The administration of Gov. Greg Gianforte intends to contract with a private Connecticut-based company to care for medically needy patients and inmates discharged from the Montana State Hospital, the Montana Mental Health Nursing Care Center in Lewistown, and transferred from state corrections facilities.In a two-page letter published to the state procurement website, dated Sept. 27, the administration spelled out its plans to “sole source” a contract with iCare Managment, LLC “to provide community nursing home level of care for a difficult-to-place population.” That population, the letter said, “includes those facing discharge from the Montana State Hospital, the Montana Mental Health Nursing Care Center, and medical parolees or other discharge placements from the Department of Corrections.”READ THE UPDATED LETTERDownloadThe listed requirements for the facility include round-the-clock care, experience working with people involved in the criminal legal system, and a track record of complying with federal regulations from the Centers for Medicare and Medicaid.The letter did not include an estimated price or length of time for the work. While the notice stated that the health and corrections departments are not requesting competitive proposals from other vendors, groups are permitted to submit alternative bids by 2 p.m. on Friday, Oct. 11.After Montana Free Press published news of the intent-to-contract letter on Tuesday morning, a spokesperson for the state health department said the agency will post an updated letter to the procurement website specifying that the contracted facility must be operated in Montana.State law and administrative rules allow state agencies to enter into sole source contracts when there is vendor compatibility with current services or equipment, no equivalent product exists or “only one source is acceptable or suitable for the supply or service item.”A spokesperson for the Department of Corrections said that, while the contract is not finalized, it estimates that between 50 and 70 currently incarcerated people who are eligible for medical parole could be served by the agreement.The Department of Public Health and Human Services did not provide answers to a list of questions about the proposed contract before publication.In a Tuesday email, iCare Management spokesperson David Skoczulek said he would “defer any comment to representatives from the State of Montana.” A spokesperson for Gianforte did not respond to a list of questions and request for comment about the contract notice.State institutions, including the psychiatric facility in Warm Springs and the nursing home in Lewistown, are often the last residential options for high-needs patients struggling with mental illnesses, many of whom are elderly, have been convicted of crimes, or are medically frail. Patients who are stabilized and prepared for discharge can stay in those public facilities for years if local residential care settings decline to accept them. Similarly, medically needy inmates serving long sentences at the Montana State Prison or other correctional facilities may become eligible for medical parole. Finding a place for them to go, however, can prove challenging.David Carlson, executive director of the federally appointed watchdog group Disability Rights Montana, raised concerns about the contract announcement in a Tuesday email to MTFP.“The need to discharge people with chronic co-occurring dementia, brain injury, and intellectual disabilities who are no longer benefiting from whatever substandard treatment the hospital has to offer is longstanding. Why is there a rush today to push a sole source contract to a specific institutional provider?”Carlson also flagged the possibility of patients and parollees going to other institutional settings through the new contract, rather than to community-based providers. Disability Rights Montana, he continued, has been advocating for different discharge options but had not been notified of the department’s decision in recent meetings.“I am concerned about what backroom conversations have already been had. I met with the CEO of Montana State Hospital to specifically meet about discharge options for this population and he did not even hint that something was in the works to increase discharge capacity,” Carlson said. “There should be more transparency and active participation for the people affected by these decisions.”The state health and corrections departments did not mention the prospect of contracting with a third-party group to care for that “difficult-to-place” population at budget meetings for the respective agencies in mid-September, according to lawmakers present.Montana State Prison (MSP), located in the Deer Lodge valley, houses nearly 1,600 male inmates in a secure, 68-acre compound. Credit: Montana Department of CorrectionsRep. Emma Kerr-Carpenter, D-Billings, a member of the budget committee that oversees the corrections department, said the notice of an intent to contract with iCare took her by surprise.“Why hide it, is the question. It’s not the most heinous policy proposal I’ve heard from the Department of Corrections,” Kerr-Carpenter said. “Why the cloak and dagger?”Carter Anderson, a now-retired former administrator of Montana State Hospital, said it’s not uncommon for patients in Montana to seek care from providers in other states if they can’t find local options. But he raised questions about how the state identified iCare Management as the best choice to take care of people currently in state custody.“It’s unusual to me that they would not do something like this in a [request for proposals],” Anderson said. “How do they know about these people? And how do they get to be the sole source when they haven’t had an RFP to know who else could do it?”In addition to the intent to contract with iCare, the state is also in the process of negotiating a lease agreement with Shodair Children’s Hospital in Helena to use its former main hospital building to house adult patients from Warm Springs. Shodair moved into its newly constructed hospital in Helena last year.In a Monday phone call with MTFP, Shodair CEO Craig Aasved said the old building could hold as many as 20 patients, but that he is not aware of the state having settled on a final number.“We’re in discussion with DPHHS about leasing that space to them as they make transitional improvements to their [Warm Springs] campus,” Aasved said. Though the former hospital is physically close to Shodair’s new location, Aasved said the two facilities are separate and would be operated independently of one another. He said Shodair would not be providing staff or programming for the state’s patients from Warm Springs.“That’s all in their wheelhouse. All we’re doing is providing a building and the security,” Aasved said.“How do they get to be the sole source when they haven’t had an RFP to know who else could do it?” Former Montana State Hospital administrator Carter Anderson The preparations for patient transfers from the state hospital come more than two years after the southwest Montana facility lost certification from the federal Centers for Medicaid and Medicare Services following patient falls, deaths and other safety concerns.The Gianforte administration has hired the New York-based consultant group Alvarez & Marsal and contracted with California-based Traditions Behavioral Health in an effort to improve operations at the 270-bed Warm Springs campus and, eventually, apply for recertification from federal authorities.  After recent leadership turnover and a wave of staff resignations, the state announced that Dr. Kevin Flanigan will serve as the hospital’s permanent CEO. At its September budget meeting, state health department Director Charlie Brereton said its previous goal of applying for recertification by the end of 2024 had been pushed back due to delays in upgrading physical aspects of the Warm Springs campus.This story was updated Oct. 1, 2024, to include additional comment from the state health department and Disability Rights Montana. 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