has been some horrific things that have happened to members.” To be certified by a national organization protects the members as much as the home owners.

Recovery residences have gained a footing in the country as an effective means to recovery because when properly administered and supervised, they work! Studies have shown that recovering individuals are less likely to relapse when living in a recovery residence.

“Often family and friends want to help,” said Richard, “but they don’t know how.”

A “sober living” residence offers support and structure that a family cannot give, no matter how much they want to help. “In sober living there is a thin line between helping and enabling,” said Richard.

Citing reports of city law enforcement that claim that there is a group of less than a hundred people in Billings who consume $18 million of city resources because of their recidivism, Terri said that through their recovery houses and treatment at places like Rimrock Foundation, she personally has seen seven of the individuals on that list break free and regain their lives.

Over the seven years that the Todds have been operating, they estimate that about 2500 people have passed through their homes – some for only a few days and others as long as three years.

In 2019, a study done by the National Institute of Health examined the net benefit of recovery residences and determined that there was a gain of $29,000 to the community, every six months, for each recovery resident, because “they are not utilizing services at such a rapid pace,” said Terri.

“We have been super blessed. We have had people who have started their own businesses and come back to hire others from their residence,” said Terri. “Our whole goal is no one has to be alone. They can come back here at any time.”

In the “sober living” residences the Todds operate, there are strict protocols by which the residents must abide. “We operate as a large family  — every one contributes to the house.”

The goal is for each individual to be self-supporting in six weeks. “We have to help them through road blocks such as getting IDs, etc.”

 “We work with them on basic life skills…stuff others take for granted. We teach them a work ethic and give them the tools to get themselves out of the position they are in.”

In their “sober living” households, of which there are typically about 12 members, the focus is on creating a family unit. There are requirements to attend a meeting of household members once a week, and to have a meal together once a week. There are curfews and the houses are open for visits from family or probation officers, with whom they communicate immediately should someone be evicted.

Residents must have a job or be engaged in trying to obtain one, an endeavor in which supervisors assist by teaching them how to do it.

Richard points out that these are people who have been “takers” all their lives, and they have to learn how to be part of a community. Besides becoming employed they are encouraged to volunteer in the community.

The Todds have been able to keep conflicts with the neighbors to a minimum by communicating with them and letting them know how to contact them if there is a problem.  They do not allow any sex offenders in their homes because they do not want their neighbors to have to worry about their children.

The proposed legislation basically requires that recovery residences prohibit certain activities, maintain a registry of residents, and be certified by a qualifying organization in order to get vouchers and transitional assistance funding from the Department of Corrections. If passed the legislation would become law on October 1, 2023.

The legislation recognizes that such facilities can provide a healthy and sober living environment that helps those, with substance use disorders, achieve and maintain sobriety.

If passed the new law would require that a recovery residence register with the Department of Public Health and Human Services. They may also seek certification from a certifying organization of which there are several nationally, such as Oxford Houses, National Alliance for Recovery Residences, or Nuway.

The new law requires that a facility provide administrative oversight, quality standards and policies and protocols for its residents.

The recovery residence may not limit a resident’s duration of stay to an arbitrary or fixed amount of time. A resident’s length of stay is to be determined by their needs and progress and willingness to abide by protocols.

Responsibilities in overseeing the recovery residences are also assigned to the Department of Health and Human Services and to the Department of Corrections, including the provision of rent vouchers or transitional recovery funds for rent.

Why do people move?

9 November 2022
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How much impact do tax policies have?

The Tax Foundation has ranked Montana as Number Two among states to gain population due to Interstate Migration. As a percentage of population Montana gained 1.14 percent in population from 2019-2020 in population based upon an analysis of address changes from the IRS.  Idaho was Number 1 with 2. 05 percent. Arizona was Number 3 with 1.10 percent.

In total 28 states gained in population including Florida, Texas, North Carolina, and South Carolina—while 22 states and the District of Columbia experienced a net loss—led by New York, California, Illinois, Massachusetts, and New Jersey. Washington DC was actually the “state” to have had the greatest out migration with a loss of -2.17 percent, followed by New York with -1. 28 percent. North Dakota was 47th with a loss of – 0.72 percent in population, followed by California with a loss of -0.67 percent.

