Keila Szpaller

(Daily Montanan) Gov. Greg Gianforte vetoed a bill to help more people access assisted living, pointing to significant fiscal impacts and a “cumbersome process.”

“While I look forward to signing into law an overdue increase in rates for all of Montana’s Medicaid providers, I have significant concerns that Senate Bill 296 is misguided policy brought by a stakeholder organization that has highlighted potential short-term savings but neglected to understand the legislation’s significant long-term fiscal impact and burden on taxpayers,” said Gianforte, a Republican, in his veto letter.

However, an expert in the industry said the governor’s letter misinterprets the legislation, which wasn’t set to take effect until July 1, 2025. Bill sponsor Sen. Becky Beard, R-Elliston, also said she was disappointed to see the veto, especially given the clarity she believed supporters had provided during debates.

“I was surprised because we had such overwhelming support,” Beard said. “So many legislators, 82 percent of them, voted for the bill, and he vetoed it. And his letter that accompanied his veto was a bit terse in that (it says) we aren’t understanding the ramifications of what would be occurring.”

She said some of her fellow peers also criticized the bill as growing an entitlement program, but they misconstrue the way the bill works as well as the financial implications. She said it would affect fewer than 1% of Montanans, and without it, their care could cost more.

According to the Montana Secretary of State’s Office, legislators have until 5 p.m. June 15 to return a poll that could override the veto. The bill is among 16 vetoed bills currently awaiting poll results.

During the past year, the state has seen nursing home facilities close, and legislators spent a lot of energy this session working on setting rates that would help them be able to afford to care for people on Medicaid.

But nursing homes are expensive, and SB 296 aimed to bolster support for seniors who might not be able to stay home on their own anymore, but don’t need the higher level of care in a nursing home yet.

Legislators amended the bill, and it passed with just a couple of policies in place, but they were ones that would have saved the state money, said Rose Hughes, executive director of the Montana Health Care Association.

Currently, some seniors — an estimated 146, according to the last fiscal note — were on the waiting list for an assisted living facility through the Big Sky Waiver Program. The program allows people who would otherwise be in an institution to live in their homes and receive services or live in an assisted living facility in their community.

The bill proposed transferring those receiving waivers to a different program, the Community First Choice Program. Hughes said the savings comes from a higher federal match through Community First Choice, 6% more than the waiver (a 70% federal match compared to 64%).

It also comes from an $11 a day savings on case management, she said, dollars that don’t need to be spent per client.

(Case management helps for people in their homes, but if they’re in an assisted living facility, the staff provide that service.)

She estimated the savings at $6,500 per year for each person being served, just under 900. She said the savings means those on the waiting list for an assisted living facility can be served at no additional cost to the state, and another 70 waiting for other Big Sky Waiver services also can be served, again with no extra cost to the state.

“So with that savings, we were able to serve all of the people on the Big Sky Waiver waitlist who are waiting for assisted living … and still save money,” Hughes said.

Hughes said the bill also would save money because it would serve people who would otherwise go to nursing homes if they can’t access assisted living when they need it. She said the figure is hard to quantify.

“But experts will tell you that it is important to serve older people as soon as they need help rather than making them wait and creating an opportunity for them to fall or experience some other traumatic event that leads to hospitalization and nursing home placement,” Hughes said in a written response to the veto.

The bill also set up a process for increasing room and board payments annually as Social Security increases, she said. Those costs aren’t covered by Medicaid, and Hughes said the bill created a setup similar to ones in other states.

“If room and board never goes up, that’s just one more reason not to accept a Medicaid patient,” she said.

People who end up having to skip over assisted living will end up in a nursing home, “the most expensive and the most isolated” option, Beard said. She said she had hoped, with so much support from legislators, the benefits in the bill were clear.

“I know we hammered that over and over again, but when you have different branches of government locked in their philosophical positions, it’s really hard, I guess, to break through that,” Beard said.

She said people who have worked hard their whole lives deserve better: “We had a lot of people very relieved that we got this bill passed.”

Addressed to Senate President Jason Ellsworth, R-Hamilton, and House Speaker Matt Regier, R-Kalispell, Gov. Gianforte’s letter also describes the bill as “creating a new entitlement program” and described the room and board increase as a “cumbersome” process.

“While being mindful of the budget authority provided to us by the legislature, my administration will continue to support Montana’s skilled nursing and assisted living facilities as they modernize and adapt to changing demand and an ever-evolving senior and long-term care landscape,” Gianforte said. “However, as more Montanans elect to age in their homes and outside of an institution, I cannot support fiscally unsound legislation that undermines and ignores that personal decision.”

The personal decision most older Montanans choose when they need help, though, is assisted living, a home- and community-based setting, according to the Montana Health Care Association.

“This legislation assures that they do not end up in a nursing home while waiting for assisted living services,” Hughes said in her response to the veto. “Right now, people are CHOOSING assisted living but are unable to access it.”

Beard said supporters need to diligently monitor the bill and cross their fingers. She was originally inspired to sponsor the legislation because of the lack of support for people who didn’t have options to stay in their homes.

She heard many stories from providers, and she saw her own family’s experience.

“My mother and grandmother were living together in their private home, and grandma was 102, and my mother was 82, and my mother had dementia and my grandmother couldn’t hear or see, and I didn’t know which one was taking care of whom,” Beard said.

She said her grandmother has passed away, and her mom is in a facility for seniors, but not everyone has that choice. She said people are running out of options because facilities aren’t available.

Beard didn’t receive a copy of the veto letter directly, but she said she had been checking the legislative website regularly, and that’s where she saw the bill had gotten redlined. An override is possible but not guaranteed.

“If this fails in the end, we need to be prepared in the next session to yet again address the issues and see if we can’t get better options available for this segment of our population … keeping them as close to home, friends, family as possible,” Beard said.