HELENA — During this year’s Montana legislative session, one of the biggest topics of discussion was a proposal to increase the Medicaid reimbursement rates paid to nursing homes and other care providers. In the end, the Legislature passed and Gov. Greg Gianforte signed a budget that provided a substantial increase, but some providers say their challenges aren’t over yet.
Providers said reimbursement rates simply haven’t kept up with the costs of providing service in Montana, and that was making it harder for them to keep their operations going. Nursing facilities faced particular hurdles, with reports saying 11 closed their doors in 2022.
Legislators from both parties and the Gianforte administration all expressed support for some level of increases in Medicaid rates, though they differed on how large those increases should be. According to the Montana Department of Public Health and Human Services, the final state budget includes $339 million in increases for Medicaid providers over the next two years.
Gianforte touted the state’s investment Tuesday as he continued his annual “56 County Tour,” visiting residents at the Roosevelt Memorial Nursing Home in Culbertson, as well as the founder of Thy Neighbor, a business in Sidney that provides in-home support for seniors and people with disabilities.
“With more seniors electing to age-in-place in their homes and communities, Gov. Gianforte has made it a priority to invest in Montana’s senior and long-term care continuum, including by delivering the largest-ever Medicaid provider rate increase,” his office said in a news release.
However, even with the increase, some facilities say they’re still facing a delicate situation. On Tuesday, the advocacy group Big Sky 55+ held an online news conference with nursing home administrators.
Wes Thompson, administrator of the Valley View Home in Glasgow, said the dramatic rise in costs has left facilities like his without a safety net.
“We've invested everything in trying to keep the lights on and residents happy and comfortable, safe and feeling as happy as they can, in their own communities that they built,” he said.
Jason Cronk, president and CEO of Immanuel Lutheran Communities in Kalispell, said, over the last three years, his facility and others have dealt with regulations, inflation and a severe lack of care staff – leading to the need for more expensive contracted workers. He said they plan to direct the increased Medicaid funding to making their wages and benefits more competitive.
“We continue to face wage pressures, and this increase is really directly going to our direct care workers – who we want to first of all keep, but also try to eliminate the traveling nurses that we have,” Cronk said.
Administrators also said they’re waiting to see the final rules from DPHHS on how the rate increases will be implemented. Because of the state’s rulemaking process, the rates have to be filed and have a public comment period before they can go into effect.
“Every single day that goes by, we're losing tons and tons of money, of funding – every single day,” said Thompson. “So when it comes to the state rules, I certainly hope they come out as quickly as possible.”
A DPHHS spokesperson said the department has moved as quickly as it can to get the rules in place, given the state’s established rulemaking procedures and the signing of the main budget bill on June 14. They said the rules were filed with the Montana Secretary of State’s Office on Tuesday and will be published on the DPHHS website July 7. The public comment period will be open through Aug. 4.
The spokesperson said, once the rules are finalized, DPHHS is committed to paying the new rates retroactively to July 1.
Cronk also raised concerns Tuesday about a proposed federal rule that would create minimum staffing requirements, saying it would only further penalize facilities that are already struggling to find workers.
This week, Democratic U.S. Sen. Jon Tester sent a letter on that issue to the Office of Management and Budget director, saying any staffing requirement should include flexibility, particularly for rural facilities that may have more obstacles to finding employees.
