Lawmakers debate how to meet demand for services, demand for labor and cuts to some social services
The Montana Department of Public Health and Human Services (Photo by Eric Seidle/ For the Daily Montanan).
One man in Montana sleeps in his wheelchair because he doesn’t have the money to pay an in-home worker.
Wednesday, Rep. Mary Caferro, D-Helena, said Montana has the money to help him, so she repeatedly opposed millions of dollars of reductions in Medicaid expenditures for the state health department — $6 million less for senior and long-term care, she said, and $100 million less for disability services for the biennium, among others.
“We have the money to solve problems this session. We’ve been passing bills out of the approps committee left and right that have $100 million price tags on them,” she said of the Appropriations. “We can’t put a price tag on the people that this budget supports.”
But an equally dogged Sen. Carl Glimm, R-Kila, repeatedly argued for a precise and prudent approach to the budget for the Department of Public Health and Human Services, the state’s largest agency.
If DPHHS projects people won’t use the services, and there’s no ability to address the need given the workforce shortage, then a bigger allocation doesn’t actually solve the problem, he said.
“If we’re budgeting, our job is to budget as accurately as we can, and if people aren’t going to qualify to be on Medicaid expansion, then we shouldn’t budget for them to be there,” Glimm said.
The Appropriations Subcommittee on Public Health and Human Services took its first executive action on agency spending Wednesday.
The series of votes are a starting point, but they reflect how legislators might start shaping the $7 billion budget the Gianforte Administration proposed for DPHHS.
That total includes federal money and represents a roughly 17% increase from the last biennium and a 22% increase in general fund spending.
Chairperson Rep. Bob Keenan, R-Bigfork, said the items the committee took up reflected mostly baseline spending across the agency’s 16 divisions. For example, in initial votes, legislators approved overtime spending at the Montana State Hospital and a reduction for the foster care caseload.
Keenan said the committee would take up amendments and provider rates — of particularly high interest this legislative session — on Thursday. He also said the subcommittee may still make changes to items it considered Wednesday.
After the meeting, he said one of the challenges of Medicaid in the DPHHS budget is clearly, people need services — but the workers have not been available. So he said someone who needs help preparing meals and bathing might not find a caregiver.
“That’s the tragedy of the situation that we’re in,” Keenan said.
Caferro said another issue is when DPHHS starts reviewing whether people remain qualified for Medicaid this spring, some will fall through the cracks — particularly people with mental illness.
The six legislators agreed on most of the line items, although reductions in Medicaid spending drew some controversy.
For example, Sen. Chris Pope, D-Bozeman, said one theme generally that concerned him was making reductions despite long waiting lists filled with vulnerable people. He said he did not want to send a signal to DPHHS that going backwards was OK.
“We have waiting lists of people – thousands of people waiting for these services,” Pope said.
(He also noted the depth of the problem: “I don’t think we’re going to be able to solve this today.”)
But Glimm argued that simply putting money into a line item wasn’t a true fix: “In my mind, it’s not a solution. It’s just putting forward a false idea that the money is there, and we’re going to spend it. And we aren’t.”
And if the department does end up needing more money, Keenan said DPHHS has much flexibility within its Medicaid budget to move dollars to address problems that might arise.
Agencies can request additional money during the interim, and he noted the difficulties at the state hospital in Warm Springs resulted in an additional $66 million of unanticipated spending during two years.
“There’s enough cash flow in here to weather those storms,” Keenan said.
With just Rep. Jane Gillette, R-Bozeman, in favor, the subcommittee turned down an agency request to spend $5.2 million related to a computer system.
The spending for foster care, adoption and guardianship caseloads elicited some discussion. DPHHS is requesting a $27 million reduction for foster care — and $14 million more for adoptions and guardianships, all of which the subcommittee approved for the biennium.
Sen. Dennis Lenz, R-Billings, said the department is moving toward more adoptions and guardianships, although too slowly at times. But he said he supported those budget items for the time being.
Glimm noted lawmakers have hammered DPHHS about the high number of foster children in the system, and the reduction reflects progress. In this case, he said the drop in numbers reflects a positive outcome of fewer children in foster care — so the budget drops, too.
Caferro said the reason for the reduction isn’t totally clear, but the department has done good work to keep families together. However, she said she wants the work to continue, and “it’s a little premature” to trim the budget.
“What if we hit a recession? … We’ll be back here, probably cutting these very programs,” she said.
Pope wondered if the drop in foster care and increase in adoptions and guardianships in the budget square up, and legislative staff member Josh Poulette said that would be a fair assessment.
At the end of the meeting, Keenan, Gillette, Pope and Caferro all voted down three items that combined represented roughly $42 million in Medicaid related reductions for the biennium.
It wasn’t the final vote by any means, but Caferro expressed surprise.
“Seriously?” Caferro said.
Said Keenan: “Seriously. Have a nice lunch.”
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