Proposed cuts to health and substance abuse disorder services for people on Medicaid will be devastating, providers said at a state health department hearing Thursday in Helena.
The cuts would make up for budget reductions passed in November during a special session of the Legislature.
About 100 people filled a room and listened to three hours of testimony from people who said services like living in group homes or having access to therapy sessions have saved their lives. There was also a brief protest outside the building near the Capitol in Helena.
“What we’re at risk of having here is frequent hospitalization, frequent stays in county jails and not the support services to get those community members back to that least restrictive environment,” said Heidi White, a master’s of social work practicum student at Sunburst Foundation, which provides mental health services in Western Montana.
The changes are part of rules and a new manual proposed by the state Department of Public Health and Human Services. If the changes go into effect, things like therapy sessions for people on Medicaid with mental illnesses or substance abuse disorders would be capped at 12 a year. Stays in group homes would also be limited and targeted case management for some adults and youth would be limited to 24 hours a year.
Budget cuts were passed in a November special session of the Legislature after revenues came in lower than expected and the state had its most expensive fire season in history. Earlier this week advocates called for some of the cuts to be delayed as revenue reports early this year are more optimistic than previously expected.
Those who spoke at Thursday’s hearing said that mental illness and substance abuse disorders are complex issues that can’t be treated sufficiently in that limited amount of time.
“There’s no way of addressing addiction in the amount of time that is given to us with the proposed rules,” said Anthony Mascarenas, who works at White Sky Hope Center on the Rocky Boy’s Reservation in north-central Montana.
While the center now operates on federal grant money, Mascarenas said he doesn’t know how it would carry on treatment under the proposed rules once it spends down the grant money.
To save money, the department also is implementing something called utilization review. That review means the health department will contract with a company that will determine if some services are medically necessary.
Montana has used this system of prior authorization in the past, with a company called Magellan. In 1999, the company resigned two weeks after the Legislature called for it to be fired because of poor management. The departure was seen as the end to the state's 22-month foray into managed mental health care.
Tammera V. Nauts, executive director of the Missoula Recovery Center, questioned the logic in moving to utilization management.
“Why pay millions of dollars to a company that broke the system 20 years ago?” she asked.
Brenda Kneeland, chief executive officer of Eastern Montana Mental Health in Miles City, said the move would amount to “reverting to a system of managed care that almost wiped out the behavioral health care system in Montana in the mid-1990s. We are returning to a process of authorization for services that has failed us in the past.”
Several others also criticized the new manual that details many of the changes.
Sheila Smith, who worked at Western Montana Mental Health Center in Kalispell, said the manual looked “very, very much like a rough draft.”
“It seemed to come out so quickly with so little review and contains so, so, so many problems,” Smith said. “It was pretty stunning to me after so many years to see something of that quality come before us now. ... What was the hurry? Who is driving this train, because we are on the tracks of a wreck and we never know who’s driving. It just comes out from left field right at us month after month and in the end it affects the people we serve.”
Christine Gascon, of Choteau, said that she received a text during the hearing Thursday about a client who had learned of the cuts in a letter that went out to people before providers had a chance to discuss it with them. Her local sheriff told her the client had to be airlifted for medical treatment after attempting suicide because of fear about the cuts.
Health department director Sheila Hogan said she undertook substantial outreach efforts, telling providers in September that she wanted to meet with them to discuss the cuts.
“I have had at least 32 meetings,” Hogan said after the hearing Thursday. “I have gone to every meeting I’ve been invited to. … I went everywhere from Dillon to Billings.”
Hogan said that she didn’t understand why some providers at the hearing said the health department didn't reach out for input on the cuts. She also said that while the department has tried to hear provider concerns, it’s impossible to meet budget reductions without everyone feeling the pain.
“Bottom line, we have a $49 million target we need to reach and I will listen to any and all suggestions, but bottom line is we have got to cut rates. We’re trying to make sure we have some semblance of a system. … I know how I feel; I can only imagine how people feel that are providing services and are seeing clients that are impacted.”
The department does not respond to comments during hearings, but does issue a document after the comment period closes with its responses.
The proposed manual and rules are set to take effect April 1. Comments can be submitted until March 9 by mailing Kenneth Mordan, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; faxing 406-444- 9744; or emailing firstname.lastname@example.org.