This blog is the fourth in a series to bring to light the impacts that state budget cuts have on the lives of everyday Montanans.
We began this series with a post about cuts within the Department of Health and Human Services (DPHHS), which resulted in the closure of more than half of the state’s outreach offices. In subsequent blogs we covered cuts to mental health services and the unintended consequences of eliminating services for Montanans with disabilities and mental health needs. Our focus here is the cuts to substance use disorder services and targeted case management, as well as the rule changes that will further limit Montanan’s access to treatment options.
As a quick refresher on the state budget cuts: Prior to the special session, cuts made by the legislature have resulted in about $14 million in cuts to the rates paid to health care providers who accept Medicaid patients. These cuts have taken a toll on service providers’ ability to accept and provide care for Medicaid patients, including adults and children suffering from mental illness. These providers include non-profits around the state, in addition to hospitals and doctors.
On top of cuts made during the regular session, the special session resulted in an additional $18 million cut from targeted case management for children and adults with mental health needs, substance use disorders, and developmental disabilities.
Despite the nearly 100 people who opposed the proposed DPHHS rule changes, struggling families who need mental health support and substance use treatment services will be facing insurmountable barriers to adequately access resources to live stable, healthy, and productive lives. Put simply, these budget cuts and rule changes hamstring social workers, case managers, addiction treatment specialists, and medical professionals who serve on the frontline of the opioid and methamphetamine crises in our state.
If the changes go into effect on April 1st, outpatient therapy services would be reduced, case management cut, and the number of treatment sessions for people not deemed severely disabled limited. Therapy sessions for people on Medicaid with substance abuse disorders would be capped at 12 visits a year and stays in group homes would be limited, with targeted case management for some adults and youth held to 24 hours a year. These maximum limits are far below the number of visits most people need for successful treatment and recovery.
The Montana Attorney general recently held a summit to find solutions to the opioid and methamphetamine use disorder crisis and the state wisely expanded SUD service options through Medicaid Expansion so that more treatment could be provided. Yet the state is now forcing a reduction in treatment services with severe cuts to provider rates and rule changes to treatment services.
According to social workers and service providers who testified at the DPHHS rule hearings, treatment services cannot be effective when limited by these cuts and rule changes. At the DPHHS rule hearing in March, Anthony Mascarenas at White Sky Hope Center on the Rocky Boy’s Reservation said, “There’s no way of addressing addiction in the amount of time that is given to us with the proposed rules.”
And in many cases, organization’s expenses will drastically increase and will not be able to pay clinicians a fair wage. Tammera Nauts, the Executive Director of the Recovery Center in Missoula said at the DPHHS hearing, "When you dismantle a system and you restrict providers' ability to make a decent wage, and provide services to our clients, you’re not just screwing with the S.U.D. system, you’re screwing with public health, with the ERs, with the jails, with … it goes on and on. The domino effect in this particular area is extraordinary."
Some service providers will have to shut their doors entirely, such as the Center for Children and Families in Billings did, the Livingston Mental Health Center, and the Sinopah House based in Kalsipell, which is the only therapeutic group home for adolescent girls in the state.
When providers are losing money on every Medicaid patient, they will serve fewer Medicaid patients. Just one example is Rimrock, Billings’ largest addiction treatment provider. Rimrock estimates that compliance with the new requirements 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.
The directors of Montana’s community mental health centers said it best: “The bottom line is Montanans lose access. When we should be moving forward with increased treatment options, we are heading in exactly the opposite direction.”
While the total impact of these cuts is yet unknown, we know from providers who directly serve people in need of SUDs treatment that the budget cuts to health and human services will have dire consequences for Montana families. The legislature could have supported common-sense revenue measures. But instead the state opted to create more hardship for Montanans who struggle day in and day out with addiction and mental health needs. We can and should do better.
At MBPC, we know that Montana can choose another path; we can decide to adequately invest in the public services that educate our children, keep our communities safe, and provide much-needed health care to our neighbors.
MBPC is a nonprofit organization focused on providing credible and timely research and analysis on budget, tax, and economic issues that impact low- and moderate-income Montana families.