Montana House passes bill to fund Medicaid rates per Guidehouse study 65-35
The Montana state Capitol in Helena on Jan. 2, 2023. (Photo by Blair Miller, Daily Montanan)
The Montana House passed a bill 65-35 to fully fund Medicaid reimbursement rates based on a consultant study — with calls from some legislators to address a crisis in the state, but with the idea House Bill 649 still needs work.
The bill notes 11 nursing homes have closed in Montana in the last year, and low reimbursement rates are contributing to a workforce shortage among those who provide services to vulnerable Montanans. It said consequences include group home closures.
Rep. Bob Keenan, R-Bigfork, led the subcommittee that supported higher reimbursement rates than the increase the Governor’s Office proposed — but still not the full amount the national consultant said is needed.
During debate, Keenan said he feels a responsibility to fix the problem.
However, Keenan also said the legislature needs to deal with correct information, and some of the data it had received was not precise.
“It’s really important that we have accurate information,” Keenan said.
For example, he said the bill identifies 857 lost nursing home beds, but those are licensed beds, not the numbers of people who have had to move – that’s 336, he said.
When a facility in Bigfork closed, he said it wasn’t 83 people who had to move, it was 36. And he said in six cases, a corporation decided to close a nursing home, and the closure wasn’t forced – although he acknowledged the businesses are stressed.
He questioned sponsor Rep. Mary Caferro, D-Helena, about specific language in the bill that called for setting nursing home rates “prior to applying the occupancy adjustment.”
Keenan asked what that phrase meant and how it would affect the bottom line.
Caferro said she had been asking the same question. She said two sets of rates were presented for nursing facilities, but she had not received an answer on the reason for the difference from the Department of Public Health and Human Services.
The bill passed on second reading Thursday. In committee, Caferro had said the cost would be $12 million of state money a year; an amendment had passed to align the bill with House Bill 2, the overall budget bill.
Generally, Keenan said he was committed to addressing low reimbursement rates: “We will fix this.”
At the same time, Keenan said some facilities have demonstrated bad management, and the state should not have to backfill for their poor financial decisions.
He said Caferro’s bill needed a lot of work, but he ended up voting in favor of it despite his concerns.
“If we’re not careful, this could be a total budget buster,” Keenan said.
Rep. John Fitzpatrick, R-Anaconda, spoke in strong support of the bill after giving a history of how nursing homes and community-based care evolved in Montana with state policies.
He also questioned the Gianforte Administration’s reaction to results of the study by Guidehouse, the national consultant.
Fitzpatrick said the Governor’s Office deserved credit for undertaking a good study. However, he said, having received the analysis, the administration appeared to have “repudiated it” by proposing a budget that funds facilities “much lower” than the study called for.
But he said the study is made up of “real numbers.” He said businesses are still short, and there’s “only so much you can suck up.”
“It’s time to pony up the money and fix the problem,” Fitzpatrick said.
Rep. James Bergstrom, R-Buffalo, said he agreed with Fitzpatrick, and he said time was of the essence.
“I guarantee you that there are nursing homes all over the state that are watching what we do here literally today, and they’re going to make decisions on whether they’re going to get out of the business or stay based on what we do here,” Bergstrom said.
House Appropriations Chair Rep. Llew Jones, R-Conrad, said he had had many conversations with Keenan, and he knows Keenan takes the problem seriously and has been “working and fretting” constantly about the topic.
Jones asked Keenan to share how far the subcommittee had gone in closing the gap between current reimbursements and the amount Guidehouse said is needed, and Keenan pointed to numbers that would hit 95% to 97% of the recommended benchmark in the biennium.
Jones said he wasn’t sure Guidehouse was perfect, and lawmakers would need to vote their conscience on the bill. However, he said he didn’t want anyone to make an inference that Keenan’s subcommittee hadn’t tried to adjust numbers to reflect reality.
“I know you’re working to get the rates right,” said Jones, who voted yes.
Rep. Jodee Etchart, R-Billings, said she was being lobbied hard to support the bill, and she was certain her colleagues were in the same boat.
“Everybody wants this, and I want it too,” Etchart said.
However, after hearing about concerning language, she felt reluctant to support it. She asked Keenan if he could work on the worrisome language if the bill passed on second reading.
Keenan said yes. He said if the bill passes, it will go to Appropriations, and it did have problems that needed to be worked out.
Etchart ended up supporting the bill.
Rep. Jerry Schillinger, R-Circle, spoke against the bill, but he said he the subcommittee did good work.
He said he himself had served on a local nursing home board, and the issues didn’t start yesterday and wouldn’t end tomorrow. Schillinger advised fellow lawmakers they wouldn’t solve the problem “by throwing money at it.”
In her close, Caferro said the bill affects 20,000 jobs and tens of thousands of Montanans, including a child chained to an oxygen tank and women caring for loved ones with Alzheimer’s.
She said the bill offers Montanans economic independence, and it offers respect and privacy when people need help bathing and dressing.
She said it affects Montanans who worked for decades and paid their taxes and helped build the state but now can’t contribute and need help.
She also said it offers Montanans freedom to grow old in their own homes and be cared for by familiar faces.
“I don’t consider this throwing money at a problem. It is solving a problem,” Caferro said.
Earlier in the day at a news conference, Gov. Greg Gianforte didn’t say whether he would support fully funding reimbursement rates if the legislature passed such a bill. However, he said he and lawmakers agreed reimbursements are too low.
“There’s no disagreement that we need to raise rates. I look forward to getting the bill that they pass,” Gianforte said.
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