Reports the Tax Foundation: “For many years, policymakers, journalists, and taxpayers have debated the role state tax policy plays in individuals’ and businesses’ location decisions. Annual data about who is moving—and where—provide clues about the factors contributing to these moves.”

The Tax Foundation explained that these data, capture many of the interstate moves made early in the pandemic—between mid-March and mid-July 2020—but do not necessarily capture the bulk of pandemic-related moves, many of which occurred later in 2020 and even into 2021. It is more accurate however, than the more timely reports provided by moving companies. The IRS data are by default more comprehensive and provide important insights into the movement of adjusted gross income (AGI) among states.

When all individuals associated with each tax return are accounted for, including spouses and dependents, only one state, Wisconsin, saw a loss in tax returns attributable to interstate migration but a gain in individuals associated with the returns of those who moved in.

“Many factors influence an individual’s or family’s decision to move from one state to another….Cost-of-living considerations, including tax differentials, may not be the primary reason for an interstate move, but they are often one of several factors people consider when deciding whether—and where—to move.”

With this in mind, one observation from the 2019-2020 IRS migration data is that a strong positive relationship exists between state tax competitiveness and inbound migration. Overall, states with lower taxes and sound tax structures experienced stronger inbound migration than states with higher taxes and more burdensome structures.

Of the 10 states that experienced the largest gains in income taxpayers, five do not levy individual income taxes on wage or salary income at all, and two others had top marginal individual income tax rates that were below the national median at the time. Recently, those states have grown even more competitive. Nine of the top 10 states either forgo individual income taxes on wage and salary income, have a flat income tax, or are moving to a flat income tax.

Additionally, among the 28 states that experienced net inbound migration of income tax filers, only nine had a top marginal individual income tax rate above the national median. Meanwhile, among the 22 states (and the District of Columbia) that experienced net outbound migration of income tax filers, 15 states and D.C. had top marginal rates above the median. In the aggregate, states with a top marginal rate at or below the 2019 median of 5.4 percent gained 225,000 net new residents from the states with rates above the median.

A robust positive relationship also exists between states with below-average state and local tax collections per capita and those experiencing strong inbound migration. Of the 28 states that saw a net gain in income tax filers due to interstate migration, 22 had below-average state and local tax collections per capita in fiscal year 2020, while half of the states that experienced net outbound migration had above-average collections per capita.

Furthermore, a strong positive relationship exists between states with well-structured tax codes and those that experience net inbound migration. Among the 25 best ranking states on the 2020 State Business Tax Climate Index, which had a snapshot date of July 1, 2019, 20 states experienced net inbound migration between 2019 and 2020. Meanwhile, among the 25 worst ranking states on the Index, 17 experienced a net loss of taxpayers to interstate migration.

The Tax Foundation advises, “The reason policymakers should care about their state’s interstate migration patterns is the effect of interstate migration on tax revenue, economic output, and economic growth over time. Between 2019 and 2020, most states that experienced a net loss in income tax filers attributable to interstate migration also experienced a net loss in income associated with interstate migration, while most states that gained taxpayers also experienced corresponding gains in AGI.

Hawaii was the only state to lose residents on net yet experience a net gain in AGI, with new residents bringing in an average of $75,000 in AGI per return while departing residents had an average of $64,000 per return. Meanwhile, only three states—Indiana, Kentucky, and Missouri—saw a net gain in income tax filers but a net loss in AGI, with new residents earning less on average than the people who moved out.

Some of this is due to cost-of-living adjustments that tend to occur when individuals leave employment in one state for employment in another. For example, even if their job duties are substantially similar, a registered nurse employed in a high-cost-of-living state is likely to have a higher salary than one employed in a lower-cost-of-living state due to cost-of-living considerations that affect market rate earnings in different parts of the country.

There is evidence, however, that in states like Hawaii, the loss of relatively lower-income residents is somewhat attributable to high taxes and high costs of living causing lower- and middle-income residents to seek more affordable destinations elsewhere. Notably, four of the top five states Hawaii residents moved to—Washington, Texas, Nevada, and Florida—forgo individual income taxes on wage income.

Likewise, some of the gain of relatively lower-income residents in Indiana, Kentucky, and Missouri is likely due to the relatively low cost of living in those states compared to other locations. Crucially for economic growth, however, a low tax environment also encourages investment and entrepreneurial decision-making and attracts highly mobile higher earners as well.

