At this time in the 2017 legislative session, those who worked with seniors and people with disabilities were shaken to the core. The governor had proposed large cuts to programs in the Senior and Long Term Care Division, and the Legislature not only went along but took even deeper cuts. By session's end, the cuts had been restored, but there were no provider rate increases, slots to serve people on waiting lists or other improvements to services for the elderly and disabled included in HB 2, the state's main budget bill.
However, with little fanfare, HB 17 passed the Legislature by overwhelming majorities, with no "no" votes being cast in the House and only four "no" votes in the Senate. The Governor signed the bill into law. It was the most significant piece of legislation for seniors passed by the 2017 session. It came to the Legislature from the Children, Families Health and Human Services Interim Committee, which had studied issues associated with the increasing number of Montana families living with the devastating impacts of Alzheimer's disease and related dementias (ADRD). HB 17 appropriated funds to:
• provide 200 new slots under the Big Sky Waiver to serve seniors and people with disabilities in their homes and in assisted living facilities;
• significantly increase rates paid to assisted living facilities; and
• create a new, higher assisted living rate for memory care.
This was designed to increase access to in-home and assisted living services for those on waiting lists and those with ADRD. The study concluded that more slots were needed for both in home services and assisted living in order to alleviate the stress on families looking for care for their loved ones. The study also determined that low Medicaid rates made it difficult for people on Medicaid to receive care in assisted living facilities, even when it was clear that assisted living was a good choice for them. Less than half of assisted living facilities accept Medicaid and most of those who do severely limit the number of Medicaid clients they serve.
The rate increases and special memory care category would increase access by those on Medicaid including those with Alzheimer's, and the new slots would help reduce the waiting list for both in-home and assisted living services.
So, how is HB 17 working? It isn't - not at all. Not one dime of the funding was ever seen by the people waiting for services or the programs providing the services. HB 17 was dismantled by SB 261 when revenues for FY 2017 came in below estimates. SB 261 stripped all of the appropriations while leaving a skeleton in place that describes what could have been. The language in SB 261 also left it to the Governor to include the funding in his proposed budget to the 2019 session - if he chose. When the budget picture improved and funds were restored to many human services and other programs, nothing whatsoever was restored to HB 17, nor did the Governor include any funding in his proposed budget.
There is good news though. The Joint Appropriations Subcommittee on Health and Human Services voted to fund a significant portion of HB 17. This session's HB 2 as it goes to the full appropriations committee includes funding for the assisted living rate increases envisioned by HB 17 and also 100 of the 200 slots that were part of HB 17.
We are pleased this funding is part of HB 2 and look forward to working with the legislature throughout the second half of the session to assure that the vision of HB 17 that so overwhelmingly passed in 2017 and was signed by the governor, finally becomes a reality. Seniors and families coping with the affects of Alzheimer's, people with disabilities relegated to waiting lists and others who need community services have waited long enough.
Now is the time to ask your legislators to support these important services for seniors.
Rose M. Hughes is the executive director of the Montana Health Care Association and writes from Helena.