MTPR

Montana Medicaid Providers, Recipients Anxiously Await Budget Restoration Details

Aug 29, 2018

Many of Montana’s poorest and most vulnerable people — and the health care providers who serve them — are anxiously awaiting news from Governor Steve Bullock this week. Bullock is expected to release his plan to restore some funding to health programs for the state’s poor and disabled that have been devastated by budget cuts over the last year.

MTPR Capitol Reporter Corin Cates-Carney is here now to talk about the upcoming announcement.

Eric Whitney: The Bullock administration is saying that it’s “restoring” cuts to Medicaid — but it’s not a 100 percent restoration, right? Not every program that was cut will be brought back to the same funding level it was at before the cuts? Or is all the money that was cut being backfilled?

CCC: No, not all the money that was cut will be backfilled. The special session resulted in $49 million being cut from the state health department, and last month, the governor said there’s now enough in state coffers to restore about $30 million of that. When the Bullock administration made that announcement, it held a big hearing to get public input on what the top priorities should be.

EW: And so this week all the people who rely on those health programs, and the state contractors who provide a lot of them, they’ve been anxiously awaiting the announcement of what exactly will be restored, and which $19 million worth of programs and services will remain cut.

CCC: Right. And on Tuesday the Bullock administration released a plan for some restorations, saying that it was rolling back a Medicaid pay cut. That was one of the more controversial cuts in the package of spending reductions to balance the state budget. It basically told all the doctors, clinics, hospitals and other health care providers who serve Medicaid clients that the state was going to reduce how much it paid them by about 3 percent. Many of those providers have said for years that Medicaid already doesn’t cover what it costs them to provide care, or is break-even at best. And that pay cut is what caused lots of the non-profits that serve Medicaid clients to lay off staff or just plain shut down.

EW: How many agencies closed, or jobs were lost?

CCC: According to one count by the Behavioral Health Alliance of Montana, 10 offices closed across the state. All of those were in rural towns. And just over 100 jobs were lost.

EW: So, the Bullock administration says it will restore the pay for Medicaid service providers. What else do we know about which health care services will be restored?

CCC: The governor has said the state will put money back into a dental services for the poor beyond just basic exams and fillings — things like crowns and dentures. There was a lot of public backlash when those were cut because bad oral health can lead to a lot of other health problems down the line if it doesn’t get fixed.

EW: When the budget cuts were announced, we did a lot of reporting about impacts to people who need mental health care, or who have developmental disabilities and need help getting by day to day - any news there?

CCC: It appears that the governor is considering putting money back into those programs, but we don’t have details yet. And people who work in that system say it was already very fragile even before the budget cuts - that there already wasn’t enough money, or money was tight to help provide housing for young at-risk moms, or drug treatment, mental health services, and programs that help people with disabilities live independently. Providers say those programs actually save taxpayers money by keeping people in their homes and out of more expensive institutions.

EW: In public meetings before and after the cuts, dozens of people told some pretty compelling stories about what these social services meant to them, right?   

CCC: Yeah, that's right. There were a few stories like the one that the mother of a 20-year-old nonverbal man with severe autism told in a letter to state lawmakers earlier this month. She said that people who help look after her son, their workload doubled because of these budget cuts. And that made it harder for them to help people like her son.

There’s a group of about 30 mental health care providers called the Behavioral Health Alliance of Montana that’s calling for the creation of a state task force to design a new system that can help people with disabilities and behavioral health issues, something they say was needed even before the budget cuts.  

EW: Do you know if the governor and health department are open to that idea? 

CCC: It’s not clear if they’ll take up that exact recommendation. But the governor has directed state officials to improve Montana’s mental health system.

EW: But to do it with $19 million less than was originally budgeted last cycle, because, as we said, this budget restoration isn’t a full restoration.

CCC: Montana already had a serious shortage of mental health services, and the nation’s highest suicide rate, and even with this restorations, the mental health system here is still going to have a lot less money going forward than professionals in the field say the state needs. Although some providers say that changing the model of care here is just as important as having adequate funding.

EW: If these programs are so important, why were they cut in the first place?

CCC: We’ve done quite a bit of reporting on the $227 million dollar budget shortfall that the governor’s office projected last year. With that projection came the need to make cuts in order to balance the state budget. Bullock and the Republican-led Legislature couldn't come up with a way to avoid cutting state spending. There’s were a lot of political back and forth that we don't really have time to get into. But, big picture, because public health is far and away the biggest state dollar expense, that’s where a lot of the cuts came from. And that’s where most of the budget restorations will go now that state revenues are up.

EW: So, still unclear what exactly is going to be restored to programs run by the state health department - when do you expect to hear details?

CCC: The governor’s budget director is meeting with reporters Thursday afternoon. It’s not clear if we’ll get all the details, but I’ll be there asking questions.