Treasury to Gather More Info on Small Businesses

9 November 2022
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A new federal law passed in 2020 is set to expand the role of the U.S. Treasury’s Financial Crimes Enforcement Network (FinCEN) to collect and store confidential personal information about small businesses that have fewer than 20 full-time employees. As a part of the federal government’s moves to begin enforcing the new law, FinCEN recently released a final rule stating how the new law – known as the Corporate Transparency Act (CTA) – will take effect.  

The National Federation of Independent Business (NFIB) and small business owners have long opposed the CTA and key voted against it in the 116th Congress. Eighty percent of small business owners opposed the law in a 2018 Federal Member Ballot, according to the NFIB. However, the new rule did not provide the much-needed clarity on reporting requirements that NFIB members and small business owners were fighting to secure.

“FinCEN failed to strike a balance on which businesses must report, what information must be reported, and when the information must be reported,” said Jeff Brabant, NFIB Director of Federal Government Relations. “At the same time, under this rule, many small businesses will not know if they need to register with FinCEN, with the prospect of civil and criminal penalties hanging over their head for non-compliance. This will inevitably lead to small businesses contracting out the reporting requirements with consultants at a significant cost.”

NFIB is concerned that FinCEN has failed to adequately define what businesses must report. FinCEN defines a reporting company as any company with 20 or fewer employees that was created by filing paperwork with a Secretary of State or similar state agency. With 50 different states having 50 different standards and practices for incorporating, this can potentially lead to business owners being unsure if they must report or not. For example, some states require sole proprietorships and general partnerships to register with state agencies and some states do not. 

The new rule is effective January 1, 2024. Reporting companies created or registered before that date will have one year (until January 1, 2025) to file their initial reports, while reporting companies created or registered after January 1, 2024, will have 30 days after creation or registration to file their initial reports.

Once the initial report has been filed, both existing and new reporting companies will have 30 days from a change in beneficial ownership information to file updates.

FinCEN has plans to consider additional proposals that will establish rules for who may access beneficial ownership information, for what purposes, and what safeguards will be required to ensure that the information is secured and protected.

FinCEN is still in the process of developing the infrastructure to administer these requirements, including the information technology system that will be used to store beneficial ownership information in accordance with the strict security and confidentiality requirements of the CTA.

Financial Crimes Enforcement Network Improvement Act

NFIB has opposed the original CTA since it first started moving through Congress several years ago, but NFIB members have been pushing for Congress to pass the Financial Crimes Enforcement Network Improvement Act, H.R. 7623, since it was introduced in April.

State Employee Pay Plan

9 November 2022
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Following extensive bargaining, Governor Greg Gianforte and public employee unions have reached an agreement for the state pay plan. Covering the 2024-2025 biennium, the agreement includes wage increases, health benefit cost freezes, one-time payments, and other far-reaching contractual changes.

The agreement includes a $1.50 per hour or 4% raise—whichever is greater—on July 1 each year of the upcoming biennium. Single members’ out-of-pocket health benefit contributions, copay amounts, deductibles, and co-insurance costs will not increase through 2025. Additionally, one-time payments prorated to a 40-hour work week and worth up to $1,040 will be provided to every employee. The agreement also provides increased meal per diems and the addition of an annual flexible holiday which will replace every other year’s Election Day holiday.

Unions representing public employees bargain a state pay plan with the governor prior to every legislative session. The bargained pay plan must then be approved by the legislature.

Gov. Gianforte Unveils Agenda To Improve Health Care

9 November 2022
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Governor Greg Gianforte recently shared elements of his health care agenda for the 2023 legislative session and the year ahead, emphasizing the need to increase access to affordable, high-quality health care.

“Creating greater, and better, access to health care and lowering Montanans’ costs for care are core pillars of our health care agenda for 2023,” Gov. Gianforte said. “I look forward to working with legislators, patients, doctors, providers, and hospital administrators to develop more meaningful, innovative solutions that improve Montanans’ health and their access to care.”

At the Montana College of Osteopathic Medicine, the governor highlighted the importance of recruiting and retaining medical professionals to expand access to care.

