A mother who about a decade ago got help at Mountain Home Montana, a  residential program and mental health center for young mothers and their children, recently reached out on the group’s Facebook page to share her success story.

“She said she didn’t know how to get out of the difficult situation she was in and Mountain Home gave her the tools to thrive,” said executive director Crissie McMullan. Now the woman is a nurse and has two children.

Mountain Home in Missoula serves moms ages 16-24. Forty percent of the women who come to the program have been a part of the foster care system and 60 percent are homeless. About 1,000 moms and their children have come to the program since it started in 2000.

“They have a lot of things they’re trying to overcome in order to be healthy people and healthy parents,” McMullan said.

Mountain Home’s residential program and targeted case management provide the foothold and tools for moms to achieve, but funding for the programs could be eliminated under budget cuts proposed by the Department of Public Health and Human Services to make up for a revenue shortfall.

The cuts within the health department are by far the most significant across all state agencies. The agency is required to make $105 million in cuts, or 10 percent of its budget. Those cuts trigger another loss of $136 million in federal matching dollars. And both come on top of a budget already reduced tens of millions of dollars by the Legislature in the last session.

Reading the cuts can feel like a punch to the gut for vulnerable families — eliminating the stipend for foster parents to buy diapers, getting rid of some Offices of Public Assistance, cutting the contract to help blind and low-vision children learn mobility skills and reducing the funding for elderly who can’t afford nursing home care on their own.

Even things that sound like bland government programs or complex reimbursement systems can have a huge impact on the health and safety of Montanans statewide.

Part C funding, set to be eliminated if cuts go through, sounds anonymous enough, but it’s the program that helps infants and toddlers with developmental disabilities. Reducing the rate Medicaid providers are reimbursed may not sound that bad in the aggregate, but it could lead to the loss of doctors in parts of the state where there aren't many to begin with.

Under one of the cuts proposed by the Department of Public Health and Human Services, a portion of funding for a program called Second Chance homes would be eliminated. That’s how Mountain Home can provide housing to women and their children. The money helps pay the water and power bills to keep the house open, McMullan said.

There’s already more demand than ability to provide services, with a wait list fluctuating between three and six months.

A second blow would come from eliminating targeted case management. Mountain Home’s mental health center has two full-time employees that help people go from being homeless to being able to provide for themselves.

“It’s a key bridge to independence for the moms we serve,” McMullan said. Case managers create goals for parenting skills, work situations, housing, education and more, then help women meet them.

The case management reimbursement from the health department is the only way Mountain Home has been able to pay for those services.

McMullan said she already works to bring in private funding, but most of the sources she’s reached out to are already tapped out and hearing pleas from other programs they support.

“We already do a lot of additional fundraising to make our programs work,” McMullan said. “The state isn’t providing 100 percent of our funding by any means.”

The health department said that to meet the 10 percent cuts required by the governor, services had to be reduced across the board and no division could be spared.

None of the choices was easy to make.

“Everything on the list is a worry,” said Erica Johnston, the operations services branch manager for the health department. “Nobody can read the list of cuts in the Department of Public Health … and not get a sense of how extremely toxic this has been. We work here because we care and nothing on this list is easy to get to.”

Marie Matthews, Medicaid services director, said the agency already operates at 14 percent for administrative costs, a number it’s worked to bring down over the last few years. Seventy percent of the general fund dollars that come into the department go right back out the door for direct services to Montanans.

“The agency runs so tight already that we’ve already asked people to get rid of the things that don’t have value, so we’re talking about things that still have value but just a little bit less value than something else.”

The Child and Family Services division, which is dealing with increasing numbers of children removed from their homes and placed into foster care, could see furloughs under the proposed cuts. The division has struggled in recent years to recruit and retain employees because of already high workloads.

“There’s some trade offs and some pretty unsavory choices on that list, but that program was requested to offer up 10 percent,” Johnston said.

In addition to cutting programs and services, department-wide the proposed cuts include 17 full-time equivalent positions in addition to furloughs. That comes on top of an existing 8 percent vacancy rate.

At Mountain Home, McMullan said the cost of not helping women can end up being greater than providing the services, McMullan said, putting more costs back on the health department.

“One example is the cost of Child and Family Services,” she said. “If they aren’t living here and they are homeless, Child and Family Services will at some point intervene and if they have to put that child into foster care or a group home, sometimes for the rest of that child’s life, that’s hundreds of thousands of dollars, plus legal costs.”

She called on lawmakers to come back for a special session and raise taxes to keep programs like Mountain Home operating.

If a special session doesn’t happen, cuts could come as soon as the end of next week, though they could take months to phase in.

 “It’s a pay-now-or-pay-later kind of thing,” McMullan said. “I think it’s also a false choice that we can only make cuts off of either one program for vulnerable families or another program for vulnerable families. There are ways that we can continue to provide these essential services.”

Matthews put it more simply.

“There’s choices,” Matthews sid. “The leaders have choices.”

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