It’s been more than a decade since Krissy was first diagnosed with a chronic pain condition so severe that, at its worst, made it nearly impossible for her to work a job.
As she’s slowly figured out a regimen to manage her pain, Krissy, whose name has been changed by the Montana State News Bureau for this story due to her fear of professional retribution, has been able to secure her nursing license and start working full-time. For the last three years, she’s been required to participate in the state’s medical assistance program for health care workers or risk losing her professional license.
Medical assistance programs are widely considered a best practice for states to monitor health care professionals struggling with addiction, mental illness and some physical conditions to make sure they aren’t practicing while impaired while still giving them a path to continue working. They typically include case management, peer support and compliance checks with a treatment plan.
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There were about 70 participants in the Montana Medical Assistance Program as of December 2024, a mix of pharmacists, medical examiners, nurses and dentists. Some enroll voluntarily, while others are required to by their licensing board as a form of disciplinary action.
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The Montana Department of Labor and Industry, the state agency responsible for licensure, transitioned administration of the program from one vendor to another over a two-year period in 2021 and 2022. A legislative audit released this week found that mismanagement in that window led to serious risks for the public and the state.
“The agency’s last minute decisions, untimely communication with stakeholders and lack of contract enforcement led to stakeholder frustration, incomplete program data and distrust that continue to exist today,” auditors wrote.
In late 2021, DLI notified the Montana Professional Assistance Program, the Billings nonprofit that had been contracting with the state to provide these services for more than three decades, that it would not be renewing its agreement. Earlier that year, the Montana labor department had raised concerns of harassment and discrimination complaints against the group’s director.
For the next year, DLI took over and ran the recovery program as a stopgap measure while it solicited applications for a new vendor. In October 2022, the agency awarded a $1.6 million, three-year contract to Maximus, Inc., a multi-billion-dollar global government contractor based out of Virginia. According to the audit, Maximus, Inc. employs three staff to run the Montana initiative, none of whom live in the state.
It was a chaotic transition, auditors found, characterized by haphazard communication, poor planning and incomplete data collection. The previous vendor gave incomplete data to DLI regarding program participants, including some with suspended or inactive licenses who could have been practicing without proper monitoring, the report stated.
In an Aug. 13 written response to the report, DLI Commissioner Sarah Swanson said the agency “did not concur” that records of participants had gone missing during the transition.
“Accordingly, DLI maintains that all licensee statuses were properly documented, and there is no basis for the assertion that any program participants were unaccounted for nor at any time were the citizens of Montana at risk,” Swanson wrote.
During this transitional window, program participants and members of the licensing boards also started to flag some “particularly serious concerns” about the Maximus takeover, according to the audit.
Former and current program participants told auditors that Maximus did not make them feel cared about, was unresponsive, did not treat them fairly, and did not provide realistic referrals or clear expectations.
“Many alleged unfair treatment, which negatively affected their morale, self-esteem and mental health,” auditors wrote. “Some expressed fear of retaliation if the vendor learned of their survey participation and warned that others may have felt the same.”
Reporting from the Montana Free Press first illuminated complaints in 2023 regarding treatment of participants and an unsupportive environment for medical professionals who need help, in some cases triggering them to give up their licenses rather than continue in the program.
At the time, the state defended the Maximus-run program as “compassionate and caring.”
Maximus did not respond to requests for comment by the time of publication.
Multiple participants, including Krissy, said in interviews that the challenges identified in the audit report are not a thing of the past. Rather, program participants continue to deal with inconsistent expectations, punitive backlash and significant financial costs in order to get the greenlight from the treatment plan. If they don’t, they risk losing their professional license.
“The goal of this program should be to make sure you are safe and healthy enough to be a nurse in Montana. That is what we all understand,” Krissy said. “That’s why we are here. We care about that; we want to be safe enough to be health care professionals. It just feels like we are treated incredibly badly.”
This week, Krissy said she received a call from the program telling her she had to find time that day to “take a test I’ve never even heard of” as proof she’s complying with her treatment plan. It meant she had to drop her plans and pony up the $294 for the test (participants are expected to foot the bills for testing and mandatory online group support meetings), or risk being slapped with a noncompliance penalty that could result in losing her license.
“If you let them give you every noncompliance they want to, you’ll never get out of the program,” she said.
Auditors recommended that DLI craft a clear transition plan to avoid something similar the next time it switches vendors. They also urged the labor department to improve oversight of the program, especially when it comes to quality assurance controls.
In her response, Swanson said DLI has already hired a staff liaison to work with Maximus and “continues to proactively solicit and resolve concerns from participants, members and stakeholders, and is working to implement additional mechanisms to foster collective problem-solving.”
Carly Graf is the State Bureau health care reporter for Lee Montana.
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State Bureau Health Care Reporter
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