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Montana Health Department Gets Earful On Restoring Medicaid Budget Cuts

State Budget Director Dan Villa and State Health Department Director Sheila Hogan hear input on how to allocate $45 million in restored state funding at a listening session in Helena, MT August 1, 2018.
Eric Whitney
State Budget Director Dan Villa and State Health Department Director Sheila Hogan hear input on how to allocate $45 million in restored state funding at a listening session in Helena, MT August 1, 2018.

"This has been a very difficult year," says Sheila Hogan, director of Montana's state health department.

She was talking to hundreds of people online and in a hotel ballroom in Helena who were not shy about telling her just how tough their year has been. They were people impacted by a nearly three percent cut in payments to people and organizations that help Montanans on Medicaid.

"It's been a tough ride, my heart goes out to everyone in this room and the people that we care about," says Hogan.

The rate cuts were enacted January first, after state lawmakers and Governor Steve Bullock last year couldn't agree on how much tax revenue the state should expect this fiscal year, nor on how to potentially bring in more to avoid a projected budget deficit.

Then, in July, when actual revenue came in higher than the Bullock administration projected, Bullock announced he would restore cuts to how much Montana pays Medicaid providers.

So Wednesday, the health department held a listening session and for hours took input on budget priorities for the revenue that came in above administration projections. Hundreds turned out either in person at a hotel ballroom in Helena or online. Over and over again they echoed Mary Windecker, director of the Behavioral Health Alliance of Montana.

"Medicaid already pays well below cost for most services, and this cut unfairly penalized the providers willing to accept Medicaid's low rates, which are on average 60 percent lower than traditional insurer rates," said Windecker.

And that means, Windecker says, that people and clinics that provide mental health and addiction treatment have been dropping out, and a statewide system that's been decades in the making is falling apart. 

"Frankly, I wonder why I'm even here having to talk to day," Corin Fisch said.

Fisch is a counsellor at Misfits Counseling Services in Great Falls. She was one of several who said that cutting payments for addiction or mental health counseling only means more Montanans end up getting treatment in hospitals, which is many times more expensive. 

"As you can see the Medicaid cuts to chemical dependency services in no way save the state money," said Fishch

"The other way it hurts us is it aboslutely puts those people in our jails, and we don't have room for those people," said Gallatin County Sheriff Brain Gootkin. "These people are the people that need our help."

Gootkin spoke on behalf of the Montana Sheriffs and Peace Officers association. He said the closure of mental health and addiction facilities is eliminating progress law enforcement has made in transitioning from incarcerating people with mental illness to helping them get treatment.

He said officers across the state are now spending valuable hours transporting people who are sick to the state hospital instead of stopping criminals.

"These people are the people that need our help," said Gootkin. "We have enough evil people that we need to put in jail."

Cascading problems associated with budget cuts are not news to state health department officials. But they and state budget director Dan Villa say the Bullock administration had no choice, as Montana is legally bound to have a balanced budget, and there hasn't been enough revenue to continue Medicaid programs.

Now that enough money has come in to restore $45 million to state agencies, the health department has initiated the rulemaking process to restore at least the 2.99 percent cut to Medicaid provider rates. It says the soonest that can happen is September first.

Eric Whitney is NPR's Mountain West/Great Plains Bureau Chief, and was the former news director for Montana Public Radio.
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