Op-Ed: Medicaid rates for Montana nursing homes

As Montanans, we care for each other. Across the rural-urban divide, generational divide, and Brawl of the Wild divide. Of all our constituents across Montana, the most deserving are our elderly neighbors who are on Medicaid benefits. They have served Montana well, and at this final stage in their lives seek the promise of compassionate, medically appropriate care. Most of them are out of money, have used up their care options with family members and loved ones, and cannot afford in-home care, which can cost more than $20,000 a month and is rarely covered by private insurance or Medicaid.

Our elder care economy is broken. Since January 2022, more than 10 percent of Montana's skilled nursing rest homes have closed. And most of the facilities still operating, whether private or public, are teetering on the edge of closure.

The cancer in Montana's elder care system is the low Medicaid reimbursement rate. The rate averages about $212 per day per patient, while actual cost of care is well over $300 per day. No facility can remain financially viable under these circumstances, private or public. As a result, most facilities in Montana don't accept Medicaid customers, leaving few options for those who need services the most.

We represent counties across the state - rural, urban, conservative, liberal, and everything in between. Our message for the Montana DPHHS, Governor Gianforte, and the 2023 legislature is this: please help save our skilled nursing facilities by investing in a rate increase for nursing homes. We need your leadership now more than ever. 

County facilities operate economically and efficiently - they make good choices and serve their communities. Our facilities' financial problems are because Medicaid rates for nursing homes are unconscionably low and don't come close to covering reasonable costs of care. The state isn't paying for services they're asking these facilities to provide.

In turn, county taxpayers subsidize the state to keep our local nursing homes open. Legally, these Medicaid residents are the state's responsibility, but the state is shirking its responsibility.

Most of our counties and critical access hospitals in rural communities support these facilities with property tax funded mill levies. Rural, urban, conservative and liberal voters alike see value in funding crucial care services for our elderly neighbors in need. For example, Gallatin County voters just passed a mill levy to support their county rest home. A majority of voters in every house district precinct supported it, regardless of whether the district elected republicans or democrats to the legislature. 

We have skin in the game at the local level. Now we're asking the state to do its part. 

The state has exceeded its budget to run state hospital and other state-run facilities by millions of dollars because of the skyrocketing costs of operating them. But so far, Governor Gianforte's administration has not recognized that every facility, including private/for-profit and county-run facilities, is experiencing the same kind of cost increases. This administration pays almost $800 per day to fund care for Medicaid residents in the dementia ward of the state hospital. Yet they're only paying community facilities about $212 per day for senior long-term care Medicaid residents. All we ask for is parity - raise rates for community facilities and demand for beds at the state hospital will decrease, meaning more elderly Montanans will receive quality care.

We're in this together. No group is more deserving of a safety net than our elderly Medicaid recipients. We urge Governor Gianforte, and members of the 2023 Montana Legislature, to please fix the rate reimbursement for nursing homes. The house is on fire and we need your help. 

Submitted by Mary Armstrong, Valley County Commissioner, on behalf of the county commissions of:

Gallatin 

Glacier

Golden

Jefferson

Pondera

Rosebud

Lake

McCone

Mineral

Madison

Judith Basin

Phillips

Daniels

Valley

Roosevelt

Wibaux

Hill

Big Horn

Missoula