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Long-Term Care &
Community-Based Services

Medicaid and Dept. of Health & Human Services

Op-Ed: "Terry Minow: Medicaid unwind hits older Montanans hard" Billings Gazette, February 25, 2024

"The administration’s poorly thought-out, under-staffed Medicaid redetermination process has hurt thousands of Montanans, especially our elders and children." Read the op-ed here.

Commentary: "Setting the Record Straight on Medicaid" by Kim Gillan, Billings Gazette, 
February 4, 2024

"Montana launched a process that is difficult, confusing, and sometimes impossible for people to reapply or maintain eligibility. The result: almost one in every three Medicaid recipients has been denied not because of eligibility but 64% for technical or procedural issues. Montana now has among the highest and worst records in the nation for terminating health insurance for children. Disgraceful." Read more here.

Commentary: "Montana’s Medicaid disenrollment is even a bigger catastrophe than previously reported" by Darrell Ehrlick, Daily Montanan, January 25, 2024

Our ideologue governor has taken a system that was often cited as a model of how the Medicaid expansion could work and dismantled it, hurting Montanans who struggle, hospitals and healthcare professionals, and reneging on a financial set-up so sweet that it should make anyone with a little business acumen scratch their head. Read more here.

"Montana health department pushes back on legislators’ request for data on Medicaid enrollment" by Keila Szpaller, Daily Montanan, January 18, 2024. 

"Telephone hold times can take three to six hours, but assisted living director of operations Michael Coe said he knows one way to get a resident bumped up the health department’s priority list for a Medicaid waiver.

“Really, the only way to get service for somebody is to threaten to evict them,” said Coe, with Caslen Living Centers, of people who have no source of money." Read more here.

"Delays in state contracts leave Montana health providers strapped" by Katheryn Houghton, Daily Montanan, January 11, 2024

"Contractors have reported going months without pay; one said it had been nine months. Some have laid off employees, scaled back services, or stalled programs." Read more here.

"Feds signal alarm over Montana’s drop in childhood Medicaid coverage" by Mara Silvers, Montana Free Press, December 22, 2023

"Montana’s Department of Public Health and Human Services Director Charlie Brereton has resisted various calls to slow down the review process so participants have more time to respond to the state’s inquiries. 

'I will not be pausing the process. I’m not adding more months to the process,” Brereton told lawmakers on an interim budget committee a few days before Becerra’s letter was sent. 'We’re sticking to our 10-month plan.'" Read more here.

Native American Healthcare Series (Lee Newspapers)

"Gone Too Soon", a three part-series by Nora Mabie, Missoulian, January 16-30, 2024. Read the Series here.


"Montana's long-term care system needs to be rebuilt; leaders talk about how" by Emily Schabacker, The Billings Gazette, November 19, 2023
Reporter Emily Schabacker, who did extensive and quality reporting during the 2023 Montana Legislative session, provides an excellent perspective on Montana's long-term care crisis.  

"As the sixth oldest state in the country, Montana has felt the effects of what’s nicknamed “the silver tsunami” more intensely than most other states. But access to senior and long-term care has been dwindling in the years since the pandemic and innovation in senior service work has been slow to develop." Read the perspective in the Billings Gazette here, or here if you're not a subscriber. 

Post-session LTC Press Conference

June 27, 2023

Speakers include:

  • Rep. Mary Caferro, sponsor of HB 649, and Democratic Vice Chair of the House Appropriations Committee

  • Wes Thompson, CEO of Valley View Home, Glasgow 

  • Jason Cronk, CEO of Immanuel Lutheran Communities, Kalispell

  • Zach Brown, Gallatin County Commissioner

  • Moderated by Margie MacDonald, Big Sky 55+


"More Montana seniors winding up homeless, due to housing shortage, long-term care crisis" by Emily Schabacker, Helena Independent Record, August 11, 2023 

"In Bozeman, for example, the bare-minimum monthly cost of living rings up to about $2,400, while seniors in the area bring in an average of $1,100 a month on Social Security, said Margaret Mason, associate director and senior programs director for HRDC.

The gap has led seniors, who often have unique housing and health needs, to rely on more emergency shelters that are not designed to care for older adults.

'We’re on the precipice of a really severe crisis,' Mason said."  Read more here or here (without paywall).

