- Associated Press - Wednesday, August 8, 2018

Bozeman Daily Chronicle, Aug. 5, on the aftermath of the state budget crisis:

State public health and human services officials greeted with mixed reactions news that some of the funding cut from their budget will be restored. While the restored funding will allow the agency to resume some of its vital services, those officials say a lot of damage has been done.

And they’re right about that.

Laid off professionals lost their jobs and have moved on to other positions never to return. Their expertise and institutional memory has been lost. And the clients they served have been put through unnecessary difficulties and dangers.

There are important lessons lawmakers should take away from this debacle: The process of predicting future revenue collections must be improved; and when money is appropriated for a service, that represents a commitment - one that must be kept.

The Legislature passed a budget in 2017. But the budget was based on overly rosy revenue projections lawmakers new full well were unlikely to be met. When revenue shortfalls became apparent last fall, Gov. Steve Bullock called a special session of the Legislature that ultimately enacted draconian cuts to important services for the disabled, poor and elderly.

But then the see-saw of competing revenue projections from the governor’s office and the Legislature kicked in and suddenly there is more money. Now the governor has some $45 million to redistribute and, rightfully so, most of it will be going to public health departments to restore services that were discontinued - largely in rural areas where they are most needed.

The governor and lawmakers need to get together - soon - and agree on a single method for projecting revenue. Together they need to scrutinize how this is done and why these projections fluctuate wildly within a budget cycle. And they need some expert help to fine tune this process so it becomes more accurate and reliable.

Most importantly, lawmakers have to realize that the budget they pass represents a commitment - to the employees of state government and the people they serve. When revenue shortfalls happen, the first course of action should not be to grab the budget axe. Before the special session last November, Bullock proposed very reasonable tax increases - on rental cars and hotels - that would have helped erase the anticipated deficit. But GOP lawmakers said no, and important programs went on the chopping block.

This is no way to run a railroad.

The governor and legislators need to change the way they do business - starting now.

Editorial: https://bit.ly/2MsbPMl


Missoulian, Aug. 5, on the aftermath of the state budget crisis:

A crisis has been slowly unfolding this summer as round after round of cuts eroded the Montana Department of Public Health and Human Services budget.

Now Gov. Steve Bullock is hoping to unwind this mess, announcing that he plans to restore millions of dollars to DPHHS and other state agencies hit hard by low revenue estimates. The state had braced for $140 million in lost revenue, but it looks like it will come in only $29 million short.

That means, after revenue numbers are finalized over the next month, some $111 million will be allocated back to state agencies, to the general fund and to a new rainy day fund. The formula for figuring how much goes to each is set in a bill passed by the Legislature, and directs $20 million toward the general fund, $45.6 million into the rainy day fund and $45.6 million back to government agencies.

DPHHS is expected to receive most of the state agencies’ portion, because as the state’s largest department, it suffered the largest budget cuts - more than $49 million in the special legislative session alone.

The department was in dire straits even before the cuts, struggling to handle an exponentially increasing caseload with a rapidly shrinking staff. Last October, DPHHS counted nearly 90 unfilled positions. Now, it has about 420 open positions and is in the process of closing offices and sharply curtailing services in locations throughout Montana, leaving entire communities to fend for themselves and placing an even larger burden on the backs of remaining state employees, all but ensuring higher turnover, longer turnaround times and poorer outcomes.

The funding infusion will come too late for many of Montana’s most vulnerable - abused and neglected children, the elderly and disabled - who are suffering right now from the recent loss of critical services. But all Montanans will pay the price for failing to provide aid when it is least costly and most effective to do so. The damage has already been done.

DPHHS is an especially poor place to scrimp for savings because every dollar cut from its budget triggers the loss of even more dollars from federal matching funds. Compounding the problem, already rock-bottom Medicaid reimbursement rates were lowered even more, leaving providers throughout the state in the impossible position of either cutting their Medicaid clients or continuing to serve them at a loss. The Montana Health Care Association and a group of nursing homes even filed a lawsuit against the state over the reduction in the reimbursement rate paid to nursing homes and assisted-living facilities.

Bullock announced in late July that he plans to use some of the extra state revenue to restore the reimbursement rate for Medicaid providers. Unfortunately this relief, while welcome, comes too late for many providers and their clients.

The nonprofit Helena Industries, which helped provide case management and jobs to more than 900 people with disabilities, shut down earlier this year as a direct result of the lower reimbursement rates. And last month, AWARE Inc. announced that it plans to cut up to 30 positions from its offices, located in more than a dozen communities statewide. The nonprofit provides both residential and community-based services for adults and youth, including psychiatric, transportation and employment assistance.

Montana’s Republican legislators set the stage for this situation when they required steep reductions in the state budget while refusing to consider raising taxes, and Democrat Bullock’s administration bears responsibility for distributing the cuts across the various state agencies.

But the source of the problem appears to be the wildly imprecise revenue projection models on which Montana’s executive and legislative leaders rely to create each two-year budget.

The Governor’s Budget Office and the Legislative Fiscal Division typically use different models and assumptions, and therefore tend to arrive at very different conclusions. Last year, before the special session, Montana was preparing for a $227 million shortfall in revenues. After the special session, it expected to weather a shortfall of $140 million. Now it’s looking at a loss of “only” $29 million.

