Gazette opinion: Social safety net in Billings cannot take these cuts

February 28, 2018 GMT

A year ago, the Center for Children and Families was housing 40 homeless children and mothers. Two dozen of the moms were in outpatient addiction treatment with the center; others were in treatment with other Billings counseling services. Many of these women were participating in drug treatment court programs.

The center, 3021 Third Ave. N., closed Wednesday — another victim of the deep cutbacks in Medicaid payments and state-funded human services under way since last summer.

“We are ceasing operations today” Amy Fladmo, the center’s executive director, told The Billings Gazette Wednesday. “Devastating” is the word she used repeatedly when describing the Medicaid reductions that precipitated the closure.

Directed by the governor and the legislature to reduce spending, the Montana Department of Public Health and Human Services stopped paying for Second Chance Homes that sheltered children and mothers together in Billings, Helena and Missoula.

The loss of housing was devastating, Fladmo said. Then she learned of the substance abuse treatment cutbacks that are the subject of a public hearing at 10 a.m. Thursday in Helena. “I learned of the deep cuts, almost cutting in half reimbursements for substance abuse treatment and reductions in the number of sessions reimbursed. We just didn’t have the capacity to absorb those cuts.”

Ninety percent of the parents and children the center served were enrolled in Medicaid. So when reimbursements were reduced by 3 percent in January, the financial impact was significant. The elimination of targeted case management was another financial hit.

The center’s shutdown this week will result in up to 15 layoffs and the loss of addiction treatment services as well as desperately needed housing for addicted moms and their children. However, most other center services are transitioning to other local agencies, Fladmo said.

The center’s demise should set off alarms in Billings and throughout the state. Other services have been curtailed in small and large communities where barely break-even Medicaid services couldn’t operate with these payment reductions.

“It’s going to be very difficult to continue intensive outpatient treatment,” Lenette Kosovich, Rimrock CEO, told The Gazette recently. “I don’t know what to do. These are catastrophic changes.”

Rimrock, Billings’ largest addiction treatment provider, estimates that compliance with the new requirements proposed at Thursday’s hearing in Helena will increase the nonprofit organization’s expenses by at least $124,000. Combined with Medicaid payment reductions, the DPHHS rule changes “will put us upside down over $500,000. We cannot absorb that kind of financial hit and will also have to decrease services along with our peers,” Kosovich said in a letter to Billings lawmakers serving on the interim health committee.

Rimrock already has more the 200 people on a waiting list for its residential treatment. What happens to them if Rimrock and other Montana treatment providers reduce the number of people served because they can’t afford to maintain present operations? When providers are losing money on every Medicaid patient, they will serve fewer Medicaid patients.

The decision to shut down the Center for Children and Families was forced by a combination of cuts that have already been implemented by DPHHS and by looming cuts that are certain to occur — unless something changes drastically. That’s why The Gazette again calls on Gov. Steve Bullock to order a pause in the DPHHS budget-cutting process. As time goes on and more is learned about the complex spending reductions, it has become evident that the sacrifices are falling hardest on the state’s most vulnerable children and families.

Bullock must halt this rush to dismantle Montana’s addiction treatment and mental health system. DPHHS needs to consult the Montana providers about the least destructive ways to reduce costs overall. The governor should look again at the cost of delaying Medicaid cuts versus the loss of community services statewide.