unhealthy cuts

About 8,000 RiverStone Health patients have been hurt by state budget cuts made in the November special legislative session. RiverStone, the Yellowstone City-County Health Department, had to lay off 12.5 full-time-equivalent employees and estimates it will lose more than $1.4 million.

Last week, RiverStone CEO John Felton, Mental Health Center CEO Barbara Mettler and Rimrock CEO Lenette Kosovich told Yellowstone County commissioners what cuts the state Legislature and Gov. Steve Bullock made last year have cost our community.

At RiverStone:

- A health program that served 600 foster children last year was eliminated. (Yellowstone County recently had about 1,000 abused and neglected children in the child protection system, including those placed with relatives, placed in licensed foster homes or under supervised reunification with parents.)

- A program for low-income children with high health-care needs was slashed, so instead of serving 900 needy kids, targeted case management now is available to only 100.

- Passport to Health, which promoted primary care and deterred emergency room overuse, was abolished for 5,000 patients.

- The Medicaid Health Improvement Program that helped medically complex patients stay healthy outside the hospital ended service to nearly 1,500 RiverStone patients. A “replacement” program is expected to serve only about 150 patients statewide.

Earlier this year, Rimrock opened two additional houses for treatment of women with severe substance abuse disorders. It no longer has a waiting list, but all Medicaid patients now must wait five days for the state’s utilization review contractor to decide whether Rimrock correctly assessed their need for residential treatment. To comply with the new Montana Department of Public Health and Human Services utilization review requirement, Rimrock reassigned two licensed addiction counselors from treatment to paperwork, Kosovich told The Gazette.

In response to budget cuts, DPHHS changed how it pays for outpatient addiction treatment, forcing providers like Rimrock and the Mental Health Center to change their treatment protocols in ways that aren’t considered best professional practice. Every type of addiction treatment service now has a lower rate than it did in 2015, according to information Kosovich presented last week to Yellowstone County commissioners.

Mettler has eliminated 25 Mental Health Center positions since January, including three layoffs last week, because of revenue losses totaling $840,000 in the current fiscal year.

The Mental Health Center isn’t planning to close any satellite offices in neighboring counties, but Mettler said it will reduce the days its counselor works in Columbus and Big Timber from five to three per week.

While reimbursements have decreased, the cost of complying with state Medicaid requirements has gone up. For example, the Mental Health Center now must get approval from an out-of-state management company before it can get paid for the care of patients in the Program of Assertive Community Treatment. Last week, this intensive program was helping 83 seriously mentally ill adults live safely in Billings. Without PACT, most would be in the state psychiatric hospital.

About 60 percent of Mental Health Center clients rely on Medicaid. Mettler said these are seriously mentally ill people who would be at high risk of suicide or incarceration if not for their community treatment.

The Montana Department of Public Health and Human Services lost $95.2 million in general funds for the biennium because of state revenue shortfalls. Most of that general fund “savings” would have been used to match federal funds, so the total loss to Montana’s economy is closer to $300 million.

Candidates for Montana Legislature are out campaigning now. When they seek your vote, please ask them what they will do about the loss of public health care money and services in this community. Ask what changes they will support to pay for the essential care that keeps seriously ill people healthy outside the hospital and prevents future health problems for abused children.

The health care crisis that RiverStone, Rimrock and Mental Health Center leaders described in Billings started in Helena; that’s where it must be remedied.

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