Montana Budget

Director of DPHHS, Sheila Hogan, center, and Dan Villa, the governor's budget director, listen to recommendations Wednesday from health and human service providers as the state decides where to restore millions of dollars in funding that had been cut to fill a budget shortfall.

Damage done to Montana’s health and human services safety net won’t be repaired by the partial restoration of state budget cuts announced by Gov. Steve Bullock.

Since last summer, services have been taken away from some of Montana’s most vulnerable children and adults. Clinics have closed and care professionals have been laid off – all to save money at the expense of seriously ill and disabled people. Families have suffered without services they relied on for daily, dignified living. This was the message from Medicaid providers and clients who participated in a listening session Wednesday in Helena.

Gov. Steve Bullock has already decided how to use $5 million: Reversing the across-the-board Medicaid rate cut effective Jan. 1.

That change will be worth much more than $5 million to Montana Medicaid providers and the state’s economy because the general fund pays only about 30 percent of the Medicaid bill; the federal government pays the rest. So when the state spends $5 million, payments actually go up by about $15 million.

Although the rate cut reversal is welcome, providers from across Montana pleaded Wednesday for the state to also rescind recent rule changes that are contrary to best practices for chemical dependency treatment. Addiction treatment providers also are struggling with new administrative burdens to get preapproval and re-approval for residential treatment of the most severely drug-addicted patients.

“Children, youth and adults with mental health and substance use disorders have lost key portions of their community-based behavioral health care and have moved at an increasing rate into higher acuity and more costly centers of care,” Mary Windecker, executive director of the Montana Behavioral Health Alliance told state budget director Dan Villa and Department of Public Health and Human Services Director Sheila Hogan.

“The rural communities have been impacted disproportionately as rural centers have closed, in-home support services have been canceled, and people are only allowed to attend one group therapy session per day. Rural participants are not realistically able to travel multiple days to group meeting sites under the new rules.

“From larger centers, the cuts have hit their bottom line at 10-15 percent. There has been no fat in the behavioral health agencies ever, and these cuts are unsustainable as proven by the closing of so many offices and services.”

The Behavioral Health Alliance proposed an idea for transforming Montana’s Medicaid behavioral health system that deserves serious consideration from the state: Move to a value-based purchasing system.

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“In a value-based purchasing system, the behavioral health agencies are responsible for managing the care of the patients they see and treat daily rather than adding another layer of bureaucracy and paperwork to an already over-taxed system,” Windecker said.

More than a dozen states use some form of value-based purchasing for all or part of their Medicaid program. Such a change cannot be made quickly. It would have to fit Montana’s needs and it ought to be phased in after a pilot project shows success in our state.

“One of the things we have been offering all along is our help,” Rimrock CEO Lenette Kosovich told The Gazette after the Helena meeting. “We feel much of this could have been avoided if they had talked with us. There has been a lot of damage in the wake of the cuts.”

“People aren’t seeking treatment; they’ve been scared away. It’s horrible,” said Kosovich, who said Rimrock no longer has a waiting list for residential treatment.

Much as we’d like to think that suddenly there’s much less need for people in Billings to get effective addiction treatment, we know the need is great. Our courts are filled with criminal defendants whose illegal behavior is connected to drug abuse. Our foster care system overflows with the neglected children of drug addicts. Many of the people who wander the streets of our city are intoxicated at all hours of the day and night.

Mike Chavers, CEO at Yellowstone Boys and Girls Ranch, was among about 150 people attending the Wednesday listening session in Helena. The next day, he hosted about 90 people, including Hogan, the DPHHS director, at a “solutions” conference on the YGBR campus west of Billings. Chavers found “bright spots” in the budget crisis: “YBGR and other agencies have begun talking together in ways we haven’t before,” Chavers said. “We are looking at how are we working together and avoiding duplication.”

Continuing such collaboration will be crucial to building back services that have been abolished and doing so in ways that are sustainable and effective to meet the needs of Montanans.

The state employees who have been told to do more with less cannot fix the safety net without the help and cooperation of community service providers. Collaboration means taking good advice from Montana providers, meeting professional care standards and following best practices for the high quality, compassionate care Montana’s elderly, disabled and ill citizens deserve.

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