The Bullock administration is going ahead with $37.5 million in proposed budget cuts to medical services for the poor, including elimination of coverage for dentures and crowns for the 150,000 adults covered by Medicaid in Montana.
The cuts – part of larger overall spending cuts approved by the Legislature in November to cover a projected $227 million state budget shortfall – cover a wide swath of services for the poor and disabled.
“In general, it looks like (the Bullock administration) is trying to make do with an awful hand of cards that the Legislature has dealt them,” said Matt Kelley, health officer for the Gallatin City-County Health Department in Bozeman. “But it’s still a pretty grim situation.”
The administration outlined the cuts late last year, and at a Feb. 1 hearing in Helena, scores of health-care providers and advocates for the poor urged the governor to find other places to cut spending.
Yet this week, state health officials released the final rules to implement this round of cuts, reducing funds for dental services, case management for troubled families and mental health support, among other things.
The state did decide to exempt therapeutic foster care from reductions in payments.
David Hemion, executive director of the Montana Dental Association, said eliminating coverage for dentures and crowns and other expensive dental procedures is a harsh blow for the elderly and the working poor.
“Dentures are essential for nutrition, especially for people in nursing homes that don’t have a lot of options without dentures, to maintain their nutrition,” he said. “(And) people who are poor or who are starting out with an entry-level job, and they have no teeth, are going to have a much harder time being employed.”
The cuts to dental services, which also include less orthodontic care for kids, amount to nearly $10 million of the $37.5 million in cuts over the next 15 months.
“It’s just not fair to look at the budget and say we can make these cuts and it really doesn’t impact anyone that greatly,” Hemion said. “We can do better as a state, than looking at disabled and elderly people and saying they can go without these services.”
Kelley said the cuts will restrict in-home support services for kids in at-risk families, and predicted the savings will end up costing the state and local governments more money in the future.
The Bullock administration said it may consider some changes to the dental program that will save money and perhaps alleviate cuts.
But it has no immediate plans to reduce the overall cuts, saying its hands were tied by the Legislature, which put the cuts into law.
State tax revenue came in better than expected last month, but Bullock doesn’t have any legal power to undo any cuts until the next fiscal year, which begins in July.
Bullock could decide to overspend current budget authority and ask the Legislature to pay for that overrun next year, but has not indicated he’s willing to do that.
Hemion said his group remains hopeful that some of the dental-service cuts can be softened, but doesn’t know what may happen.
“Going forward, we’re going to work really hard to get this money restored in the budget,” he said. “If they have additional money, there’s no reason to make these cuts.”