“With an increasingly aging population as well as our growing population, demand for health care providers continues to rise in Montana, and our supply can’t keep up. This has been a growing issue that we’ve faced for many years. We’re coming to the table with more solutions in 2023,” the governor said, before outlining his plan to make it easier for qualified health care providers to practice medicine in Montana by reducing unnecessary barriers they face.

“Imagine if you’re a doctor who’s registered to practice medicine in another state and are in good standing there. You move to Montana. You shouldn’t have to jump through burdensome hoops to start treating patients in your community here,” the governor continued. “We must reform our licensure regime to reduce those barriers.”

Addressing the substance use crisis and shortage of mental health providers, Gov. Gianforte highlighted programs his administration has implemented, including the HEART Fund and the Angel Initiative, to increase access to treatment and recovery for those struggling with addiction.

Building on those successes, the governor addressed a plan to improve access to mental health resources, saying, “Montana should enter into a behavioral health compact to reduce barriers that qualified providers face. By taking that step, Montanans will have better access to mental health care.”

He also credited Rocky Vista’s Montana College of Osteopathic Medicine, the first medical school in Montana, as a key part of the solution in meeting the demand for medical professionals.

Acknowledging the federal government has a larger role in lowering health care costs, the governor emphasized the state must do what it can to lower costs, including increasing medical billing transparency.

“What if, before a procedure, you knew what you would pay? What if your provider and your insurer provided you with a cost estimate? We must ensure Montanans have access to important pricing information prior to receiving services,” Gov. Gianforte said. “With greater transparency on costs in advance, Montanans can better make health care decisions that work for them and their families.”

The governor began his remarks by acknowledging Montana’s health care workers and the important work they do.

Last Sunday, a patient entered the Billings Clinic emergency room and attempted suicide before law enforcement intervened.

“What happened Sunday was troubling and traumatic. It’s a reminder that our health care workers are on the frontlines, every day, serving our communities. They see patients, as well as their friends and family, at their most vulnerable, and it takes a toll on them,” the governor said.

“No nurse or doctor or provider should fear for their well-being simply by showing up for work and doing their best to care for patients,”

Future Visions?

9 November 2022
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Federal planning requirements, passed down to local governments, have for a number of decades pursued what’s called “traffic calming” strategies aimed at making driving less desirable and pressuring citizens to abandon their personal vehicles. Often tied to qualifying for federal transportation funds, the federal efforts, have more recently, been elevated, but they have encountered a problem according to Axios Richmond: “While the city considers dramatically rolling back parking requirements to encourage denser, walkable neighborhoods, an unseen force is still quietly demanding developers build big parking decks.” Banks ! Banks almost always require developers to build a minimum number of parking spaces — often well above the requirements set by the city, complain centralized planners. Banks and developers are responding to consumer demands. They are also speculating that it will be a good investment, all the more so, because of the escalating emphasis of most municipal planning and regulators to eliminate the availability of on-street or public parking. The planners worry – even though it is not their money — that in ten years all those parking spaces will be a “financial albatross,” said Axios.

Feds Take Aim at Gig Economy

9 November 2022
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By Casey Harper, The Center Square

The U.S. Department of Labor proposed a new rule in mid-October that would overhaul how independent contractors like freelancers and drivers for ridesharing apps are classified, potentially upending the gig economy that has exploded in growth in recent years.

The DOL said in its rule proposal that it would change how the federal government determines who is a freelancer and who is an employee.

How exactly contractors will be determined remains to be fully worked out, but it is expected that many freelance positions could become classified as regular workers.

“The Department believes that this proposal, if finalized, will provide more consistent guidance to employers as they determine whether workers are economically dependent on the employer for work or are in business for themselves, as well as useful guidance to workers on whether they are correctly classified as employees or independent contractors,” DOL said.

The DOL says the new rule will provide more benefits and protections for workers.

Critics, though, argue this will put major costs on businesses. Small businesses in particular can rely on an assortment of independent contractors to help keep their business afloat before they can afford full time hires.

“The modern workplace is more complex in the wake of the COVID-19 pandemic,” said National Retail Federation Senior Vice President of Government Relations David French “Retailers, along with countless other employers, maintain a wide range of business relationships with independent contractors, including billing, facility maintenance, data analysis, delivery, marketing and other critical services.

