ARPA steering group recommends $102 million in COVID aid healthcare programs

A state commission Thursday recommended approval of more than $100 million in federally funded COVID-19 relief programs under the umbrella of public health and healthcare, one of the first significant allocation of funds in Montana from the American Rescue Plan Act.

A steering group of lawmakers and appointees from the executive branch — among them Department of Public Health and Human Services Director Adam Meier — voted in favor with near-uniformity for more than a dozen projects and programs eligible for funding under ARPA, the most recent federal COVID-19 package, including a 15% increase in Supplemental Nutrition Assistance Program benefits for all eligible households in the state through September, millions of dollars to drum up demand for vaccines and more.

“We’re hoping to make sure that this money will be put in a place that is most impactful and still aligns with the federal guidelines,” said Rep. Frank Garner, R-Kalispell, who chaired Thursday’s meeting of the Health Advisory Commission and championed major legislation this session implementing ARPA in Montana.

That bill, House Bill 632, formed four advisory commissions to recommend allocations of more than $1.5 billion in ARPA funds to the governor’s office — health, infrastructure, broadband and economic development. Garner said this arrangement is unique among all other states, where governors generally have taken unilateral control over the expenditure of federal COVID-19 aid funds.

Though the commission’s power is purely advisory, it can recommend to amend or deny federally-funded expenditures and also require performance audits from the departments carrying out the programs receiving the money.

“It makes a ton of sense … for the Legislature to be working with the executive on it to make sure these funds are used appropriately,” Garner said. 

Two of the commissions have already met, though to approve smaller, time-limited expenditures. Thursday’s meeting marks the first regular meeting of the steering groups, which are set to convene consistently through the summer.

The federal government strictly prescribed eligible uses for many of the healthcare-related funds, so the bulk of projects and programs considered Thursday received broad approval, though not without some concern about whether the government was being clear enough that most of the money can only be spent on a one-time basis.

These include the SNAP increase, $28 million for continued pandemic EBT for students to receive free or reduced-price school lunches over the summer, around $1.5 million for different child abuse prevention and family service programs, $5.6 million in substance abuse block grants and $4.3 million in mental health block grants to build out capacity in Montana for mental healthcare and suicide prevention.

However, some “heartburn,” as Sen. Mary McNally, D-Billings, put it, occurred over a recommendation to allocate around $450,000 in SNAP administration funds for Montana to join a SNAP National Accuracy Clearinghouse that collaborates with other states to identify instances of benefit duplication as required by the 2018 U.S. Farm Bill.

Lorianne Burhop, chief policy officer with the Montana Food Bank Network, told to the commission that the state was missing a “rare opportunity” to improve benefit systems and technology to instead fund implementation of the clearinghouse that a 2018 law requires it join anyway.

“This is not in line with the purpose of the ARPA funds,” said Burhop.

Meier, the DPHHS director, said it’s his understanding that the bucket of funds set aside for SNAP administration in ARPA don’t need a direct tie to COVID-19.

Similarly, a cadre of lawmakers in the GOP voted against several expenditures related to COVID-19 testing and vaccine distribution, though the commission ultimately only amended one of its COVID-related recommendations.

These include around $12.8 million to supplement additional grants that support vaccine distribution to vulnerable populations, a possibly-overlapping $785,000 for a DPHHS ad campaign to increase confidence in the vaccine, $1.5 million to support testing for COVID-19 variants, a separate $33 million to expand testing and vaccinations “among populations at higher risk and that are underserved,” especially those in rural and tribal areas, and $7.25 million for workforce development in the public health and epidemiology sectors.

Rep. Terry Moore, R-Billings, for example was skeptical of the fact that part of the federal money could be used to retroactively pay for existing vaccination efforts by local governments and concerned about overlap between different pots of federal funds.

One section that the commission did recommend to alter was a proposed $32 million for COVID-19 testing and management in schools. The money could be used to buy tests, hire school health coordinators and build out healthcare infrastructure, said DPHHS Communicable Disease Control and Prevention bureau chief Jim Murphy.

But Murphy conceded that the demand for this funding would be low over the summer, so the commission agreed to only sign off on 10% of that sum until it can meet again to reconsider and approve another chunk.

“I think you’ll see more of that in future commission meetings,” said Garner. “We’ve got some members that have made it very clear they’re not going to approve the expenditures unless they have all the information.”

Ultimately, though some votes reached as close to 6-4, the presence of several appointees from the governor’s office on the commission — including Meier, General Counsel Anita Milanovich, Mike Foster, Gianforte’s pick to lead ARPA disbursement, and health policy advisor Charlie Brereton — and more-or-less consistent votes in favor from Garner and the two Democrats ensured that most proposals brought by the governor’s office had clear paths to approval.

The commission’s next meeting is slated for June 24. One big unknown for all of the ARPA commissions is how the ongoing release of federal guidance on allowable expenditures under the aid package will affect the state’s plans to distribute the money.

Foster told the commission that the governor’s office is assembling comments from the state for the U.S. Department of Treasury on its recent interim final rule-making. He said that the executive is “still waiting for some clarifications about the bill that have a big impact on what the advisory commissions are doing”

Garner said the commission system ensures flexibility in the face of changing guidance from the feds.

“We built in some flexibility when we constructed HB632,” he said. “All the guidance isn’t going to be out until mid-summer. We have to be prepared to respond changes in the guidance. We are able to react.”