Proponent at hearing on Medicaid rates: ‘Who puts you guys to bed?’

Last week, a 45-year-old person who is homeless and dying was dropped off on the doorstep of the Gallatin Rest Home in Bozeman, according to the director.

Darcel Vaughn, the administrator, said she wasn’t going to turn the person away even though she had no idea whether Medicaid would cover the cost of her care.

Vaughn told the story to the House Appropriations Committee on Thursday.

“You need to be fiscally responsible, but you need to be human responsible,” Vaughn said. “And I took her in so that she has … a warm bed and a place to die.”

Vaughn testified on a bill that would push Medicaid provider rates the rest of the way to “benchmark” levels recommended by a national consultant.

In its budget proposal, the Gianforte Administration proposed bumping up provider rates, and then an Appropriations subcommittee added more money to a level many people who testified described as “historic.”

At the meeting last week, legislators didn’t take action on House Bill 649, but they did examine the proposal from many angles.

In response to a question from the committee, sponsor and Helena Democrat Rep. Mary Caferro said an updated fiscal note for the bill is in the works.

House Bill 649 would pay for the gap between House Bill 2, the big budget bill with the additional funds the subcommittee approved, and benchmarks a national consultant recommended, plus inflationary increases.

The fiscal note is expected to estimate the cost of that gap.

Caferro said the difference between the amount proposed by the Governor’s Office and benchmarks would be $25 million in general fund dollars over the biennium.

At the meeting, Rep. John Fitzpatrick, R-Anaconda, said news outlets have splashed nursing home closures across their front pages, and people know about the troubles they are having.

Fitzpatrick wanted to know about other providers — group homes. How many have closed since the 2021 legislative session? How many clients are being served now versus then?

One proponent of the bill said his organization had closed eight group homes since March 2021. Another said the day before the hearing, she had to suspend services for a home in Missoula, and children as young as 5 years old already are going out of state.

In response to Fitzpatrick’s request, Mitch Tropila, with Easter Seals Goodwill Northern Rocky Mountain, said the data about group homes wouldn’t be straightforward, but he agreed he could help gather information for the committee.

Rep. Bob Keenan, R-Bigfork, also had questions.

Vaughn had talked about not having money at Gallatin Rest Home for basic upkeep, such as new air conditioning, but she also acknowledged the charge for residents who pay privately was $250, although the cost was $507.63.

“So you’re losing $257 a day on private pays?” Keenan asked.

(Vaughn was teary and said she was nervous — “I haven’t done this before” — and Keenan told her others were nervous too, and all she needed to do was get the butterflies to “fly in formation” for a couple of minutes.)

In response to his question, Vaughn said the facility was losing money on everyone, and Keenan asked a Gallatin County Commissioner about the losses too.

Commissioner Zach Brown had said voters in Gallatin County approved a levy to support the nursing home, and it passed with 63% support and in every single precinct — whether the district elected a Republican or Democrat to the legislature.

So Brown said the local taxpayers were footing the bill for a state obligation.

But Keenan, who received many comments of gratitude from people who testified for leading the subcommittee that already pushed up rates, said he wanted to know the reason the facility was choosing to undercharge people if it needed money — and then turning to the state for dollars.

“How can we possibly save your bacon if you’re not saving your own?” Keenan said.

Brown said it was a fair question. One factor, he said, is the number of people who do pay privately is a small portion of the census, most of the residents are Medicaid recipients, and the waiting list for Medicaid is “out the door.”

He said the facility is doing its best to get staffing levels up in order to fill more beds. In the past, he also said a rehab unit used to bring in more money, but it closed during the pandemic because of staffing.

Rep. Terry Falk, R-Kalispell, asked several questions too, including about Caferro’s thinking on inflation. The bill provides for an inflation bump of 3% or the increase in the Consumer Price Index, whichever is greater, and Falk said that allowance could get expensive.

Caferro said “it wasn’t good thinking” and noted she’d requested an amendment that cites code and flips the 3% to a maximum — so not a floor but a ceiling, Falk said.

Proponents of the bill testified the inflation inclusion would mean they wouldn’t have to come back during the 2023 session and fight for cost-of-living increases all over again.

Rep. Bill Mercer, R-Billings, also quizzed Caferro. He wanted her to explain why she wanted to put even more money toward Medicaid providers — since the subcommittee already infused a significant amount.

Mercer wasn’t trying to debate the national study by consultants, he said. Rather, he wanted her to explain what the state was buying with the extra dollars.

Caferro said the national consultants had recommended benchmarks as a base, the base was from a previous year, and the amount currently in the big budget bill for future years didn’t go the full distance based on data: “This is the cost of doing business.”

If lawmakers made a decision based on data, Caferro said, the state was buying people not having to go to sleep in their wheelchairs, as at least one member of the public testified.

At the hearing, Rudy Shriner, who used a wheelchair, said he wanted to ask committee members a question: “Who gets you guys up and who puts you guys to bed? Because that’s something I worry about on a daily basis.”

Shriner, of Helena, said his parents are deceased, his brother lives out of town, and he relies on paid caregivers. But he can’t keep people regularly employed because the rates are so low.

“If I can’t get to bed or get out of bed, I can’t work,” Shriner said.

Shriner said he works for the Department of Transportation and volunteers for the Helena Police Department. He chooses to be a productive member of society, and he asked legislators to keep his question in mind.