Dozens of people, including health care providers and foster parents, came to Helena on Thursday to register their opposition to proposed reductions in state Medicaid services.
The Montana Department of Public Health & Human Services has proposed wide-ranging rule changes for the state’s Medicaid system, including a number of cuts in available services and reimbursement rates for providers.
Agency leaders say they have to make these changes, after the Montana Legislature cut DPHHS’s funding by $49 million last year to help close a $227 million budget shortfall.
“These are not funding reductions that any of us want to make,” said DPHHS director Sheila Hogan.
DPHHS held a public hearing on the proposed changes Thursday. Many of the people who spoke said they were concerned the proposals would make it much harder for the most vulnerable Montanans to get the care they need.
“The proposed rules as written effectively eviscerate these critical services that help struggling families and often are key to keeping families together,” said Beth Cogswell, executive director of Youth Homes.
One proposed rule would limit reimbursement for home support services, in which specialists work in-home with families whose children have serious emotional or behavioral issues. Jim Parker of Western Montana Mental Health Center said the change could force the center to lay off seven home support specialists, who serve about 70 families.
“We no longer have the resources to do more while being paid less and still maintain evidence-based quality care,” he said.
That reduction in reimbursement also affects therapeutic foster care, in which foster parents receive additional training to care for children with needs that can’t be met in the regular foster care system. Foster parent Tom Bourguignon said he’s concerned about what it would mean for the providers that currently offer that training.
“If they weren’t providing those services, then families such as mine would have to go to the state to get the same services, or not receive those services at all,” he said.
The rule proposals would limit the number of children eligible to receive targeted case management services. Only those with specific health conditions expected to last at least a year would qualify. Children born into high-risk families would no longer be eligible.
The proposed rule changes would also make substantial reductions to Medicaid’s dental services. Adults would no longer receive coverage for crowns or for dentures. Comprehensive orthodontic treatment would be limited to people 20 and younger with specific conditions like cleft palate or serious overbite.
DPHHS leaders said the changes were aimed at reducing coverage of higher-cost procedures.
Joanna Wales, a dentist with Community Health Partners in Livingston, said dental services are especially important for lower-income people who receive Medicaid.
“You don’t need subsidized dentures unless you’ve had a bunch of life circumstances go terribly wrong,” she said.
Wales said receiving dentures can even help patients improve their chances of getting a job.
Many of the people who spoke at Thursday’s hearing said they understood the state needed to reduce costs, but that they believed the reductions would force people to seek more intensive forms of care – costing the state more in the long term.
One group of care providers did voice support for the rule proposals. Carl Roth, president of the Montana Optometric Association, said his members were in favor of a section limiting the number of eye exams and new eyeglasses that would be covered. Under the new rule, people over 21 would be eligible for one exam and one pair of glasses every two years, instead of every year.
DPHHS will continue taking public comments on their rule proposals by mail and online until Feb. 9. You can find a link to the full list of proposed changes here (https://dphhs.mt.gov/AdministrativeRules).