Funding restored, but providers say damage has been done

The latest twists in public funding for mental health care in Montana have left providers in the Flathead and across the state cautiously optimistic, yet adamant that more must be done to repair community health solutions following last year’s devastating budget cuts.

In the latest response to the cuts, Gov. Steve Bullock announced a restoration of around $30 million to the Department of Public Health and Human Services by Sept. 1. But a lawsuit filed last week on behalf of disability advocates seeks to put a stay on slashed rates and restore funding sooner.

State mental health funding has long been a roller coaster for providers, with ups and downs depending on the state’s financial stability. According to a report by the Bozeman Daily Chronicle, mental health spending per resident increased in the decade up until 2015. But inaccurate forecasting and a severe fire season last year left the state far short of its projected budget. In order to address the shortfall, a special legislative session in late 2017 passed a series of cuts to services for mentally ill or disabled residents.

Since the cuts went into effect earlier this year, mental health providers have adapted with layoffs, closures and overworking personnel. Many families and providers were particularly outraged by the cuts to case management services, which nearly halved the funding for those who work consistently with clients — helping them find jobs, pay rent, or make appointments — to prevent mental health crises.

The path to stabilize the situation is growing clearer, but many worry that the damage far exceeds a quick fix.

“They dismantled a system that took decades to build — you can’t rebuild those overnight,” said Sheila Smith, director of the Western Montana Mental Health Center in Kalispell.

Earlier this year, Western Montana let go several case management workers and closed its facility in Libby in response to the cuts.

Bullock’s announced $30 million restoration will help reverse a broad 2.99 percent cut to the Medicaid reimbursement rate. But the future of the case management budget remains unclear.

“Certainly getting the 2.99 percent cut back will help. It doesn’t sound like much but it is something,” said Smith.

But the reinstatement “doesn’t undo the damage that’s been done.”

The disruption has long-term effects on clients, she said, not to mention the challenge of rehiring staff. “It’s hard to get people to come back,” she said, referencing lost case workers. “Would you come back to work for a service that the government could cut on a whim?”

“We will get reinstated the 2.99 percent for Medicaid, which will be helpful,” said Mandy Winegardner, the site manager at Sunburst Mental Health Services in Kalispell. “But there’s no word on case management yet and that’s what we’re looking for.”

That specific rate cut has left too few staff to work with Montanans living with a mental illness or disability.

“We’ve had to turn a lot of people away who’ve been referred by the hospital,” said Winegardner. “And it’s not just us that’s happening to.”

Concerns over the swiftness of the case management cuts, among others, have also prompted judicial action. Last Tuesday, several disability rights advocates sued the Montana Department of Public Health and Human Services, claiming that the special session cuts were enacted in an “arbitrary, unlawful and unconstitutional manner,” in violation of the Montana Administrative Procedure Act.

“This lawsuit is the direct result of unlawful and unconstitutional decisions by the state that threaten significant and long-lasting harm to Montanans and their families,” said Beth Brenneman, a petitioning attorney for Disability Rights Montana, in a press release. “The new rates have wreaked havoc on the community-based Medicaid services system.”

The suit alleges that the Legislature did not accurately publish the potential rate cuts before enacting them in late 2017, leaving many health providers shocked and stranded.

“We do not believe based upon our clients that the developmental disability rates were available at the time the proposed rule was published in July 2017,” said Brenneman.

“The whole point of the process is to know what happened.”

The legal action seeks to go further than Bullock’s planned restoration by retroactively compensating for lost funding in 2018. “[The state is] going to reinstate the rates from Sept. 1 in the future. What we’re looking to do is reinstate the rates immediately and fill retroactively out to Jan. 1,” said Brenneman.

The state health department, meanwhile, is currently accepting public comment on how and where to restore funding, while the Legislature’s Children, Families, Health and Human Services Committee, which has oversight on the department, held a public hearing for dozens of health providers on Monday.

In Kalispell, Smith said she has “cautious optimism” on the impact of public comment on the department, which she said is the key to building a more robust, stable system.

“Work with providers with good models,” she urged. “If it’s created in a vacuum, it’s probably not going to be that great. You can’t build it quickly.”

Reporter Adrian Horton can be reached at ahorton@dailyinterlake.com or at 758-4439.