"Gianforte signs budget bill, Buckley’s child care scholarship expansion bill" by Blair Miller, Daily Montanan, June 15, 2023

"Gianforte did not line-item veto any portions of the bill as some Republican legislators had requested, keeping in a $300 million Medicaid reimbursement rate for health care providers that some lawmakers opposed but which Democrats and some Republicans had pushed for all session.

'This session, Montana Democrats finally convinced Republicans to invest in our community health care providers, and Montana’s seniors and working families will at last have a better shot at getting the care they need close to home,' said Rep. Mary Caferro, D-Helena, the leader of the push to increase the reimbursement rates, in a statement." Read more here.

"Democrats ask for explanation on stalled budget bill, others, call delays ‘chaotic way to govern’", by Blair Miller, Daily Montanan, June 2 2023

"The Democrats say they have concerns about the Medicaid provider rate funding in HB2 as well as the codification and $7 million annual expansion of the Best Beginnings Scholarship program..." Read the article here.

"Healthcare Provider Rates Remain in Limbo" by Mara Silvers, Montana Free Press, May 30, 2023 

"In total, Republicans and Democrats approved roughly $330 million in new state and federal funds to support Medicaid rate increases during the 2023 session. But nothing is official until House Bill 2 is signed by Gov. Greg Gianforte." Read the article here.

Governor vetoes assisted living bill; sponsor disappointed, override polling underway" by Keila Szpaller, Daily Montanan, May 30, 2023

"People who end up having to skip over assisted living will end up in a nursing home, 'the most expensive and the most isolated' option, Beard said. She said she had hoped, with so much support from legislators, the benefits in the bill were clear.

'I know we hammered that over and over again, but when you have different branches of government locked in their philosophical positions, it’s really hard, I guess, to break through that,' Beard said." Read the article here

"Montana Medicaid providers get more money, but not full funding, in most recent House action," Keila Szpaller, Daily Montanan, April 3, 2023

"John and Carol Harwood [of Joliet] said they are parents of an adult child who lived in a group home for adults with developmental disabilities, and Medicaid has brought them quality care and peace of mind. But now, they said budgets are hemorrhaging money. John Harwood turned to scripture as guidance and wisdom to consider at this crossroads.

'We then that are strong ought to bear the infirmities of the weak and not to please ourselves,' he read from Romans in the Bible." Read more here.

"St. John's United in Billings closing 60 nursing home units," Emily Schabacker, Billings Gazette, April 1, 2023

"The State of Montana reimburses health care facilities at a predetermined rate to cover the cost of services delivered to a Medicaid patient. But the rate has failed to adequately cover the cost of care for years, particularly in skilled nursing where the vast majority of patients are on the public insurance. Combined with an unprecedented health care workforce shortage, nursing home budgets have hemorrhaged cash over the last three years." Read more here.

"Amendment to fund Medicaid provider rates to benchmark fails,"
Emily Schabacker, Billings Gazette, March 14, 2023

“The concern I have with this issue is that we’re making a big bet. And the bet is this: we’ve either provided them with enough money so that they can continue on and go through the next biennium and survive. Or two, we’ve short changed them and we’re going to lose service providers,” [John] Fitzpatrick said. Read more here.

Press Conference

March 30, 2023 Virtual Press Conference

Press conference speakers:

  • Rep. Mary Caferro, sponsor of HB 649 

  • Wes Thompson, Administrator of Valley View Nursing Home, Glasgow 

  • David Trost, CEO of St. John's United, Billings

  • John and Carol Harwood from Joliet, parents whose adult child lived in a Group Home for adults with developmental disabilities.

  • Moderated by Margie MacDonald, Big Sky 55+

Critical Information

Big Sky 55+ Long Term Care Virtual Town Hall, 2/6/2023

A Map of 2022 Skilled Nursing Closures in Montana

What does it cost to provide skilled nursing long-term care in Montana?

Click here to read the Montana Healthcare Association fact sheet detailing the research done over the biennium to arrive at the numbers being discussed in the 2023 HB 2 Budget deliberations.

Montana Nursing Facility Rate Study, Presented by Guidehouse to the Montana DPHHS, December 2022

This is the Guidehouse provider rate study determining what it costs to provide care in Nursing Facilites.

Read the study here.

