Devin Armstrong packed up his belongings this spring and said goodbye to housemates at the Missoula assisting living home he shared for five years.
Armstrong is 30-years-old, a people person, a computer wiz and has cerebral palsy. He’s wheelchair- bound and needs help with everyday tasks.
Armstrong didn’t leave BeeHive Homes by choice. He was forced out when the facility decided to close its traumatic brain injury unit. The facility is among many around the state that have struggled in recent years to afford staff and keep their doors open.
Armstrong’s mom, Wendy Lofthouse, his stepdad and two brothers helped him pack up a moving truck. Lofthouse said the move was incredibly taxing on her son. He wasn’t up to talking about it, but agreed for others to share his story.
Lofthouse said Armstrong was determined to move out when he turned 18, he wanted to make his own way and found a place to do that at BeeHive.
“It gave Devin the assistance that he needed but he still had the freedom to go to the movies, or go to the mall or a friend’s house or have a friend over, ” Lofthouse said.
Armstrong’s family went into a spiral when they were told his assisted living unit would close. Lofthouse says she called at least a dozen providers with no luck.
“It’s hard to be rejected. And at the base of it, the very deepest part of it, it’s rejection that you don’t belong,” Lofthouse said. “And as a mom, even though my son is 30. I want to protect him from that. But I also recognize that I’m not always going to be here. So by sheltering him completely from the harsh realities that there are limited options for housing for someone in his situation isn’t going to give him any favors when he navigates those waters later on.”
Stories like Armstrong’s filled the Capitol halls during Montana’s 2023 legislative session – people with state-subsidized insurance in need of behavioral health, senior or disability care struggle to find and afford it. Providers said the state’s Medicaid safety net was falling far short.
Montana Medicaid providers of behavioral health, disability, long-term and nursing care will see about a 20% raise from the state this year as a result of policy passed this year.
The question now is, will that be enough to make a meaningful difference in the lack of available care, or will it simply maintain the status quo?
According to the Montana Health Care Association, more than 850 nursing home beds were lost in 2022. Western Montana Mental Health Center eliminated two-thirds of its available beds in April for people experiencing a mental health crisis.
According to the Montana Health Care Association, more than 850 nursing home beds were lost in 2022. Western Montana Mental Health Center eliminated two-thirds of its available beds in April for people experiencing a mental health crisis.
Erin Heitzmann is the administrator of BeeHive Homes and says the closure of Devin’s home ultimately came down to the state’s Medicaid rates.
“There’s been two assisted communities that I know of now that no longer take Medicaid that had in the past," Heitzmann said. “And I can understand because the rate of hourly wages we’ve had to increase to get people to work has gone up so much higher.”
A state-commissioned study found the reimbursement rates the state paid Medicaid providers failed to cover the average cost of doing business – meaning providers were losing money when caring for Montana’s most vulnerable. Some facilities will now only take people who can pay more through private insurance.
Legislators and Gov. Greg Gianforte decided to raise the Medicaid rates to 100% of the identified gap by 2025. That totals $339 million over the next two years.
Rose Hughes, director of the Montana Health Care Association, has advocated for care providers for 40 years and said Medicaid rates weren’t always so low.
“Providers in Montana until maybe the last few years considered Montana a good place to do business in terms of Medicaid. The rates are never generous, they never cover costs. But we managed to keep up,” Hughes said.
But she said things started to change. Inflation jumped, new regulations required more investment and a workforce shortage led to highly competitive wages. The circumstances were untenable for some.
“It was just a difficult time these last few years and everything went downhill rapidly,” Hughes said.
Providers and advocates are celebrating the higher reimbursement rates, but caution they’re only a minimum for covering costs. Rose Hughes, director of the Montana Health Care Association said there are still questions about whether the money is going to fix a system that’s been neglected for years and if these rates will be enough to attract workers.
Providers and advocates are celebrating the higher reimbursement rates, but caution they’re only a minimum for covering costs. Hughes said there are still questions about whether the money is going to fix a system that’s been neglected for years and if these rates will be enough to attract workers.
Heitzmann with BeeHive Homes said reimbursement rates are certainly beneficial, but bureaucratic challenges with the state health department make it difficult for money to get to providers, even if more of it is available. She said she used to see new residents get approved for Medicaid waivers on the day they were admitted for care.
“And now it’s almost gone to where it’s the opposite where we will say we’re going to accept somebody but the approval doesn’t come through for several weeks,” Heitzmann said. The delay means less money for her business, which means they’re not always willing to take Medicaid patients.
The state health department didn’t make Medicaid Director Mike Randol available for an interview for this story. Department spokesperson Jon Ebelet said the agency is moving “as quickly as possible” to implement the new rates.
The state health department has begun the administrative process to raise the rates and could be finished as early as September.
Mary Windecker, director of the Montana Behavioral Health Alliance, said increases to provider rates is “a wonderful change in the right direction.”
However, she said it’s a short-term fix and the behavioral health system requires systemic change in how the state pays providers.
“What we really need to do is move to a value based system that fully covers the cost of care rather than this fee for service that only about five states in the country still have – a fee for service system where people are paid for the widgets they produce. It’s just not the most effective or efficient rate setting."Mary Windecker, director of the Montana Behavioral Health Alliance
“What we really need to do is move to a value based system that fully covers the cost of care rather than this fee for service that only about five states in the country still have – a fee for service system where people are paid for the widgets they produce. It’s just not the most effective or efficient rate setting,” Windecker said.
Windecker said the state is already moving in the direction of a value-based system and she’s excited to see work on that before the next legislative session.
A commission created by lawmakers is studying ways to overhaul the behavioral health and disability services systems, which could include ending the fee-for-service model.
In the meantime, people like Devin Armstrong still have few choices for care.
At the eleventh hour, Armstrong was able to find a place to live in Missoula close to his family and he’s happy to be there. But the situation is not ideal. He’s surrounded by elderly folks rather than his peers. It’s more of a clinical setting, rather than homey.
And while his mom is thankful for the care he receives there, she wants more for him.
“If I could win the lottery and all of a sudden come into a couple million dollars, I would have this place for people like Devin with the needs but yet the abilities he has also. So he could just be his best self and have the supports he needs but yet be intellectually stimulated with conversation every day and have a family that cares about you around you,” Lofthouse said.