Other critics said many workers prefer the freedom and flexibility of contract work, or the “side hustle.”

“The DOL is out-of-touch with the modern economy and how people want to work, as evident by its proposed independent contractor rule,” said Karen Kerrigan, president and CEO of the Small Business Entrepreneurship Council. “Moreover, an independent contractor’s cherished flexibility could be taken away. These are all outcomes that will exacerbate the weakening economy and harm America’s small business ecosystem.”

Many Americans started side businesses that provide services to other businesses during the pandemic. Under this new rule, those business relationships could become illegal.

“More people are starting businesses because they have access to modern tools and platforms that make it simple and affordable,” Kerrigan said. “Overwhelmingly, they want to be their own boss and want control over their own time. The proposed DOL rule is a massive step backwards, as it resurrects an outdated approach that works against flexibility and regulatory certainty.

“The proposed rule will create uncertainty, higher costs and complexity, and snuff out countless innovative ideas and entrepreneurial dreams in their infancy.”

French said the rule would also drive up costs for consumers.

“The current rules clearly define the difference between employees and independent contractors, providing much-needed legal certainty for employers, employees and independent contractors alike,” he said. “The changes being proposed by the Labor Department will significantly increase costs for businesses across all industries, and further drive already rampant inflation.

“This decision will only foster massive confusion, endless litigation, reduced innovation and fewer opportunities for employees and independent contractors alike,” he added.

Equipment Tax Reforms Could Attract Businesses

9 November 2022
Dennis Pyburn
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By David Beasley, The Center Square

Gov. Greg Gianforte’s plan to provide more relief from the state’s business equipment tax could attract more businesses to Montana, according to one small business advocacy group.

The governor said earlier this month that he wants more reforms to the business equipment tax when the legislature convenes next year. In 2021, lawmakers raised the tax exemption from $100,000 to $300,000, which provided 3,400 businesses with tax relief, according to the governor’s office.

“Taxing critical business equipment makes it harder to grow a small business and is a wet blanket on job creation,” Gianforte said in a statement. 

“In 2023, we want to build on that success, further reforming the business equipment tax so small business owners can grow their operations and create more good-paying Montana jobs,” he added.

The price of equipment needed to operate businesses has increased with inflation, according to Ronda Wiggers, Montana state director for the National Federal of Independent Business.

“If you are a store owner who buys cabinets, or a farmer who buys a combine, or you buy freezers and refrigerators for your restaurant, in the state of Montana we tax those,” she told The Center Square. “We put a taxable value on that, and we tax them. Although the taxable value depreciates over time, you don’t just pay it once. You pay it every year. It’s an ongoing tax.”

When the state eliminated the first $100,000 of value from taxation a few years ago, “that took care of a lot of our small businesses,” she said. “Most of the stores, for example, probably don’t have over $100,000 worth of display cases.”

Since local governments obtain revenue from the equipment tax, the state last year covered any losses they might incur from raising the exemption to $300,000, Wiggers said.

Gianforte has not yet detailed what his proposal will be for raising the exemption this year, although there has been some speculation he may support increasing it to $500,000, according to Wiggers. 

A higher exemption could attract more equipment-intensive businesses like in the manufacturing sector, Wiggers noted.

“When you are trying to attract those kinds of businesses to the state, they are looking at the bottom line,” she said. “Having an equipment tax in one state and not having it in another would very much affect something like manufacturing.”

City Plans Rec Facility

9 November 2022
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After five years of planning, the preliminary plans for a multi-use recreation center for Billings have been released.

The proposed $98.7 million facility would be located adjacent to Amend Park at the corner of King Avenue East and South Billings Boulevard, on property that the city acquired through a tax increment finance district. The plans call for a 177,000 square-foot facility that would include an ice sheet for hockey and skating, a leisure and activity swimming pool, a 50-meter competition pool, four sports courts, open fitness and activity areas and an indoor running track.

A facility with that price tag will require multiple sources of funding according to city officials. Besides funds from the South Billings Boulevard Tax Increment District, it will require community contributions and a bond request from the voters.

Funding a project of that size would require cash from multiple sources, including tax increment finance dollars, philanthropic support and most notably a voter-approved bond.

A&E designed the facility after gathering broad community input.

