Elinor Smith

HELENA (UM Legislative News Service) - The Montana Legislature is back in the Capitol after a mid-session break and the talk is all about the state budget. The House Appropriations Committee has started chipping away at the more than 50-page bill that will decide the state budget for the next two years.

Thursday, lawmakers debated the cost and budget of Montana’s Medicaid program and the services provided through it.

Rep. Llew Jones, R-Conrad, is the sponsor of HB 2. The way he puts it, the committee will have to eat the elephant one bite at a time to hear, debate and amend all sections of the budget. He said the committee would work on the budget every day until they get through it all. House Bill 2 is broken up into different sections -- covering the state of Montana’s expenses ranging from education to what lawmakers debated Thursday: Healthcare.

“House Bill 2 is the main state budget bill. It's about $13.4 billion in total appropriation authority. The legislative budget is at about $32 million lower than the executive request,” Jones said.   

State-funded healthcare services are all listed under Section B, which makes up a large portion of the budget. Healthcare in Montana spends just about half of the state’s overall budget, costing Montana’s general fund – essentially the state’s checkbook –  about $2.5 billion dollars a year.

Section B funding is used for things like foster care, Medicaid, long-term care for the elderly, addiction treatment and much more. 

Section B has to fund about 16 different services, encompassing all phases of Montanans’ medical and social necessities from birth to death and there’s only so much money to go around. Covid and the inflated cost of living made a perfect storm for healthcare providers and professionals across the state.

Healthcare advocates and providers have told lawmakers that they need provider rates – the rate at which the state Medicaid program reimburses healthcare providers – to pay the full cost of care or they may have to shut facilities down. A recent study commissioned by the state showed Montana’s provider rates are well below the cost of care. 

Sydney Blair is the chief executive officer for Many Rivers Whole Health, a 15-county behavioral health provider in North Central Montana. She said if provider rates aren’t fully funded, it's likely she won’t be able to keep her facility running at the size it is now. 

“What that means to us is that right now -- three behavioral health group homes are at risk of closure. We have -- that means that 20 some FTEs will be affected and about 24 clients will be turned out into the community that usually end up … in the correctional facilities or at the state hospital,” Blair said. 

Advocates say mental health facilities and long-term care facilities are the most affected by low provider rates as they serve some of the most vulnerable populations in Montana and historically employ some of the most underpaid staff in the healthcare field. 

Margaret MacDonald represents Montana 65+, an organization focused on advocating for Montana’s senior citizens.

“With this rapidly growing population in this demographic, it would be a disaster for us to see another dozen nursing homes close their doors, as has occurred in this state over the past year. Those closures tell us something of critical importance to you and to all of us today as we consider the state biennium budget, they tell us that these facilities, the county commissioners and the managers who oversee them are not crying wolf,” MacDonald said. 

The final issue has to do with postpartum care. The committee is debating expanding Medicaid coverage to include all needed services for the mother and the child up to twelve months after the birth of the child. Melody Cunningham represented the Montana Chapter of the American Academy of Pediatrics. 

“We do know that that first year is critical for moms and babies bonding, and that if they bond well, that has positive outcomes from a physical as well as mental health standpoint for the, for the children,” Cunningham said.  

The committee is aiming to come to a final budget and vote on HB 2 by noon on Tuesday, March 14th.