MISSOULA – Throughout 2017, the budgetary decisions made by the Montana Legislature left healthcare providers and their clients wondering what would happen next, and how they would get the services they need.
The population we’re talking about here is about 2,500 people over the age of 16, who are living with a developmental disability in Montana.
For about 25 years, four organizations had contracts to provide targeted case management to this population. This service allows them to have access to employment and live in their own home and maintain a good quality of life. The alternative for many of these people is an assisted living center or some other type of institution.
Then, the 2017 Legislature slashed more than $200 million from the Montana Department of Public Health and Human Services to account for shortfalls in the state budget.
Some of these cuts came by way of rate reductions to case management providers. This means they will be paid less to do the work, and many services statewide have been reduced or eliminated completely.
“The big challenge right now is this is a new normal for us, and for people with disabilities, what’s going to become of them,” said Martin Blair, executive director at the Rural Institute for Inclusive Communities at the University of Montana.
In late December, the DPHHS announced they would take over all case management for that population, and eliminate the contracts to the four organizations: AWARE, Inc., Helena Industries, Opportunity Resources of Missoula, Central Montana Medical Center of Lewistown. That’s a total of 3,600 people.
That didn’t happen, but public policy officer with AWARE-Inc., Pat Noonan, says the announcement caused chaos as dozens of jobs were threatened and providers were looking at big losses.
What did happen is the DPHHS changed course, and decided to see if providers could do the work and keep their doors open with fewer resources.
They began accepting proposals, and AWARE-Inc. was awarded the $2.86 million contract in mid-May.
They are a non-profit that operates statewide and were able to swing a proposal that could tackle this big caseload and make ends meet. The contract started June 1.
“We know it’s a big challenge, and it’s definitely something that we’re keeping an eye on, making this thing work. But we just felt that it was part of our mission and it was important to make this work for the people who need this service,” Noonan said.
But that doesn’t mean everything is going back to normal for the people who need their services. Case managers support many aspects of a person’s life, giving them access to school, jobs, living in their homes, healthcare.
Before the contract, AWARE worked with 700 clients, but now their caseload has more than tripled. They’re trying to hire about two dozen additional case managers for 2,500 clients.
Even more telling, these case managers have doubled the number of people they have to serve. They used to have 30 people they had to serve, now they will have 60 on their caseload.
AWARE-Inc. is optimistic about making it through the next year, but are not accepting the new standard of care that they are expected to deliver with limited resources, he said.
“There has been a lot of change in a chaotic couple of years for folks with mental health or developmental disabilities. AWARE is ready and excited to try to help them get through this transition and so hopefully we can go back to the next legislature and fix some of the problems that were created by the previous one,” Noonan said.
This contract is in place until next June, but even that is not a guarantee.
It could all change next winter when the 2019 Montana legislature convenes. Health care and service providers plan to let lawmakers know how tough these cuts have been and who they’re really hurting.
Besides the clients that AWARE will be serving, there are about 1,100 others living with developmental disabilities who will be served by other resources within the state.