Surprise and shock would best describe our reaction to the Medicaid cuts the Montana Department of Public Health and Human Services proposed.
The Montana Health Care Association represents facilities and programs that care for elderly and disabled Montanans, including programs that help people stay in their homes, assisted living facilities and nursing homes. The cuts also affect people with developmental disabilities and mental illness. These are the largest and most widespread cuts I can remember in 30-plus years of working in long-term care. Even worse, they were not discussed at the legislature, and they are not necessary.
Senate Bill 261 is a good example of the unintended consequences that result when transparency takes a back seat to expediency. There's plenty of blame to go around but I doubt anyone involved intended to harm our most vulnerable people and the hard working caregivers who work for low pay to make others' lives better. Yet here we are.
SB 261 attempted to prioritize among more and less essential state services. Level 2 (less priority) included an across-the-board cut to all agencies, including DPHHS, of one-half of 1 percent. DPHHS chose to take every dollar of this across-the-board cut from provider rates. This is absolutely not required by SB 261.
The legislation also provided a level 3 cut (higher priority services) of $3.5 million in general fund, or about 1 percent, from Medicaid. So, the legislation anticipates a 1 percent cut in Medicaid, but we are facing a 3.5 percent cut — triple what the legislature intended. These cuts, which would total $24 million in state and federal funds, are not required.
Do we really want to take $24 million in services away from people who are elderly, disabled, mentally ill and developmentally disabled?
• The workforce crisis in human services will get even worse because low Medicaid rates drive low pay for caregivers.
• People who need help are being denied services because there is no one to do the work. Some Medicaid clients are even being sent out of state due to a lack of caregivers.
• A number of rural nursing homes have considered closing and others have closed special care units or limited Medicaid services because Medicaid pays less than cost for nursing home care.
• Only about half of assisted living facilities accept Medicaid and 75 percent of those that do severely limit the number of Medicaid residents they accept.
• About 500 individuals who are elderly or disabled are on a waiting listfor home and community based services. Over 1,000 individuals with developmental disabilities are also on a waiting list.
• Mental health centers are already laying off workers in anticipation of these cuts.
These are not cuts to government — they are cuts to people. Let the Governor's Office and your legislators know we can and should do better than this.