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State health dept's budget takes shape

State health dept's budget takes shape


A budget committee Friday gave initial approval to small increases in the rates foster families and some Medicaid providers are paid, while saying proposals from Gov. Greg Gianforte need vetting by policy committees before they'll be funded.

The Health and Human Services Appropriations Subcommittee on Friday took votes that gave initial shape to the state Department of Public Health and Human Services' budget, a process that will continue Monday before being folded into the Legislature's main budget bill. No decisions are final until the budget is passed and signed by the governor.

The committee said while they supported the idea behind the Healing and Ending Addiction Through Recovery and Treatment, or HEART, Act proposed by Gianforte, they wanted to have the idea sent to a policy committee for examination.

Gianforte wants to use $7 million from recreational marijuana revenues and funds from the state's tobacco settlement to support community-based substance use disorder and mental health treatment programs. That money would leverage federal dollars to put about $24 million toward the program, Gianforte's budget office has said.

In unanimously voting against the funding Friday, the committee made clear they weren't shutting down the proposal.

“We didn’t get an awful lot of information about this, and I think it needs to go through a policy committee to fully vet the program,” said Sen. Carl Glimm, R-Kila.

Rep. Mary Caferro, D-Helena, said while she strongly supports community-based services for people with mental illness and substance use disorders, she took issue with tapping the tobacco settlement money.

“I believe this should be funded in a different way,” Caferro said, adding she worried about programs already funded with tobacco money. “ … It’s robbing Peter to pay Paul.”

Voters approved recreational marijuana last November, but there's been conflict over where money from a tax on sales should go. Committee chair Rep. Matt Regier, R-Kalispell, said without a clear proposal on how to spend the marijuana money, it was premature to sign off it for the HEART Act.

Travis Hall, Gianforte's senior adviser and director of strategic communications, emphasized Friday the program hadn't been denied.

"As we understand it, the committee did not reject HEART funding, but instead is waiting on legislation that implements the recreational marijuana initiative before appropriating funds for measures attached to the implementation," Hall said. "That legislation is forthcoming."

The committee also declined to approve $1 million in money Gianforte's budget proposed for suicide prevention, though it did unanimously approve a request from the governor to move the suicide prevention coordinator and related budget authority from the department director’s office to the Addictive and Mental Disorders Division.

In voting against the additional funding, Glimm said he didn’t support the measure because he has not received sufficient details on how the program works now and if it's successful.

“I haven't’ seen it. It’s possible I missed it, but at this point I’d like to see a more comprehensive look at what we’re doing and how it works,” Glimm said.

Medicaid and Health Services branch manager Marie Matthews said the funding would have been used for wellness promotion and substance use disorder prevention. Matthews said those are drivers to suicide and the approach is in line with the U.S. Surgeon General’s recommendations.

Montana consistently ranks near or at the bottom in terms of suicide rate per capita. Rep. Frank Garner, R-Kalispell, told the committee that during the last legislative session, he went to the funeral of a friend whose son died by suicide.

“I made a commitment when I came here. I will not support a motion that cuts a matchbook from our suicide (prevention) efforts in the state. I think it’s woeful what they are, and if there’s additional money that we can put towards it, whatever that effort is, I’m going to support it,” Garner said.

The committee did OK a $1.50-a-day increase in the rate foster families are reimbursed, though that was half of what Caferro originally proposed and far less than the $5 she wanted to ask for. The current rate is $19.57 a day.

“Many foster care parents right now are subsidizing the needs of children,” Caferro said, adding that a higher rate could create a bank of foster care parents available when needed, which would mean stability for children. The  increase is expected to cost about $3.5 million over the biennium.

The committee also voted to increase the rates health care providers are paid for Medicaid services by 1% in the first year of the budget and 2% in the second. That also was a compromise after Caferro originally proposed a higher rate. Staffers on the committee said by next week they'd have a clear picture of how much that proposal, and others, would cost.

Though the committee passed that increase, it also voted to cut the Medicaid hospitals services rate for all hospitals except critical access ones by 1%, which would save $5.09 million.

The committee also approved a reduction of 3% from the governor’s requested budget for the caseload for traditional Medicaid and Medicaid expansion, which results in a $128.9 million reduction in spending, with about $22.6 million of that state dollars. Regier said in the past the department has overshot estimates for how much it will spend on Medicaid, but Caferro questioned why the savings weren't being directed to other services.

The committee did not give funding for the Comprehensive School and Community Treatment program, citing frustrations with how the health department handled funding issues.

That program provides Medicaid reimbursement for mental health services and outpatient treatment for school-aged children through partnerships between school districts and community health providers. Services can be provided either in the school or in the community.

The program was funded before with federal funds and an in-kind match from school districts, but the federal government said that wasn't allowed. The health department backfilled the program with general fund dollars. Some lawmakers on the committee objected to that, saying that spending decision should have been left to the Legislature, not the department.

The governor’s budget proposed $21 million for the program, but lawmakers didn’t take up that proposal. Instead, they debated $2.4 million that would have funded the program for the first quarter of the fiscal year, essentially until school started, but that proposal failed to get enough votes.

Caferro objected to punishing the health department for making a quick decision in a pandemic.

“The choices for the department were to leave kids hanging for mental illness and their families, or to try to come up (something that) we did not vet here. I appreciate that they took care of children first and risked criticism,” Caferro said.

Another vote by the committee removed the funding for the positions of the tribal liaison and director of American Indian health within the department. The motion came from Sen. Bob Keenan, who said he wanted to get a handle on what the positions were and what they did.

Caferro opposed the decision, which would trim the budget by about $481,635 over two years.

“We have a large population of Native Americans in our state, and each tribe and each reservation, and urban Natives, they’re all very different from each other and have a lot of contracts and consultation needs to take place between the state and Indian Country,” Caferro said.

Another vote cut the funding for 3.5 lawyer positions from the legal affairs department, positions that were vacant as of Feb. 1, according to a staffer for the committee. Glimm said the reason for that was lawsuits the department brought under the former Democratic governor's administration against businesses in the Flathead for not following public health mandates in a pandemic. Those legal proceedings were dropped by Gianforte, a Republican.

“Part of the impetus of this is the lawsuits that they’re following and working on against business in the Flathead, it’s the wrong use of legal intellect and personal services within this department,” Glimm said.

Keenan also brought a successful motion to remove all funding for the Best Beginnings STARS to Quality Program, cutting about $2.4 million over the two-year budget. The program is a voluntary quality rating and improvement system for early childhood education programs. It was long supported by former Democratic Gov. Steve Bullock, who tried but never succeeded in his eight years in office to pass a statewide pre-kindergarten program but was able to fund the STARS program through a budget maneuver.

“This is one of those programs that has never had never had discussion in a policy committee,” Keenan said. “ ... It has not been reviewed, if you will, by the Legislature.”

Sen. Mary McNally, D-Billings, said while she appreciated Keenan’s desire for more information, the state struggles with access to child care.

“We just don’t do well in this area at all,” McNally said, adding the committee heard testimony the program helped people develop child-care services and become more professional.

The committee also voted to remove a position and funding of $767,000 of federal money over the two-year budget for refugee services.

Keenan said he expected money coming from the federal government through COVID-19 aid that could pay for those services provided by agencies in Missoula.

Garner called the program “mission creep.”

The committee is set to meet again Monday.

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