By Michael Siebert/UM Legislative News Service

HELENA -- With so much talk of money during Montana’s 65th legislative session, it can be difficult to comprehend how all that money affects everyday Montanans.

This session, one group has become the de facto human face of the budget — direct care workers.

According to the Montana Disability & Health Program, nearly 13 percent of Montanans reported having some sort of disability in 2012. Among those, many have developmental disabilities, like Down syndrome and autism, and often require significant assistance to meet their basic needs.

Montana’s direct care workers provide those services to the state’s disabled. They help them bathe, get dressed and get to work every day. But private care providers, contracted by the state Department of Public Health and Human Services, are finding it increasingly difficult to keep direct care workers around longer than a few months.

The Legislature does not typically set wages for the state’s jobs. However, because the services provided to disabled Montanans are considered entitlement services, direct care workers are in the unique position of having their wages set by Medicaid. Those wages have stagnated at less than $10 per hour.

Two bills in the Montana Legislature aim to increase pay for direct care workers.

Jon Knokey
Jon Knokey

House Bill 638, introduced by Rep. Jon Knokey, R-Bozeman, appropriates $10.2 million to the Department of Public Health and Human Services to fund a $5 per hour wage increase for direct care workers over the next two years. The money would be limited exclusively to raising wages for direct care workers who aid those with developmental disabilities, and would be distributed over the next two years.

Meanwhile, Senate Bill 354, introduced by Sen. Mary Caferro, D-Helena, would raise wages for direct care workers of all kinds, including those who work with seniors and the physically disabled. The bill’s funding mechanism is an additional tax on cigarettes and other tobacco products, including e-cigarettes, and would raise wages by about $4 per hour by late 2018.

Both bills passed their respective houses. HB 638 passed on a vote of 86-14, while SB 354 passed 27-22.

How direct care workers changed the approach to disability care

Before direct care workers, those with developmental disabilities in Montana were often simply institutionalized, said Beth Brenneman, a staff attorney with Disability Rights Montana.

“People, when they had children with developmental disabilities, were encouraged up until maybe 20 years ago to have their child live an institution for their entire lives,” Brenneman said.

Direct care workers eventually stepped in to fill the role that institutions and mental health facilities once played, allowing people with disabilities to live in their own homes and, in many cases, find employment.

“Direct care workers are critical to people's independence,” Brenneman said.

The problem is that those direct care workers’ wages have barely increased since they were first set over twenty years ago. That makes it difficult to keep workers employed.

Kyle Tharp, who uses direct care services and testified on SB 354 last week, said the high turnover rate makes it hard on the people who need the help.

“A lot of times, you get to know staff, then they leave because they are not getting enough money to stay,” Tharp said. “Then you have to start over with new staff … people we don’t know until we work with them enough.”

Ken Brown, director of specialized resources at Opportunity Resources, which provides direct care services to the disabled in Missoula, said he had to close a group home because he was unable to find enough staff.

“We are in dire need of staff,” Brown said. “We can’t keep going like this. It’s a crisis.”

Knokey said this is due to a collision of government-set wages and the free market.

“This is a clear economic abnormality,” Knokey said. “You have a situation where we can’t just tell the disabled to go get a job, and make more money to provide for their services.”

Knokey said raising the wages of direct care workers makes good fiscal sense.

He said the current rate at which direct care workers are paid is low enough that they qualify for a “bevy” of government assistance programs.

“The policy choice is clear,” Knokey said. “We either spend money on wages that go directly to human capital, or we spend money on government assistance.”

Knokey’s bill was supported by a majority of Republicans, who have thus far been opposed to additional appropriations in the state budget. Senior and long-term care, the funding bracket that includes direct care workers, may face tens of millions of dollars in cuts. These two bills seek to mitigate some of those cuts.

Nancy Ballance
Nancy Ballance

Chair of the House Appropriations Committee Rep. Nancy Ballance, R-Hamilton, supported Knokey’s  bill, saying that if the Legislature can find ways to fund projects like the Montana Heritage Center, a museum of Montana history approved by the Senate last week, then they can find additional money for direct care workers.

“We can find ways to fund this,” Ballance said.

Caferro’s tobacco tax proposal was more divisive, due to Republicans’ opposition throughout the session for additional taxes.

For Caferro, though, the bill is just as much about reducing the number of Montana smokers as it is raising direct care wages.

“For years we have heard about this problem of workforce shortages, and so this provided a good revenue stream to solve that problem,” Caferro said.

Caferro said keeping direct care workers around is key to the success of the patients they care for.

“Much of the work they do is very intimate, and the actual person’s success is based on a consistent and qualified worker,” Caferro said.

Gov. Steve Bullock supports Caferro’s bill, calling a tax on cigarettes and tobacco products “reasonable.” He said he hopes supporters of Knokey’s bill will eventually come to support more revenue enhancement measures as well.

“Those who are taking care of our most vulnerable certainly ought to be getting paid a fair wage,” Bullock said.

Michael Siebert is a reporter with the UM Community News Service, a partnership of the University of Montana School of Journalism and the Montana Newspaper Association.