A marathon subcommittee meeting on Friday diced and dissected the state’s Department of Health and Human Services, cutting some programs and adding to others, but without the deep $1 billion cut Republican lawmakers had threatened earlier.
On Thursday, the Joint Subcommittee on Health and Human Services, Part B agreed to start with the proposed 2021 baseline budget, and also agreed to move line by line through much of the department’s programming, with the promise of reconvening on Monday.
Budget items that pass from the subcommittee will then be forwarded to the appropriations committee, where they will be discussed as part of the main budget bill, House Bill 2. However, because an item is added or deleted doesn’t necessarily mean it will be included in the final budget.
For example, the subcommittee voted to cut a proposal by Gov. Greg Gianforte that would have expanded community mental health, addiction and suicide prevention. The subcommittee, consisting of seven members — five Republicans and two Democrats — said that not enough information had been provided about the programs, and that a policy discussion should happen, which would give more details about the services. The committee was unanimous that Montana needed more mental health and addiction services, but said millions of dollars were too much to spend without more information.
“That needs to go through a policy committee,” said Sen. Carl Glimm, R-Kila.
Rep. Mary Caferro, R-Helena, said that she supported the programming, but questioned why it was coming out of a state special fund, rather than the general fund. Special funds, like the ones established by settlements from Big Tobacco, are used for specific programming.
“I am worried that this is robbing Peter to pay Paul,” she said, worrying that one fund to treat smoking cessation would run short because of other needs.
The committee also made significant cuts to programs at the state hospital in Boulder, only providing funds to the much-criticized unit through 2022. Further, it cut the budget for the intensive behavioral unit by half. The committee said it was uncertain how many individuals were there or what programs were still used. The Legislature in 2015 had ordered the campus closed, but it has remained open, housing individuals whose behaviors are so severe that they could not be transferred to community-based providers.
Part of the funding revealed that the Department of Justice and the Highway Patrol department were in the process of brokering a deal to continue using the Boulder property. Exact details are in the preliminary stages.
The subcommittee also cut several positions through the Health and Human Services Department, including two positions that are liaison roles with Native nations. The subcommittee cut the tribal relations coordinator at the department and also the director of American Indian Health.
“Each nation and tribe are different, and they need different consultation,” Caferro said. “The state needs that outreach to Indian Country.”
The subcommittee eliminated 11 full-time equivalents from the quality improvement division, which has oversight of community-based programs that provide residential care. Supporters of the cut say that the regulatory positions are redundant and that community-based providers are overburdened with inspections and paperwork rather than care.
And the committee eliminated any funding for the “Stars to Quality” program, which had originally been established in 2014 to implement federal quality standards for daycare providers.
The subcommittee cut one full-time equivalent position from refugee services, arguing that a program based in Missoula has enough community support to justify the cut.
And nearly $8.3 million that had been proposed for a computer system conversion also failed to get enough support to make it, with the committee united that the department had not made a case the new system would integrate well with the existing systems.
Medicaid payments were key during the hearing as the lawmakers decided to reduce the budget by 3 percent. Chairman Matt Regier, R-Kalispell, noted that in previous years, the budget had not been fully utilized with a cushion left over. The 3 percent cut was applied toward more payments to hospitals and health providers who suffer lower reimbursement rates.
The committee increased Medicaid payments to hospitals and physicians by 1 percent in 2022 and 2 percent again in 2023. The committee also reduced payments to non-critical access hospitals by one percent.
Foster care payments were increased by $1.50 per day, a substantial jump from the $19.57 daily rate currently.