The Montana Legislature’s Children, Families, Health and Human Services (CFHHS) Committee met this fall and formally objected to the Department of Public Health and Human Services’ (DPHHS) administrative rule notices that would cut Medicaid rates for all providers and services.
I write today to share my personal perspective on the severity of pending cuts, and to urge the CFHHS committee to continue their objection. The company I work for, Consumer Direct Care Network, is one of the providers who will be affected, as will the hundreds of people across the state whom we serve.
As I came to work this morning, I pondered the freedom that I have to speak, walk, take a hot shower, feed myself, organize holiday gatherings. I have worked hard as a mother to teach my children to be grateful for those seemingly little things. I remind them often that holidays are about the memories that we create and the people we spend it with that make us fulfilled and make us feel valued and loved.
My thoughts then turned to the individuals we care for and how these proposed cuts will affect them. I think there is an assumption that there can be a balance of cuts that allow some services to continue while not breaking the budget. I have to tell you that is not the case for private duty nursing (PDN). This is not a service that can withstand any further rate cuts.
The Care Network currently provides PDN across the state. We do this at a financial loss given the reimbursement rates from DPHHS. We continue to provide PDN because we know many of the families we serve have no other options. A large percentage of those served are children who were born with severe disabilities. Families spend months in the hospital waiting for an opening in PDN so they can bring their children home. We serve children on ventilators, tube feedings, and trachs — services that require constant care/supervision day and night.
I can’t help but wonder what will happen if these essential services are no longer available. I urge our legislators to imagine a child in their life and to what lengths would they go to ensure their safety — to ensure they are valued. The options for these families are to live in the hospital until PDN services are available, or to move to another state where the services are available. The average pediatric hospital stay in Montana is $1,489/day per Becker’s Hospital Review released in 2017.
In-home PDN services can be provided at a fraction of that cost. Receiving services in-home also reduces the risk of complications or secondary infections. Are our legislators prepared to send a message to Montanans that they are not welcome here because they were born “different,” or commit them to a hospital costing the state exponentially more money than in-home care?
As a mother, a daughter, a nurse, a Montanan, I beg of our legislators to uphold this objection because cuts would be absolutely devastating to many families. My final challenge to legislators and DPHHS is to picture yourselves knocking on the door to these homes and explaining that we can no longer support the family.
I ask you to further imagine explaining that their child will be re-admitted to the hospital. Or explain that the family should leave Montana to get essential care. Our conscience is one of the most powerful things we possess.
I urge you, if you could not knock on that door, please don’t lift your support of the objection behind closed doors.
Thank you for your time and consideration.