Planning was based on “a statistically valid survey” done in 2019 and repeated this spring to determine the highest priorities of the community.

Projections estimate that the facility would cost $3.4 million to operate annually while bringing in $2.5 million in revenue, a cost recovery rate of about 74%. The $901,000 gap would be filled by the city and would cost the average Billings homeowner roughly $12 to $15 a year.

WWAMI  –  50 Years Educating Montana Medical Students, Providing Montana with Doctors

18 October 2022
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By Anne Cantrell, MSU News Service

Montana State University is celebrating the 50th year of the WWAMI Medical Education Program, which allows students from Montana to pay in-state tuition while earning MD degrees from University of Washington’s top-ranking School of Medicine.

Since WWAMI’s inception at MSU in the fall of 1973, more than 1,000 students from Montana have enrolled, according to the program’s records. More than 350 WWAMI graduates currently serve as physicians in the state of Montana.

“There were two goals at the outset of the WWAMI program,” said Martin Teintze, MSU WWAMI director. “One is to provide an opportunity for Montana students to go a top-notch medical school. The other goal was to provide physicians for the state of Montana.

“The first goal has definitely been met,” Teintze continued. “For the second goal, there are more than 350 physicians practicing in the state that are WWAMI graduates. That’s a significant chunk of physicians in our state.”

In addition to Montana, other states participating in the cooperative medical education program are Washington, Wyoming, Alaska and Idaho. Montana students spend 18 months receiving instruction from MSU professors as well as physicians at Bozeman Health Deaconess Hospital. The next two and a half years are spent doing clinical rotations in a variety of Montana locations, as well as Seattle and other sites in the WWAMI region.

Montana’s first WWAMI class had 10 students. Class size grew to 20 in 1975 and then to 30 students in 2013, with support from the Montana Legislature.

Students complete their first 18 months in Bozeman, which means that two groups totaling 60 Montana students are now educated in the program at MSU each fall.

“There was general agreement when Montana joined WWAMI in 1973 that Montana needed more physicians and this was the way to do it,” Teintze said. “It was also the least expensive way to do it. Building a standalone, Montana University System-run medical school would have been vastly more expensive for the Montana taxpayer.”

Teintze expressed appreciation for Montana lawmakers who supported the state’s joining the program in the 1970s and have increased the number of Montana resident students supported by legislative funding in successive decades. Students who do not end up practicing in Montana within a year after completing their education repay a portion of the subsidy they received from the state.

“We appreciate the ongoing support the program has had from the legislature for the past 50 years,” Teintze said. “It’s a long-term investment in the health of Montanans.”

Montana WWAMI students complete the majority of their clinical training in the state at more than 50 sites under the direction of approximately 650 Montana physicians, Teintze said.

“It has really become a Montana program,” Teintze said.

In the mid 2000s, the University of Washington hired a Montana clinical dean, Jay Erickson, who developed a program called TRUST, which stands for Targeted Rural Under Served Track. The program links 12 WWAMI students in each class to underserved communities. Those students spend a couple of weeks in the community in which they are paired before starting medical school as well as a month between the 1st and 2nd year. Then, in their second year, they spend five months in those communities completing part of their clinical training. There are currently 11 TRUST sites in Montana, from Miles City to Libby and from Dillon to Glasgow.

“The objective is to provide students who are interested in this kind of a work a real experience of what it is like to be a small-town physician, and to make sure they are trained by people who have chosen it as their career path,” Teintze said.

Teintze said TRUST has seen success with its goal of increasing the number of WWAMI graduates now practicing in the state’s rural areas, with alumni of that program now practicing medicine in places like Anaconda, Ronan, Hardin, Havre, Lewistown and Miles City.

“We’re hoping this success will grow,” he said.

Teintze said that, after 50 years in operation, the need for the WWAMI program remains strong.

“The average age of the population in Montana is going up, and therefore the need for medical care is also rising,” he said. “We are also facing a wave of physician retirements at a time when the need for more physicians due to the aging population is increasing, and the situation is even more dire in rural parts of Montana.

“With the time it takes to educate a medical student – four years of medical school, plus three to five years of residency afterwards – we need to be planning now for physicians that we need seven to 10 years from now. The prudent thing is to plan ahead.”