To my amazement, two of the leading legislators responsible for drastically cutting the 2018-19 Biennium budget for the senior, long term care, mental health, and addictive disorders services of the DPHHS are now trying to hide their part in failing the people of Montana.
They have the audacity to say that the State Budget Director “makes an inexcusable attempt to avoid responsibility for the damage done … to private-sector Medicaid providers serving Montana’s most vulnerable populations –the developmentally disabled, mentally ill, and our aging populations” when they were the ones who cut the budget for the Senior and Long Term Care Division by $ 33.5 million and the Addictive and Mental Disorders Division by $ 15.8 million. These legislators severely cut the budget of both the Divisions below the level needed to maintain current services, even after DPHHS supplied the Legislature (Jan. 2017 Briefings) with input on deficiencies of existing budgets in meeting the needs of Montanans. In their editorial, these legislators laud the expertise of DPHHS officials and their specialized knowledge of the needs and budget requirements to provide for disabled, mentally ill and elderly. Too bad they flagrantly disregarded this acknowledged expertise in the briefings and from the extremely restricted amount of testimony which the joint committee allowed during the 2017 Legislative Session.
Even under the last 2016-17 Biennium budget for the Senior and Long Term Care Division, 517 Medicaid seniors who needed in-home assistance to remain in their homes were still on the waiting list and 1800 Montana seniors who were eligible and in need of nursing home placement were still on the waiting list. How many more Montana seniors will lose the DPHHS services they have been receiving as a result of the harsh budget cuts these legislators enacted.
The reduction of $ 33.5 million represents a loss of 6.2 % of the expenditures for services currently provided by the Division, whether that takes the form of: less meals served at senior centers, less seniors receiving Meals on Wheels, more Medicaid seniors losing their in-home assistance, less terminally ill seniors receiving hospice care, less care provided at the Montana Veteran’s Homes, or even greater numbers of Montana seniors on burgeoning waiting lists.
In the Addictive and Mental Disorders Division, the drastic cut of $15.8 million will directly affect the over 24,500 Montanans annually who have been receiving Community-based Mental Health Services and the over 10,000 Montanans annually who have been receiving Community Chemical Dependency Services for substance abuse. The annual fixed cost to the Division to operate the Montana State Hospital, the Montana Mental Health Nursing Care Center, and the Montana Chemical Dependency Center is $ 61.4 million. After excluding this fixed cost, the reduction of $ 15.8 million represents a loss of 8.3 % of the expenditures for Community-based services currently provided by the Division, whether that takes the form of: less Prevention/ Early Intervention Drop-in Centers and Crisis Intervention Inpatient Services; less Core Mental Health Services to allow severely mentally ill Montanans to continue living in their communities; less Transition and Recovery Programs for Montanans coming back to communities from resident mental health facilities; or less mentally ill Montanans benefiting from supported employment.
For these reasons, I fervently disagree with the legislator’s assessment of the Governor’s part in an inadequate 2018-19 budget for DPHHS. By signing HB 2 instead of vetoing it, what Governor Bullock did wrong was NOT requiring the legislature to go into a special session until they produced an adequate budget (comparable to the past 2016 -17 Biennium) for the DPHHS to meet the needs of the most vulnerable of Montanans. At least, the Governor offered a number of reasonable recommendations on how additional revenue could be raised when he, like the Legislature, anticipated a future significant decline of State revenue. In the 2017 Legislative Session, the legislators refused nearly every bill to increase revenue which would sustain services at their current level. Over 20 measures proposed for bills to raise revenue were blocked from coming to the floor for debate.
Now we are faced with yet another severe blow to the DPHHS 2018-19 budget because of Senate Bill 261 which these legislators co-sponsored and requires further mandatory budget cuts AFTER they had already put into place the drastic cuts to seniors, the mentally ill, and addicted. Under the stipulations of Senate Bill 261, the DPHHS is required to seek an additional reduction of $8.6 million in State General Fund dollars (which is actually a total additional cut of $26 million once you factor in the loss of Federal matching funds) to their 2018-19 budget. As Harry Truman said, “The buck stops here!” Rep. Ehli, Sen. Thomas, and Rep. Nancy Ballance (as the Joint Committee chair woman who orchestrated the HB 2 cuts ) need to shoulder the responsibility for the impact these cuts will have to Montanans, given the reality that when you cut dollars it results in the loss of critical services affecting people’s lives.
To provide options for decision makers in meeting SB 261, the DPHHS has offered a list of potential reductions in services to meet a $ 26 million loss of revenue to their budget (bold-faced items constitute impacts to the Divisions already hard-hit with budget cuts by HB 2):
• Eliminate health case management for foster children, provided by Missoula and Cascade County Health Departments and Riverstone Health (Billings).
• Eliminate supplemental payment to foster parents caring for infants and toddlers to help defray costs for diapers.
• Cut orientation and mobility skill instruction for 300 children with low vision or blindness.
• Cut grants for child care providers that help improve quality care.
• Cut over $2 million in funding for non-profit organizations in Billings, Missoula, and Helena that provide housing and support for teenage mothers.
• Eliminate partnership with Children Advocacy Centers that provide multidisciplinary evaluation of children victims of violence. This work and cost would be shifted back to local law enforcement agencies.
• Eliminate funding for mentoring of foster children through eight Big Brothers Big Sisters organizations across the state.
• Cut funding to domestic violence shelters across the state.
• Cut $400,000 provided to tribes to assist with foster care placement of tribal children currently in their care.
• Cut an additional $48 million in targeted case management for individuals with disabilities and those experiencing mental health and substance use disorders.
• Eliminate funding for services for developmentally disabled and at-risk children ages 0-36 months.
• Eliminate Medicare prescription drug benefits for over 10,000 low-income seniors.
• Cut $6.8 million in services for home and community-based services for seniors and people with disabilities who want to stay in their home or community, likely forcing more Montanans into nursing home care.
• Cut $8.5 million in hospice services.
• Cut $15.5 million in personal assistant services for seniors and people with disabilities living in their own home.
• Eliminate health insurance coverage for direct care workers who are already struggling to make ends meet.
• Cut $23 million in reimbursement rates for hospitals providing care to Medicaid patients, including cuts to payments for Montana’s rural critical access hospitals. These cuts could mean reduced access to services in rural Montana.
• Eliminate Medicaid’s coverage for some dental services, which could impact over 44,000 Montanans and 585 dentists providing coverage to Medicaid patients.
• Cut $1.6 million in chemical dependency treatment.
• Reduce grants to counties for mental health crisis intervention.
• Close 19 offices of public assistance in rural Montana, impacting many families’ ability to access assistance and services.
While some cuts may be inevitable when a budget crisis occurs, our legislators need to use common sense and responsibly reconsider measures to increase State revenue rather than creating yet deeper cuts hurting Montanans. There are solutions, such as the tobacco tax increase and closing tax loopholes, to ensure that our tax system is fair, raise critical revenue, and help Montana be the state we can all be proud of.
Karen Harvey
Victor