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HELENA - As lawmakers sift through the state's massive public health budget, they'll be eyeballing two new programs to boost in-home care, which allows the elderly and the disabled to get day-to-day care without going to a nursing home or institution.

One proposal is a $10 million continuation of a program started last year, funding health insurance for the low-wage workers who provide such care.

The second is the Schweitzer administration's biggest new proposal for the Department of Public Health and Human Services: Expanding available in-home slots and creating new centers that act as clearinghouses for information on care options for the elderly. It also has a $10 million price tag for the next two years.

"Both of these initiatives target people who need (care) the most and who really do look to the state for some assistance," said Anna Whiting Sorrell, director of the department.

The proposals also are a top priority for the Service Employees International Union (SEIU), which has been organizing in-home health workers in Montana.

Last week, SEIU members, which number more than 700 in Montana, converged on the Capitol for a rally and to lobby legislators to support the two programs.

"We appreciate what (lawmakers have) done, and we're asking them to continue what they've done and expand what they've done," in-home worker Joan Nemeth, of Billings, said at the rally last Thursday.

Whether lawmakers will follow through on this request may depend on the health of state revenues, which have been shrinking.

This coming month, the legislative panel examining the human service budget will recommend what to fund and what will end up on the cutting-room floor.

Sorrell said she remains optimistic that the in-home care proposals, along with the rest of the Schweitzer budget, will emerge largely intact.

The $10 million health insurance program is known as "health care for health-care workers," approved for the first time by the 2007 Legislature.

It uses state and tobacco-tax money to leverage federal funds to finance health insurance for nearly 1,000 in-home health workers, whose wages are usually $9 to $10 an hour.

The $2.6 million approved by the Legislature two years ago paid for six months worth of health insurance starting this year. To extend the program through fiscal 2011 will cost $10 million.

Ted Dick, political director for SEIU in Montana, said for some workers now covered by this program, it's the first time in many years they had health insurance - even as they themselves were providing health care.

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"We need to maintain health care for health care workers, because it's made a big difference in their lives," he said.

The second proposal would create 178 new slots for in-home care funded by Medicaid, the state-federal health program for the poor. About 470 people are on a waiting list for this care, many of whom are now staying with family members.

Getting a slot means they can live in their own homes, get help with preparing meals and other activities, remain somewhat independent and not go to a nursing home.

Such care is less expensive than a nursing home, which would be covered by Medicaid.

Sorrell said people want to stay in their homes if they can, and it's more cost-effective as well: "It's the best public policy we could have. It meets consumer needs and the financial needs of the state."

SEIU's push for more in-home care also is part of the union's plan to expand its membership by organizing in-home health workers.

Last summer, the union helped gather enough signatures to qualify a ballot measure that would have revamped in-home care in Montana and allowed SEIU to organize hundreds or perhaps thousands of new workers. The union agreed to withdraw the measure with the promise that their supporters in the 2009 Legislature would work toward expanding in-home care.

"We want to grow our union; what's wrong with that?" Dick said. "What's wrong with growing the labor movement? Everybody benefits from that. I think it's a win-win situation."

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