The Montana state Capitol in Helena on Wednesday, Jan. 18, 2023. (Photo by Blair Miller, Daily Montanan)
The House Human Services Committee on Tuesday passed a bill to fully fund Medicaid reimbursement rates recommended in an in-depth study by a national consultant — plus the cost of inflation.
House Bill 649 passed 17-4 with bipartisan support following a lengthy hearing Friday where an onslaught of providers from across the health care and medical community spoke in support.
Levi Anderson, with the Western Montana Mental Health Center, said he had just sent a letter one week earlier notifying partners across the state the center was closing 31 community-based mental health crisis stabilization beds, which represent 65% of state capacity.
“That is a direct result of a lack of funding for those services,” Anderson said.
At the meeting Tuesday, Rep. SJ Howell, D-Missoula, said all the other bills the committee would deal with rest on HB 649. In other words, if legislators are to truly address the continuum of care, they need to address “deeply underfunded providers.”
“I think this might be the most important bill this committee is going to grapple with this session,” Howell said.
Howell joined all other Democrats on the committee and a majority of Republicans in voting in favor of the bill, sponsored by Rep. Mary Caferro, D-Helena.
The bill notes inadequate rates have resulted in the closure of 11 nursing homes and loss of 857 skilled nursing facility beds in the state. It is expected to be on the House floor Thursday.
In the last session, the legislature authorized the Department of Public Health and Human Services to spend $2.75 million to pay for an analysis of provider rates in the state.
The review by national consulting firm Guidehouse showed Montana was underfunding businesses that provide support and services for people who rely on Medicaid.
Republican Gov. Greg Gianforte proposed an increase to reimbursement rates, and a legislative subcommittee approved even higher rates.
Pointing to estimates from the Health Department that showed the work the subcommittee did pushed many rates close to 100% of the recommended benchmarks, Chair Rep. Bob Keenan, R-Bigfork, said, “I think we’ve solved the problem.”
At the hearing on HB 649, Caferro, a member of the subcommittee, agreed the group worked hard and got close to benchmarks — “but not quite.” She and other sponsors proposed to close the rest of the gap.
“If we don’t fully fund the Medicaid rate, then we will continue to see a decline in people’s health and well-being to the point of death,” Caferro said.
She pointed to one woman with Alzheimer’s who had been moved to three different nursing homes because of closures and couldn’t be with loved ones: “Well, then that lady passed away.”
Caferro characterized the effects of underfunding in Montana as “tragic and unnecessary.”
She pointed to waiting lists for in-home care for seniors, for children and adults who have physical disabilities, and for children and adults who have developmental disabilities. She said community crisis centers are sitting empty and children are being sent out of state for care.
“Medicaid provides health care in every corner of the state and all parts in between,” she said. “The problem is we are running out of providers due to a long history of underfunding.”
The bill would cost $12 million a year in state funding, she said. It would translate into more money for services because the federal government matches the money the state contributes.
Caferro earlier estimated the match as at least $3 of federal money to $1 of Montana money, and in some cases as much as $9 in federal money: “It’s a good bang for the buck.”
At the hearing, she said the estimated $2.5 billion surplus includes at least $150 million saved by the state because of an enhanced federal Medicaid match, and she believes that portion should go to fund services.
In response to a question at the hearing, Mary Windecker, with the Behavioral Health Alliance of Montana, said the last couple of years, more and more people have been leaving the health care industry in the wake of rising housing costs and inflation.
Vacancies are hitting 20% to 30% across all the sectors that were studied, she said.
“We do believe that there are people out there who would very much love to work in the industry again, but they have to be able to put a roof over their head and food on the table,” Windecker said.
Caferro said those people should not be asked to sacrifice their own economic well-being. She also said she appreciated the support for health care initiatives from a wide spectrum of groups.
“I’ve never been in a legislative session where the human service issues have been so prominent, and the sponsors and people bringing the issues are so diverse, and that makes me really happy,” Caferro said.
Proponents for her bill included representatives from the Montana Medical Association, the Montana Hospital Association, St. John’s United retirement community, the Human Resource Development Councils, the Montana Association of Counties, the Montana Coalition to Solve Homelessness, the Behavioral Health Alliance of Montana, the Centers for Independent Living, the Montana Health Care Association, Montana Women Vote, and many others.
Before approving the bill, the committee adopted an amendment that Rep. Laura Smith, D-Helena, said aligned Caferro’s bill with House Bill 2, the big budget bill.
Rep. Alice Buckley, D-Bozeman, said the bill offered legislators the opportunity to support their constituents and communities across the state.
“We were elected here to do the people’s work,” Buckley said.
In addition to Howell, Smith and Buckley, the following Democratic representatives voted “yes” on HB 649: Donavon Hawk of Butte; Ed Stafman of Bozeman; Minority Leader Kim Abbott of Helena; and Zooey Zephyr of Missoula.
The following Republican representatives also supported the bill: Lola Sheldon-Galloway, of Great Falls; Jodee Etchart of Billings; George Nikolakakos of Great Falls; Tom Welch of Dillon; Gregory Frazer of Deer Lodge; Mike Yakawich of Billings; Wayne Rusk of Corvallis; Greg Oblander of Billings; Ed Buttrey of Great Falls; and Jennifer Carlson of Churchill.
Voting “no” were Republican representatives Amy Regier of Kalispell, Caleb Hinkle of Belgrade, Ron Marshall of Hamilton, and Nelly Nicol of Billings.
Daily Montanan reporter Nicole Girten contributed to this story.