In mid-June, the Legislative Fiscal Division was predicting that Montana could expect to collect $134 million more in revenue. That’s a much higher number than the most recent projection (remember: $111 million), and it was based in part on the weird decision to count $65.6 million in budget transfers as revenue. On the other hand, the state Budget Office appeared to still be significantly underestimating the amount of revenue Montana stands to collect.

Budget Director Dan Villa has suggested that his office work with the Legislative Fiscal Division in the near future to come up with a single revenue estimate for legislators. That’s a sensible start. Hopefully the two offices can figure out a way to meld their differing approaches and agree to a model that proves more accurate than those used to set the budget in 2017.

Of course, financial analysis and prediction is a complex, tricky business, and high-impact decisions being made at the federal level are doing nothing to improve Montana’s fiscal stability. But it would doubtless benefit the state if these two expert offices could, if not get on the same page, at least be in the same book.

The 2019 Legislature will convene in a just matter of months. When legislators meet again, they should not have to decide which of two competing sets of revenue projections to trust before they can even start on the hard decisions about how to budget that revenue.

Editorial: https://bit.ly/2vX33iH


Billings Gazette, Aug. 7, on the aftermath of the state budget crisis:

Damage done to Montana’s health and human services safety net won’t be repaired by the partial restoration of state budget cuts announced by Gov. Steve Bullock.

Since last summer, services have been taken away from some of Montana’s most vulnerable children and adults. Clinics have closed and care professionals have been laid off - all to save money at the expense of seriously ill and disabled people. Families have suffered without services they relied on for daily, dignified living. This was the message from Medicaid providers and clients who participated in a listening session Wednesday in Helena.

Gov. Steve Bullock has already decided how to use $5 million: Reversing the across-the-board Medicaid rate cut effective Jan. 1.

That change will be worth much more than $5 million to Montana Medicaid providers and the state’s economy because the general fund pays only about 30 percent of the Medicaid bill; the federal government pays the rest. So when the state spends $5 million, payments actually go up by about $15 million.

Although the rate cut reversal is welcome, providers from across Montana pleaded Wednesday for the state to also rescind recent rule changes that are contrary to best practices for chemical dependency treatment. Addiction treatment providers also are struggling with new administrative burdens to get preapproval and re-approval for residential treatment of the most severely drug-addicted patients.

“Children, youth and adults with mental health and substance use disorders have lost key portions of their community-based behavioral health care and have moved at an increasing rate into higher acuity and more costly centers of care,” Mary Windecker, executive director of the Montana Behavioral Health Alliance told state budget director Dan Villa and Department of Public Health and Human Services Director Sheila Hogan.

“The rural communities have been impacted disproportionately as rural centers have closed, in-home support services have been canceled, and people are only allowed to attend one group therapy session per day. Rural participants are not realistically able to travel multiple days to group meeting sites under the new rules.

“From larger centers, the cuts have hit their bottom line at 10-15 percent. There has been no fat in the behavioral health agencies ever, and these cuts are unsustainable as proven by the closing of so many offices and services.”

The Behavioral Health Alliance proposed an idea for transforming Montana’s Medicaid behavioral health system that deserves serious consideration from the state: Move to a value-based purchasing system.

“In a value-based purchasing system, the behavioral health agencies are responsible for managing the care of the patients they see and treat daily rather than adding another layer of bureaucracy and paperwork to an already over-taxed system,” Windecker said.

More than a dozen states use some form of value-based purchasing for all or part of their Medicaid program. Such a change cannot be made quickly. It would have to fit Montana’s needs and it ought to be phased in after a pilot project shows success in our state.

“One of the things we have been offering all along is our help,” Rimrock CEO Lenette Kosovich told The Gazette after the Helena meeting. “We feel much of this could have been avoided if they had talked with us. There has been a lot of damage in the wake of the cuts.”

“People aren’t seeking treatment; they’ve been scared away. It’s horrible,” said Kosovich, who said Rimrock no longer has a waiting list for residential treatment.

Much as we’d like to think that suddenly there’s much less need for people in Billings to get effective addiction treatment, we know the need is great. Our courts are filled with criminal defendants whose illegal behavior is connected to drug abuse. Our foster care system overflows with the neglected children of drug addicts. Many of the people who wander the streets of our city are intoxicated at all hours of the day and night.

Mike Chavers, CEO at Yellowstone Boys and Girls Ranch, was among about 150 people attending the Wednesday listening session in Helena. The next day, he hosted about 90 people, including Hogan, the DPHHS director, at a “solutions” conference on the YGBR campus west of Billings. Chavers found “bright spots” in the budget crisis: “YBGR and other agencies have begun talking together in ways we haven’t before,” Chavers said. “We are looking at how are we working together and avoiding duplication.”

Continuing such collaboration will be crucial to building back services that have been abolished and doing so in ways that are sustainable and effective to meet the needs of Montanans.

The state employees who have been told to do more with less cannot fix the safety net without the help and cooperation of community service providers. Collaboration means taking good advice from Montana providers, meeting professional care standards and following best practices for the high quality, compassionate care Montana’s elderly, disabled and ill citizens deserve.

Editorial: https://bit.ly/2MvIvok

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