MTPR

Budget Cuts Grow State Developmental Disability Workload By Six Times

Jan 16, 2018

Montana’s state health department is getting ready to take over day-to-day help for 3,000 people with developmental disabilities this spring, after severing contracts with four private contractors.

The department says it had no choice after state lawmakers and the governor cut $49 million out of its budget in November.

At a press conference Tuesday, state health officials said the quality of care won’t decrease, but case managers from the private non-profits who will see their contracts ended don't see how that’s possible.

Montana Department of Public Health and Human Services

"The quality of care is going to suffer," says Kibbie Crawford, a case manager in the Bozeman office of Helena Industries, one of organizations losing its state contract this spring. She says the state won’t have the resources to keep up the current level  of care.

“If all of their numbers are correct, which is questionable, then doubling the caseloads then you cannot have the same quality of care we have now, you cannot have the same personal relationship we have with these folks. And for most of them, without that real personal relationship they don't’ trust you enough to tell you what they really what or what they really need.”

Crawford is a among an estimated 70 people losing their jobs when the state ends its private contracts for developmental disability targeted case management. The elimination of these contracts was announced a few days before Christmas.

Marie Matthews, the Medicaid and Health Services Branch Manager for the Department of Public Health and Human Services met with reporters Tuesday.

“We have to reduce cost, and here we get reduce cost without reducing service,” she says.

Matthews says the state is doubling the number of its employees working in targeted case management in order to handle the incoming clients.

Right now, the state health department provides those services to about 600 people with developmental disabilities. In April, that number will grow to 3,600.

The state health department is not planning to hire additional case managers to serve the increased number of clients. It estimates that each of its case managers will have a caseload of between 50-60 people. That’s double what several private providers say is a manageable caseload.

Because the state is not hiring more workers to implement this policy change it will instead take current employees, who focus on provider compliance and care quality, and turn them into case management workers. The state health department’s Matthews says doing this removes some redundancy within the system, and gives case managers the responsibility and authority to follow up on any quality of care concerns.

“I don’t think it’s going to be easy. I think it is a must. We’ve been taxed with saving $49 million because there wasn’t a solution given that’s a different direction," Matthews says. "And we’re trying to find ways to achieve that expectation and retain the really critical services to the client population that we serve.”

Bottom line, Matthews says this is happening because the state doesn’t have enough money. She says the health department is following orders based on the budget agreement reached between Governor Steve Bullock and lawmakers in the special legislative session in November.

Matthews says the state did not seek input from non-government organizations in making the decision to end these specific case management contracts, but the state could seek third party advice on how to transition clients from private providers to state care moving forward.

According to officials with Helena Industries, Opportunity Resources in Missoula, A.W.A.R.E. in Anaconda the state health department has not reached out to their organizations asking for advice for this policy change.

Montana Public Radio was not able to reach the one other provider whose developmental disability case management contracts will be eliminated as a result of state budget cuts.