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Gazette opinion: Time running out for Montana elder care fixes

April 10, 2017 GMT

The future of Montana’s frailest elders and their caretakers remains uncertain in the last weeks of the 2017 Legislature.

Republicans on the House Taxation Committee last week maneuvered to kill a Senate bill that would have imposed a tax on e-cigarettes and substantially increased state taxes on tobacco products. Senate Bill 354 would have directed new tax revenue to health care to help narrow the growing gaps between what Montana Medicaid pays for nursing home and in-home services and what it actually costs to provide that care.

Senior and long-term care services must be funded at a level that maintains availability of services for elders and adults with disabilities. With Montana long-term care providers reporting losses exceeding $50 per day per Medicaid resident, there is no fat to trim in these abysmally insufficient rates.

House Bill 17 doesn’t directly address the nursing home rate insufficiency. But it would help low-income Montana seniors access a less expensive type of care – assisted living – when that is appropriate for their needs. Rep. Ron Ehli, R-Hamilton, sponsored this bill at the request of the interim committee that he chaired. It passed the House and Senate by wide margins. HB17 would gradually add Medicaid coverage for 200 assisted living residents over the next two years. That would be a step forward, but still not meet demand considering that 517 people were on the waiting list in January.

The other important provision of HB17 is to increase the rate paid for assisted living, including the rate Montana Medicaid pays for memory care of folks with Alzheimer’s disease and other memory loss. Present rates are so low that most assisted living facilities limit the number of Medicaid residents they admit or don’t admit any.

HB17 would slightly ease the financial strain on Montana nursing homes that also provide assisted living or memory care. At least they would get more adequate reimbursement for those residents.

However, HB17 would not come close to offsetting losses on the 60 percent of Montana nursing home residents who are covered by Medicaid. Their care is much more expensive because they need more assistance and because nursing homes are much more heavily regulated than assisted living homes. The federal Centers for Medicare and Medicaid Services has adopted new regulations that are projected to cost every U.S. nursing home upwards of $62,000 a year.

HB17 is a limited, but meaningful, proposal to provide 200 more Montanans with care they need at less cost than nursing home admission. Unfortunately, it doesn’t propose a way to generate an additional $5 million in state funding for the important services it would offer over the biennium.

House Bill 618, sponsored by Rep. Nancy Ballance, R-Hamilton, would increase the utilization fee assessed on nursing homes for the purpose of leveraging federal matching funds. The fee hike in HB618 would help, according to senior advocates, but it wouldn’t eliminate the gap between Montana Medicaid rates and actual costs of care.

Montanans need to know that a tight budget can’t be balanced by expecting nursing homes or home-care services to take cuts. The status quo isn’t acceptable because these care providers are bleeding red ink. They struggle to hire staff at salaries that aren’t even competitive with fast food restaurants.

We call on legislators to approve HB17, HB618 and to reconsider SB354. Raising tobacco taxes isn’t the perfect answer, but the nursing home and home care crisis cannot be ignored. Various other proposals to raise revenues for the general fund have been rejected. If not tobacco and e-cigarettes, what tax source would lawmakers prefer? Time is running out for legislative answers.

Legislative leaders and Gov. Steve Bullock must get together on senior and long-term care funding that will actually provide and sustain the services elderly Montanans need.