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Attorney General Tim Fox

Attorney General Tim Fox speaks at the Montana State Capitol in September.

This legislative session’s debate over Medicaid expansion could prove crucial for Montana’s fight against drug abuse, Attorney General Tim Fox said Wednesday in Missoula.

Fox raised the topic at Wednesday’s “State of Missoula” event, hosted by the Missoula Area Chamber of Commerce. Titled “Breaking Down Workforce Barriers,” it featured Fox alongside other experts who discussed a wide range of drug-related issues.

“We must address demand” for drugs, the attorney general said. “Treatment for addiction and prevention efforts must be strengthened throughout the silos of government, across the line separating public and private sectors.”

He discussed several of the state’s legislative and regulatory efforts to that end, including drug treatment courts and his office’s AID Montana program that encourages collaboration between involved groups.

Since the Montana Legislature expanded Medicaid in 2015, the state Department of Health and Human Services says more than 5,300 adults received outpatient treatment for substance use through the program, and more than 1,600 adults have received residential services for substance use.

Another speaker at Wednesday’s program — Levi Bessette, a Missoula resident and recovered drug user — said that the federally funded health insurance program figures prominently in treatment. While his deceased father’s life insurance funded his treatment, he said that “most people who are struggling with addiction don't have the money (to pay for it), and so most of them are on Medicaid.” He added that even when they have insurance coverage, those seeking treatment can find themselves on long waiting lists.

During the question-and-answer period, Fox said “in terms of treatment itself, the big issue in this legislative session, that you all ought to be engaged in, is whether or not to re-authorize Medicaid expansion.”

“I think that's a very political issue, obviously, and I think as Levi mentioned, not everybody has insurance or a mother who has a life insurance policy that unfortunately came because her husband died."

Speaking with the Missoulian afterwards, Fox added “I think it’s important for the Legislature to assess independently whether the goals of the HELP Act (that initially expanded Medicaid) have been made and what midcourse changes or tweaks might need to be made to make it better, and they always have to look at whether or not it's sustainable fiscally.”

He also noted the millions of dollars’ worth of budget cuts imposed during the Fall 2017 special session, and posited that “if we want to prioritize getting people the help that we need, we really need to look at those services and programs that were cut and prioritize whether or not those should be refunded first.”

Medicaid expansion was just one of several proposals that Fox and his fellow speakers discussed Wednesday.

He voiced strong support for drug courts, which place offenders in treatment programs rather than prison. Fox said the bulk of Montana’s funding for these programs comes from the federal government. Grants that began these programs in Lake and Lewis and Clark counties are due to expire in September 2020, and the governor’s budget proposal requests a $139,000 general fund appropriation to keep them going in fiscal year 2021.

Rep. Zach Brown, D-Bozeman, is also sponsoring a bill to revise treatment court funding. It remains in the drafting process. John Barnes, a spokesperson for the attorney general, described it as “a tax on wholesalers bringing opioids into Montana for sale.” Details of the bill were not yet available, and others may arise as the session continues.

Fox also discussed Senate Bill 61, which would require that all prescribers report to the state’s prescription drug registry, and other proposals to regulate legal drug transactions more tightly.

While most of his talk, and the event, focused on treating the addictions and initial uses that drive drug demand, Fox also raised the need to stem supply. “Interdiction has been a priority for the Montana Department of Justice on my watch, and I have continually urged the federal government to increase security at the ports of entry along our nation’s borders.”

Border security has been a priority this session for State Senator Scott Sales, R-Bozeman, who’s called for directing $8 million to President Trump’s proposed border wall.

Discussing these proposals with the Missoulian afterwards, Fox replied, “we're here today to talk about substance abuse disorders, and that's really the main topic. … We'll leave other bills to other folks but the ones that are most important to our agency are the ones that address the substance abuse disorder crisis in our state.”

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