Health care programs devastated following the state’s budget collapse over the last two years are getting pieced back together.
State lawmakers Wednesday gave initial approval for a new plan for public health spending in Montana, which accounts for more than 40 percent of the state’s total budget.
“We’ve made some great investments here and some great fixes from the 2017 cuts into provider rates for our most needy, which I’m proud of," says Miles City Republican Rep. Eric Moore, who's the chair of the legislative subcommittee that oversees the budget for the state health department.
"We’re certainly in better shape overall in the budget than we were in ‘17, but we’re not overly flush either.”
Conservative lawmakers say the budget is still tight this year so tough decisions need to be made about how to use the available public dollars.
Republican leaders have said they’ll likely reject Gov. Bullock proposals to raise additional money for the state with tax increases on tobacco, liquor, rental cars and hotel rooms.
Still, Democratic Rep. Mary Caferro says she’s happy with where the health department budget is sitting. But she says it’s only a good start.
“We have a mentality of no new taxes. And I’m not a tax and spend liberal, but I’m telling you, every year the cost of providing the same level of service goes up. ”
The subcommittee reviewing the proposed budget agreed with most of the governor’s requests.
Initial votes Wednesday supported paying for the state’s growing costs in the Children’s Health Insurance Program, known as CHIP, and continuing a 15-percent boost in funding to manage the heavy caseloads facing Montana’s foster care system.
Committee members also endorsed Gov. Bullock’s request to increase how much Medicaid pays organizations that help care for people with disabilities, mental health issues and the elderly. Pay would go up 0.91 percent next year and 1.83 percent the following year.
“I just think these people care for the least among us and I think we have to get these rates up so these providers can function, at least break even.” says Rep. Moore.
Medicaid provider rates were cut by three percent as part of the roughly $49 million taken from the state health department during the breakdown of the last state budget.
In a surprise move Wednesday, the committee recommended adding more than $3 million for more Medicaid waiver slots for community-based services for people living with Alzheimer's and forms of dementia.
One Republican, Bob Keenan, from Big Fork, joined Democrats voting to budget for the independent living services, proposed by Caferro.
“I did not expect it to pass,” says Rep. Caferro.
The program was initially funded in 2017 but was cut and never restored. Gov. Bullock did not request the money to be restored in his proposed budget.
It’s unclear if the money will stick or get pulled out as the state’s health department budget moves forward.
But the new proposed health department budget isn’t all about restoring or boosting funding.
Lawmakers also made some cuts. Around 100 job openings within the Montana health department will permanently get removed from the agency.
Republican Nancy Ballance, chair of the House Appropriations Committee said lawmakers will have to keep a close eye on the money coming into the state as the budget moves forward.
“We are fortunate to be able to fund the programs that we have, given where we think we are today on revenue.”
Ballance says she’s not overly concerned about recent state revenue projections showing the money coming into the state is slightly below estimates. New projections will come out in March.
The draft budget for the agency does not give an answer to the looming expiration of Montana’s Medicaid expansion program, which extends health coverage to low-income adults.
How lawmakers act on the expansion will define much of the 2019 legislative session. The Legislature is expected to debate bills to continue the program past its June sunset, next month.