Two Republican state lawmakers from Hamilton are asking for $5.5 million to expand a healthcare program.
"This bill is not only a good bill, it may be the most important we have to do all session."
That's Representative Nancy Ballance. She and Representative Ron Ehli are teaming up to spend more public money on healthcare services that keep elderly and disabled people out of nursing homes.
Last year, Medicaid, which is jointly-funded by the state and federal governments, spent $44 million to provide assisted living services for 2,600 Montanans. Things like helping them bathe and dress. But Ballance says that doesn’t come close to meeting the demand:
"Senior and long-term care division had 517 people on the waiting list, waiting an average of 187 days. Some obviously had been on the waiting list much, much longer," Ballance says.
Those are people age 65 and older with disabilities, including dementia and Alzheimer's disease. For younger people with developmental disabilities, the waiting list is even longer, Ballance says.
"1,303 people on the waiting list for services, again, many of them for years," says Ballance.
More than 20 people came to support Ballance and Ehli's bill, HB-17, at its first hearing Monday. They included the state Alzheimer's association and all of Montana's largest hospitals, as well as several people who run small assisted living or home care facilities.
Diana Helgeson is the administrator at Churchill Retirement Home and Assisted Living in Manhattan. She says that Montana needs to not only extend Medicaid benefits for services like hers to more people, it also needs to pay caregivers more.
"I cannot afford more than one Medicaid slot. It’s just — we don’t get enough money, I can't financially afford to make it," Helgeson said.
Ballance and Ehli's bill asks for more money to boost pay to assisted living service providers. In fact, most of the $5.5 million it asks for would go to boosting provider pay. They say that would allow providers to take on more clients who qualify for Medicaid assistance. Their bill would grow the number of Montanans who could get that assistance by 200 people.
Helgeson told the committee the story of a family that contacted her recently after they heard that one of her clients had died:
"And I had a family member come to me and say, did one that passed, was that person on Medicaid. And I said, no, we still have that one person on Medicaid. They did not pass. The person that asked me, her father passed away this morning. He didn't get the opportunity. They spent a lot of money, they couldn't afford to borrow any more to keep him there."
Lynn Mullowney Cabrera is the executive director of the Montana chapter of the Alzheimer's Association. She says it’s common for the families of people with dementia to spend down all their assets paying for care that can cost $5,000 a month.
"When those assets are exhausted, those families then and only then turn to the state for help," Cabrera says. "And so then they go on and get their Medicaid, and then they discover that there are 500 people in front of them. So what was once sort of this reluctant hope, well, here's an answer, now they're in queue behind 500 other people for services that, given this scenario, are non-existent."
But boosting funding so more Montanans can get assisted living help may not be easy in a year when the legislature is looking for budget cuts due to declines in state tax revenue. Even though the federal government would pick up more than half of the $8 million a year tab.
At a press conference Tuesday, Representative Ron Ehli said funding more assisted living, via so-called "waiver slots," can actually save the state money by keeping people out of nursing homes.
"If they're in the nursing home, then that's paid for by Medicaid," Ehli says, "and Montana's portion of that is a whole lot higher than if they were on the waiver slot."
Ehli says he's anxious to get his bill to the appropriations committee so he can start working on finding money for it. On Wednesday the full House passed it unanimously.
The bill would grow Montana's Medicaid assisted living services for 2018 and '19, but the population needing those services will continue to grow.
Lynn Mullowney Cabrera with the state chapter of the Alzheimer’s Association says projections are for more people contineung to be diagnosed with that disease:
"Let me remind you there are 19,000 people today living with this disease, another 49,000 providing their care. Those numbers will double by 2025. We’ve got some work to do."
