Chair on DPHHS: ‘All of us are not happy with this budget, but all of us might like this budget’

By: - March 23, 2023 4:00 pm

The Montana Department of Public Health and Human Services (Photo by Eric Seidle/ For the Daily Montanan).

In his opening remarks on the largest portion of the state budget, Rep. Bob Keenan, R-Bigfork, said a text message he had received might bode well for the discussion on the state health department.

One day before the Montana House took up the big budget bill, a provider told Keenan they were heading back to Montana from Tennessee, where the provider had met with some “youngsters” who wanted to return to the Treasure State.

The provider told Keenan they were grateful and wanted to wish him luck. Keenan said the youth had been placed in a psychiatric residential treatment facility in Tennessee, a group home.

Group homes have closed in Montana, but the subcommittee approved an increase in Medicaid provider rates in the budget that was on the floor.

“I’m bringing a couple (youth) home over the next couple months because of your work in subcommittee,” said Keenan, reading the note.

Keenan, chair of the appropriations subcommittee on health, said those youngsters should be placed in Montana, and he hoped the note was a good omen for the debate on the health section of House Bill 2.

Thursday, the House voted to approve that bill, as it had Wednesday, and the legislation now heads to the Senate.

The largest department it funds is the Department of Public Health and Human Services, with a $7 billion budget for the biennium, including $1.4 billion general fund dollars, and much more in federal matches.

Keenan noted the budget, which funds 16 divisions, some 2,800 employees and at least hundreds of contracts with community providers, is up 15.4% from the previous two years.

The state’s health budget was the product of trying days and emotional discussions among a small group of committee members, he said. He said factors that drove the budget coming into the session included inflation, caseload predictions, provider rates and expensive contract personnel.

“I think all of us are not happy with this budget, but all of us might like this budget,” Keenan said. “It’s that type of budget.”

He pointed out some significant decisions the subcommittee made for the biennium, also noted in a report from the Legislative Fiscal Division, including:

  • Rates for Medicaid providers increased for a total $300 million over the biennium compared to the current budget. Keenan said he would be blunt and note the priority at the legislature is typically the state employee pay plan, and he wants parity for providers, who are caring for people who need help caring for themselves: “They’ve been getting the crumbs for years.”
  • Non-Medicaid provider rates increased by $31.6 million.
  • Money for Medicaid caseloads increased by $400 million.
  • Non-Medicaid caseload dollars were reduced by $25.4 million due to lower caseloads for CHIP, the Children’s Health Insurance Program, and foster care.
  • Postpartum coverage was extended to 12 months for individuals enrolled in Medicaid, as the Gianforte Administration also had proposed. Federal law requires 60 days after birth, according to the Montana Budget and Policy Center; states have the option to extend Medicaid postpartum coverage to 12 months.
  • Childcare subsidies increased by $1 million.
  • Keenan and the report from the Legislative Fiscal Division noted another $4 million in federal money is in the budget for TANF, Temporary Assistance for Needy Families, to address expanded eligibility. The report noted another $1 million in the budget for grants to “entities that advocate for children in legal settings.”

Rep. Mary Caferro, D-Helena, said she was proud and grateful for the provider rate increases, which she described as “historic,” as others have. Keenan earlier noted the budget would fund Medicaid providers at rates that are close to the full amount a national consultant recommended, even 95% and 97%.

However, Caferro, who has a separate bill to nudge Medicaid provider rates the last distance to the recommended levels, said “we are in historic times.”

In the subcommittee, she said members of the public — not lobbyists — played an outsized role in helping lawmakers understand how the work they do plays out in real life. She thanked Keenan, who she said has been known “as a champion for decades” for people who have mental illness.

She and other Democrats proposed several amendments to the health budget, but the House voted them down on party lines, with only the “super minority” in support.

Rep. Ed Stafman, D-Bozeman, proposed restoring “continuous eligibility” for Medicaid so people don’t fall off the rolls if they encounter temporary circumstances.

In support, Rep. Donavon Hawk, D-Butte, spoke personally. He said he had to file for bankruptcy at one point, and he doesn’t know where he’d be without Medicaid.

The chamber opens its floor sessions with prayer, and Hawk made note of the practice in his thinking about Medicaid.

“As much as I enjoy coming to this floor and praying and thinking about the needy every day, I would hope that we could step up and do a little more for them,” Hawk said.

Rep. Jennifer Lynch, D-Butte, proposed $1 million for food banks out of federal funds, and she said the money would otherwise go unused. She said the money would mean an extra $2.20 a month for each family served by a pantry in Montana.

“This body voted against helping feed hungry Montanans once today. I hope we don’t do that again,” Lynch said.

In his opening, Keenan said the body won’t stop talking about how much money is enough until legislators go home. He was talking about provider rates, but the legislature will continue its debates on House Bill 2 in the Senate.

“We’re not done yet,” Keenan said.

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Keila Szpaller
Keila Szpaller

Keila Szpaller is deputy editor of the Daily Montanan and covers education. Before joining States Newsroom Montana, she served as city editor of the Missoulian, the largest news outlet in western Montana.