Cuts to most vulnerable not justified

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Montana can do better for its elderly citizens. In fact, the state needs to. Services to our most vulnerable people do not need to be cut to balance the budget. There are other choices and we are urging the Department of Public Health and Human Services to rethink proposed cuts.

Our company, EmpRes Healthcare, celebrated 20 years of service in Montana on May 1, offering skilled nursing services in mostly rural Montana including Shelby, Polson, Hot Springs, Missoula, Livingston, Lewistown, Laurel and most recently, in Billings. We agreed to run the Shelby, Lewistown and Billings facilities when their hospital owners were finding it difficult financially to maintain quality services and were facing potential closure. For Shelby and Lewistown, in addition to the economic impact of losing a major employer, closure would mean that elderly people would have to leave their community and family to get nursing home care.

Every day, the 544 employees of our employee—owned company care for 408 Montanans, 72 percent of whom depend on Medicaid. Our cost of providing care to them averages $36 per day more than the rate Medicaid pays. We operate by shifting the burden to those who pay privately and Medicare. This is not sustainable or fair. The state should pay the fair cost of serving those who rely on Medicaid.

Last year, our eight facilities paid $1,029,781 in bed taxes — which is a direct savings to the state general fund because our taxes are used instead of general fund to support rates to nursing homes. This year, we will pay $1,401,991 in bed taxes because nursing facilities agreed to increase the tax through HB618. We supported HB618 because it took advantage of available federal matching funds and reduced the substantial shortfall in our Medicaid rates. Without the tax and the rate increase it generates we would have to shift more costs to those paying privately and make decisions that could affect the quality of our services.

We are disappointed that Montana Department of Public Health and Human Services is proposing to use part of the increased tax on nursing homes to fill a hole caused by the 3.47 percent cuts the department is making. They have to know that Medicaid providers cannot handle a cut of this size. It’s three times more than the one percent cut proposed by the Legislature!

Without these cuts, funding shortfalls already make it difficult to operate. Increased costs of health insurance, food, medical supplies and equipment — as well as unfunded mandates for electronic health records and new federal regulations, put a strain on nursing home budgets. Providing even basic improvements to residents’ living environments is difficult. Given mandated and fixed costs, should the cuts become a reality, we will have to look at reducing staff hours — not because that’s a good idea, but because labor is the largest variable cost to look to when cuts are made.

Montana can do better. Montana must do better. There are other ways to balance the budget. We are willing to meet with the department to discuss ways we can partner with the state to effect long term savings and efficiencies in the way health care is provided in Montana. Together we can make sure we keep our promises to our most vulnerable neighbors.

Dale L. Patterson is director of government relations at EmpRes Healthcare Management in Vancouver, Washington.

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