In the past two years, RiverStone Health in Billings has served more than 1,800 babies and children eligible for targeted case management.

Services and support offered to children and their parents can give youngsters improved health and stability. And it can offer them a brighter future.

But a proposed revision involving Medicaid payment for that one-on-one service would make all but a few of those children ineligible for care.

“Should the rules change take effect, they would be implemented March 1,” said Barbara Schneeman, RiverStone’s vice president of Communication and Public Affairs. “That’s when things would fall apart for a lot of people.”

It’s important, Schneeman said, to put a face on the population who could lose the support they now receive. One of them is Zane Clapp, nearly 8 months old, a happy, curious baby.

One moment he’s smiling, content in his mother’s arms, and the next he’s crawling on the floor to play with a toy. He doesn’t stay still for long.

Sarah Clapp, Zane’s mom, credits much of her son’s well-being to the help she’s received from Melissa Helzer, a registered nurse case manager with RiverStone. Helzer meets with Clapp in her home, at a coffee shop or wherever it's convenient.

“She’s not only been a friend to us but a support system,” Clapp, 34, said, sitting with Helzer in the living room of her Billings apartment. “If I have a question or need or don’t know where to go, she can point me in the right direction.”

The Montana Department of Public Health and Human Services held a hearing Thursday on rules changes for a number of different programs. Comments will be accepted until next Friday.

The proposed cutbacks come out of state budget cuts in response to an anticipated revenue shortfall, combined with the most expensive fire season in state history. The $12.5 million in DPHHS cuts would trigger an additional loss of $22.2 million in federal funding.

It’s a short-term solution that could have far-reaching ramifications, Schneeman said.

“We’re trying to build families healthy and strong,” Schneeman said in an interview with Shawn Hinz, vice president of Public Health Services at RiverStone. “So children can have educational attainment, graduate from high school, go into the workforce and become taxpaying citizens, not go down the path of despair.”

A report on Early Childhood Development in Montana published in January 2018 by the Community Development Department of the Federal Reserve Bank of Minneapolis backs up Schneeman’s concern.

“Recent studies reinforce decades of research demonstrating that children’s early experiences, relationships and environments have a strong link to health, well-being and future life success,” the report said.

That may grow increasingly difficult in a state where, the report said, “the share of Montana’s infants enrolled in Medicaid with evidence of perinatal drug exposure more than doubled from 2010 to 2016, putting more of Montana’s young children at risk for health problems and developmental delays.”

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Clapp, 34, who had a high-risk pregnancy, met Melzer when she enrolled in the nurse-family partnership through the community health center. It’s a program for first-time moms, giving them targeted case management during their pregnancy.

That care extends to the baby for the first year of his or her life. Under the rules change, the targeted case management would end once the baby was born.

Others affected by the change include children outside the first year of life who have potential developmental delays, those who are at risk because they lack some basic necessities of life, and an increasing number of youngsters in the foster-care system.

Clapp, a single mom who works full-time, was at high risk because she had suffered several miscarriages. She was overwhelmed with the pregnancy and was alone, her family living in Wyoming.

“I had concerns about what I could do to keep myself healthy and make sure the pregnancy was good for the baby and he was healthy,” Clapp said.

After Zane was born, Clapp had trouble with breast feeding, so Helzer was able to give her tips and connect her with resources in the community, including a day care center. A dietitian on the team also helped Clapp with nutrition needs.

“I feel like I’m a really good mom, and I love my son more than anything,” she said. "But it’s nice to have somebody like Melissa who says ‘you can do this.’”

Hinz shared the history behind targeted case management for pregnant women and their babies in the state. The rule was put into place in 1996 and followed the path of the Montana Initiative for the Abatement of Mortality in Infants (MIAMI) Project.

“The MIAMI legislation said in Montana we would look at women during pregnancy, and especially the most vulnerable, to try to prevent low-birth babies,” Hinz said. “And then they’d follow the babies for the first year to make sure they could access medical, social and any other identified needs.”

The idea was to give this most vulnerable population access to the services they need, provided by a team of case managers. The team included a registered nurse, a registered dietitian and a social worker.

“The full complement of that team surrounded that individual, identified what their risk factors were and put together a care plan,” Hinz said.

With the rules change, the dietitian would no longer be part of the team. And the services would strictly apply to pregnant women, not their children.

Rather than unilaterally ending services for babies in their first year and for at-risk children, Hinz said RiverStone Health and other community health centers who provide the care should be consulted about how to trim the budget without destroying a proven safety net.

“If it’s going to be community owned and driven, let us be the drivers in some of these decisions,” she said.

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