Private providers of care for the elderly, disabled and other low-income clients in Montana blasted a proposed rate cut for their services Thursday, saying it will further undercut already stressed community-based care.
From mental-health centers to operators of assisted-living homes, providers at a day-long hearing in Helena implored the Bullock administration to reduce the rate cut and look elsewhere to meet budget cuts mandated by a law signed in May.
“These rate cuts will cause safety-net programs to disappear, as providers cannot overcome the cost of these cuts,” said Katherine Isaacson of Western Montana Mental Health Center in Missoula. “And suicide? We’re going to see more suicide.”
The Bullock administration has proposed cutting by 3.47 percent the rates paid for services covered by Medicaid, the state-federal program that covers medical and other health care-related services for the poor.
The proposal is in response to a law that says millions of dollars must be cut from the Department of Public Health and Human Services because state tax revenue missed a pre-determined target in June.
The law, passed by the 2017 Legislature and signed by Gov. Steve Bullock, outlines $70 million in general-fund cuts across state government.
State health officials said the law requires them to cut Medicaid rates by $26 million the next two years, in state and federal funds. The 3.47 percent cut is needed to meet that amount, they said Thursday.
But providers and their representatives argued Thursday the cut can be smaller, and that other savings could be found DPHHS, the largest agency in state government.
“What we’re really asking the department to do is take a look at whether there is anything else in that big agency that could possibly share the burden of these cuts,” said Rose Hughes of the Montana Health Care Association, which represents nursing homes and other providers.
She and others noted that state institutions, like the Montana State Hospital that cares for the mentally ill, is not facing any significant cuts – and that state employees are getting a small raise as well.
The Medicaid rate cut is scheduled to take effect Oct. 1. However, a legislative interim committee on Wednesday formally objected to the rate cut, saying it does not follow legislative intent.
The objection delays any state action to implement the rule for up to six months.
Marie Matthews, head of the Medicaid and Health Services Branch for DPHHS, said if the cuts are delayed until January, the reduction would have to be increased to 5.3 percent.
That comment brought a rebuke from former state Rep. Pat Noonan of Ramsay, who said “threatening people for successfully accessing their elected officials is at the very least underhanded and unfair.”
“The (department) should be our advocate, not our adversary,” Noonan added.
The state law says the Legislature intended to have Medicaid rates cut to meet a $7 million, two-year cut in state spending, but does not identify a specific rate reduction. The Bullock administration’s proposal cuts state spending by $8.6 million and federal matching funds for Medicaid by another $18 million.
Providers who testified Thursday said it’s already difficult to hire people for assisted living homes, in-home nursing care and other services, or even pay for certain services, because provider rates are already too low. Further cuts will make the situation worse, they said.
“How can you convince someone to come and do the dirty work that is required to care for the elderly in our state when they can make more money at Starbucks?” said Michael Coe of The Pines of Polson, an assisted-living facility. “How do I do that?”
Janessa Hendon, a nursing supervisor at Consumer Direct Care Network in Missoula, said the family of an injured logger had to move him last week to a nursing home in Washington state, because services in Montana were no longer available or affordable. He’d had in-home care in Montana for 14 years, she said.
“He died Thursday afternoon, alone and away from home and out-of-state because we failed him,” she said. “Together, the state and the providers failed him because we can’t come to a sensible solution on these rate cuts.”
Providers also said the Bullock administration has undervalued private community care-givers, and should work with them more closely to develop a collaborative system, which ultimately saves the state money.
“Community-based services, these low-cost, effective services, cannot sustain under these rate cuts,” said Michael Chavers, CEO of the Yellowstone Boys and Girls Ranch in Billings. “Together, we could help design a much more effective and cost-efficient system, if we were given the chance.”