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A bill that supporters argue would help care for more people who need assisted living care but at the same cost to the state — by changing the source of funding — didn’t make it out of committee this week.
Senate Bill 100, sponsored by Sen. Becky Beard, R-Elliston, is similar to legislation that passed in 2023 and was vetoed by Gov. Greg Gianforte, who expressed concern about potential long-term costs.
This session, SB 100 made it through an initial vote in the Senate Public Health, Welfare and Safety committee and on the Senate floor, but in Finance and Claims, it failed to pass on an 11-11 vote.
In discussion, opponents also noted financial concerns, although proponents said the bill would allow the state to serve more people at the same cost to taxpayers.
Big Sky 55+ was among the groups supporting the bill, and Margie MacDonald said Thursday she’s still hoping the bill might get out of committee.
“This is a tool that is in their hands to cut back on the waitlist, serve their constituents, and meet people’s needs in the least expensive, but most appropriate level,” MacDonald said. “And it saves the state money.”
In committee meetings, Rose Hughes, with the Montana Health Care Association, explained the way the bill would work, switching people receiving services from one federally supported program to another one.
Hughes said it would revise funding policy at the Department of Public Health and Human Services to transfer people currently using the Big Sky Waiver to pay for home- and community-based services to the Community First Choice program.
The Big Sky Waiver is an assistance program that allows people who would otherwise be institutionalized to live in their own home and community.
Community First Choice is designed to provide long-term supportive care in a home setting, but it has a 68% matching rate from the federal government compared to a 62% rate for the waiver, according to a fiscal analysis of the bill.
The additional money, the 6% higher rate, would open up slots for more people on waiting lists for the Big Sky Waiver, Hughes said.
Currently, assisted living isn’t a service allowed under Community First Choice, and the bill is contingent on approval by the Centers for Medicare and Medicaid Services.
In response to a question, Jill Sark, also with the Montana Health Care Association, said three other states do something similar.
Hughes said the change saves money another way, too. Those in the Community First Choice program aren’t required to have a case manager, which has a cost.
“So you basically save $11.45 per person per day for every person that you move over,” Hughes said.
A fiscal analysis of the bill said 916 people receiving services under the waiver would qualify for the Community First Choice plan.
Currently, 124 people are on a waiting list for the Big Sky Waiver who could be immediately helped if the state implemented the change, Beard said.
She said they’ve been Montanans’ teachers, soldiers, and farmers, and the change is a deal for taxpayers because it allows them to be in the most cost-efficient program.
“This should rank as a high priority for our state’s services for these citizens, our friends, neighbors, loved ones here in Montana,” Beard said at one committee meeting. “They’ve given so much.”
One argument proponents made is that people who need a little bit of help at home, but not, for instance, intense nursing support at a facility, end up costing taxpayers more in the long run.
That’s because they sometimes end up waiting in a hospital or nursing home they don’t need, but they are more expensive.
Hughes said there’s an estimated $4 million a year saved with the switch, and there’s an estimated $2 million cost with the switch, netting the state around $2 million in savings annually — while serving 120 more people currently waiting for assisted living care.
The idea behind the bill is the state can use the $2 million in savings to help other people who need the Big Sky Waiver.
Hughes said around 237 people are on that waitlist, and the $2 million would help most, although not all, omitting an estimated five.
Although proponents said the bill would save money, some legislators said they worry it will mean higher costs down the road, in part because of an aging population.
Sen. John Esp, R-Big Timber, said a fiscal analysis of the bill assumes a growth rate of 1% a year, but he said the proportion of older people “is much greater than 1%.” Esp said the assumptions in the bill are “skewed.”
“It will come around to bite you financially,” Esp said.
The fiscal analysis of the bill said initial conversations with the Centers for Medicare and Medicaid Services indicate the change might not be allowed.
Sen. Carl Glimm, R-Kila, said he had concerns about the fiscal analysis and that it shifted one program to being a government “entitlement,” or guarantee. He said if the estimates of the number of people served were off by just 10 people, the cost would suddenly be $500,000 more.
“They keep talking about savings, but we don’t have a good idea of what the fiscal note is on this,” Glimm said.
Sen. Christopher Pope, D-Bozeman, said he appreciated the concern about cost, but Montana is putting the building blocks together in the “continuum of care,” and he sees the opportunity with the bill for people to be better served, at home, at a lower cost. The continuum of care refers to the spectrum of support people need, especially later in life.
Hughes described it in committee as starting with home care, offering the least amount of help; then assisted living, for people who need more help, but not deep medical support; to a skilled nursing facility, with medical professionals on staff.
Pope said he believed the bill is worth it.
“We need to take a little risk here and give these programs a chance to show how this is a path forward for the state of Montana,” Pope said.
The committee voted 11-11 on Wednesday, leaving it tabled in committee, but MacDonald, with Big Sky 55+, said she hopes the bill isn’t dead yet.
Senators can move to “blast” tabled bills from committee onto the floor, but Beard said she, at least, has no plans to do so at this point in the session.