Recent Op-Eds

"Senate District 40 update" by Sen. Becky Beard (R-Elliston), Helena Independent Record, March 9, 2023

"Of Montana’s 1.1 million population, almost 20% are over 65 years of age. During the last handful of months we’re reading in the news that a number of assisted-living and nursing home facilities are shuttering their doors....That’s why I’ve introduced SB 296, creating the Senior Care Facility Access and Stabilization Act." Read more here.

"What Happened?" Op-Ed by Mike Jopek, Flathead Beacon, February 22, 2023

"Much of Montana’s staggering one-time budget surplus is federal dollars like those Medicaid funds intended to keep our rural nursing homes and assisted living facilities open. Why federal cash, entrusted to Montana, hasn’t reached seniors is anyone’s cynical and political guess." Read More

"Time to support our aging population." Op-Ed by Big Sky Senior Services Board of Directors, Montana Standard, February 28, 2023

"The primary cause of the closure of so many nursing homes is the low Medicaid reimbursement rate of $212 per day. That rate is inadequate to pay the staff qualified and needed to provide care for our loved ones 24 hours a day. Currently our legislative leaders have looked at a benchmark of $278/day based on a study run three years ago, the Governor’s budget suggested $249/day. The reality is that actual costs are estimated to be $350/day." Read More

Our Priorities this session

(a) Work vigorously to fully fund the Provider Rates recommended in the GuideHouse Provider Rate Study.
(b) Advocate for increased funding and services directed toward home and community-based services, including:  

  • Case work

  • Increases for nutrition and meals

  • Transportation support

  • Home audits and assistance for safety and accessibility

  • House-keeping and handy-man services

  • Standing up in support of Area Agencies for Aging.

(c) Support efforts to strengthen and support the care workforce, including pay and benefits, training, and respite care for family caregivers.
(d) Fund Medicaid waiver slots adequately to cover the back log. (Waivers allow for in-home care for individuals who could also qualify for skilled nursing institutional care.)
(e) Support Decennial study of Veterans long term care needs. (HB 264)
(f)  Consider putting together a bill for an interim study of senior long term care and a full continuum of home and community-based services.
(g) Stand up for child care and other issues that help enhance the work force in this service area.

More Articles

Montana Free Press, Jan 12, 2023 -- "Senior care providers, urge Montana lawmakers to boost Medicaid rates"

After 11 nursing facility closures in two years, operators are asking for a lifeline.

“The majority of people we care for are people who qualify for Medicaid. They’re your retired farmers, ranchers, nurses, teachers, [a] cross-section of Montanans who’ve given all their lives to us,” said Jason Cronk, the president of Immanuel Lutheran Communities, an assisted living and skilled nursing facility in Kalispell. “We depend on the state government to help us adequately care for and serve our Montana older adults who need us.”

Read More

Daily Montanan, Jan 28, 2023 -- "Can Montana Elder Care Survive the 2023 Montana Legislature?"

Opinion piece by Big Sky 55+ board member and lobbyist, Margie MacDonald

"Montana lost nearly a dozen nursing homes in 2022. The reality is that dozens more assisted living and long term care facilities are hanging by a thread. They are waiting to see if our governor and state Legislature will take the critical steps necessary to keep essential elder services available across this vast state. Now is the time to make your voice heard on this essential concern."

Read More

The Montana Standard, Jan 24, 2023 -- "It's Time We Stand Up for Seniors."

Opinion piece by Kim Gillan

"In mid-December, the media reported “Miles City nursing home closing, the 11th one in Montana this year,” implying a gloomy future for seniors without political leadership from the Montana Legislature and Governor Gianforte."

Read More

The Missoulian, Feb 1, 2023 -- "Stranger than Fiction"

Opinion piece by Darryl Toews, former state senator (R) and a board member of Valley View Nursing Home

"Every part of the budget for care of the elderly is underfunded. In-home care is underfunded. Assisted living is underfunded. Nursing homes are underfunded."

Read More

The Billings Gazette, Feb 11, 2023 -- "Aging Support Network Incomplete"

Article about the challenges in Montana of staffing long-term care facilities.

"Montana is one of only ten states that reported staffing shortages in 90% of its facilities."

The Billings Gazette, Feb 14, 2023 -- "Reduced Nursing Beds Bottlenecks System"

Article detailing log-jams in the long-term care system

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