As representatives of agencies providing home and community-based services across the state for Medicaid recipients, including Montana’s older adult population and those with physical, mental and developmental disabilities, we are greatly concerned by the proposed cuts that will affect the Montana citizens who most need these services.

The cuts to Community First Choice, Personal Assistance Services, Big Sky Waiver Services and Severe Disabling Mental Illness services will decrease provider agencies ability to maintain an adequate workforce and serve people in the community.

Elimination of certain programs and severe cuts to other programs have been proposed in the state budget. The services provided through these programs help people with the need for assistance with activities of daily living remain at home and out of institutions.

Montana has made significant progress rebalancing how we care for people needing long-term care (LTC) by reducing use of nursing homes from 52.6 percent of Medicaid LTC costs in 2008 to 42.8 percent in 2015, resulting in millions of dollars in savings for the state. The proposed cuts threaten these savings and Montana’s progress in caring for people where they want to be — at home.

Not only do these cuts impact the people we serve and the workforce we employ, they also significantly reduce the amount of federal matching dollars Montana receives to support community-based programs. This, in turn, affects the overall Department of Public Health and Human Services budget, the state of Montana’s economy, and returns to an institutional bias in Montana’s long-term care system.

Community-based services are a lifeline for many Montanans of all ages to be able to live and work in their communities instead of being forced into institutions. Some people are born with a life-long disability, some experience disability through a life-changing event, and still others develop disabilities through aging. No one chooses to be disabled, separated from family and friends or sent to isolating and expensive institutions.

Community-based services are a more cost-effective approach to the provision of care. If consumers can no longer receive adequate support to live safely at home, the entire community suffers the consequences, which will present themselves through the unnecessary and more expensive hospital readmissions, emergency room visits, and nursing home placements.

Collectively, our agencies serve 2,179 people and employ 3,376 Montanans statewide. We serve Montanans in every age group, from birth to end of life. The cuts proposed for community-based services will reduce services to all 3,500 people currently enrolled in these programs and served by all agencies statewide.

We encourage Gov. Bullock and our legislators to come together and find solutions that will resolve the budget issues facing our state. We encourage thoughtful consideration of solutions such as utilizing a short-term investment loan through the Board of Investments, adjusting the required amount of the ending fund balance to help meet budgetary needs, or placing more emphasis on the use of community-based services over institutional services as a cost-saving measure.

Through compromise and cooperation we are confident solutions will be found. We encourage solutions that are mindful of the citizens most in need of services, that minimize the impact on them, and that maintain the safety and well-being of all Montanans as a priority.

Submitted in collaboration with the following agencies by: Travis Hoffman, advocacy coordinator, Summit Independent Living

John Stevenson, Personal Care Program manager, Easter Seals-Goodwill NRM, Inc.
Kelly Reynolds, executive director, ResCare HomeCare
Mark Robinson, regional vice president, Addus Homecare
Ben Bledsoe, president, Consumer Direct Care Network
Kris Carlson, executive director, A Plus Health Care
Dawna Brinkel, executive director, Home Care Services
Rachel Stanek, Healthcare Division manager, Express Employment Professionals
Mike Mayer, executive director, Summit Independent Living
Tom Osborn, executive director, North Central Independent Living Services