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Montana health department asks for $150 million outside state budget bill

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Montana health department asks for $150 million outside state budget bill


Coming to the Legislature with what he referred to as an “unprecedented” request for cash, the director of the state well being division on Thursday requested lawmakers for $150 million to fill finances holes for payments about to return due, in addition to the subsequent two years.

The ask comes within the type of Home Invoice 835, carried by Rep. Bob Keenan on behalf of the state Division of Public Well being and Human Providers and governor’s finances workplace; each advocated for the invoice in a listening to earlier than the Home Appropriations Committee.

State well being division director Charlie Brereton advised lawmakers he estimates the division will want about $60 million to have the ability to shut out its books when the finances handed by lawmakers final session ends this summer time. Lawmakers in odd-numbered years go a finances that funds state authorities for the next two years.

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A sheet Brereton handed out to lawmakers Thursday outlines $56.56 million wanted by the summer time. About $37.6 million of that’s tied to higher-than-budgeted prices to run services like Montana State Hospital in Heat Springs and $13.7 million is due to higher-than-projected Medicaid enrollment.

The state hospital was already $7 million over finances by this time final 12 months, roughly midway by the biennium funded by the 2021 Legislature, largely because of an growing reliance on touring workers. That was earlier than the Facilities for Medicare and Medicaid Providers terminated a $7 million settlement for federal reimbursement funding for the ability’s repeated failure to keep up well being and security requirements; these reimbursement {dollars} would go into the state’s normal fund, and lawmakers would applicable it into the finances. 

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By December, a contracting agency employed to stabilize the state’s services projected Montana State Hospital can be greater than $39.5 million over-budget. 

Usually when state businesses over-spend what they had been budgeted within the prior legislative session, they request what’s referred to as a “supplemental.” These are usually contained in Home Invoice 3 each session. This 12 months’s iteration has already been signed into regulation and incorporates spending starting from $22,715 for the Air Nationwide Guard to $2.8 million in litigation prices for the state Division of Justice.

Roughly $123 million of the well being division’s request would go to paying for issues within the upcoming two-year finances. About $50 million of that will likely be wanted for staffing at state-run services, and that’s provided that the division is ready to decrease a reliance on costly touring medical workers by recruiting and retaining extra everlasting staff. Brereton advised lawmakers that his division has seen some successes on that entrance, however isn’t the place it must be but.

One other $50 million is required to deal with Medicaid protection the division predicts will value greater than lawmakers are at present permitting for within the finances they’re crafting now.

The division was advocating for the cash the identical day Republicans within the state Home handed alongside get together strains a model of the state finances that included the caseload projections the division says aren’t enough to cowl the spending they anticipate.

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A part of that’s as a result of the division believes one other provision within the state finances to extend Medicaid supplier charges will end in extra suppliers, permitting extra individuals capable of entry well being care. Whereas that’s a superb consequence, Brereton stated, it comes at elevated bills.

Assistant Price range Director Ryan Evans within the governor’s Workplace of Price range and Program Planning acknowledged the request is “very, very completely different” from how regular supplementals and future spending are accounted for within the budgeting course of.

“That is actually a supplemental invoice. It’s definitely a supplemental invoice for (the) ‘23 (fiscal 12 months). It’s some notion of pre-funding uncertainty into ‘24 and ‘25 coming off of extraordinary instances,” Evans stated, referencing modifications in the course of the pandemic.

Each Republicans and Democrats on the Home Appropriations committee repeatedly questioned Brereton and Evans about why the request was coming in such an uncommon approach.

Republican Rep. John Fitzpatrick, R-Anaconda, requested why the knowledge wasn’t introduced to the finances subcommittee and included into the state’s finances if the division knew it had this earlier pattern of spending.

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Evans stated that as a result of the administration finds present spending ranges “unacceptable,” it didn’t need to add the spending to the bottom finances and as a substitute wished to work with the well being division to scale back prices. 

“We thought this was a extra truthful, clear approach,” Evans stated.

Nevertheless, the invoice appropriates the cash statutorily, that means it might be in regulation going ahead. When Fitzpatrick requested Keenan why the invoice would put the spending into regulation as a substitute of clarifying it was a one-time-only appropriation, Keenan stated the committee was capable of amend the invoice to alter that provision if it wished to.

When Rep. Mary Caferro, D-Helena and vice chair of a finances subcommittee that centered solely on the well being division finances, stated not asking for a supplemental was uncommon and that she didn’t perceive the logic, Evans acknowledged the strategy was “very completely different.”

“That is excessive transparency in extraordinary conditions,” Evans advised legislators, including that the request was giant and the division and finances workplace thought this strategy would give legislators extra assessment of the way it’s spent.

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Caferro additionally questioned why it was not mentioned in additional element in the course of the two and a half months lawmakers on the finances subcommittee solely dedicated to the state well being division finances.

“Possibly I’m not not making myself clear. My query is why in (the finances subcommittee) why did we not hear about all of those issues which can be going to value $150 million or extra … to repair? Why didn’t we hear concerning the issues?”

Brereton responded that the issues at state services and caseloads had been a part of in these debates, and stated the governor’s finances director made a reference to Keenan’s invoice earlier within the session. Nevertheless, the laws was not launched till March 15 and its specifics weren’t mentioned previous to Thursday.

“I perceive we didn’t get into super-granular or detailed,” Brereton stated.

The division was capable of leverage some federal COVID-19 support, in addition to cash from the director’s discretionary fund know as a “black field” to maintain issues afloat, Brereton stated, however the federal cash has expired and the black field has simply $6.8 million left. The director additionally advised lawmakers the finances shortfalls at state-run services began greater than two finances cycles in the past and reliance on contract workers traces again to 2018.

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Joel Peden, an advocate for these with disabilities who spoke on behalf of Montana impartial dwelling facilities, stated he was involved to see lawmakers hanging an current a part of state regulation that any cash devoted to dwelling and group companies might not be transferred to different components of the state well being division. Brereton and Evans stated the change was crucial to offer the division flexibility in spending cash it had entry to.

“There are tens of 1000’s of individuals which can be very, very nervous about their home- and community-based companies proper now,” Peden stated.

Peden additionally stated he was pissed off to see $150 million going towards a contingency fund and never towards community-based companies that additionally want help.

The committee didn’t take fast motion on the invoice.

Holly Michels is the top of the Montana State Information Bureau.  You possibly can attain her at holly.michels@lee.internet

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Judge strikes down Montana law defining sex as only male or female for procedural reasons – Times of India

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Judge strikes down Montana law defining sex as only male or female for procedural reasons – Times of India


MISSOULA: A judge on Tuesday struck down a Montana law that defined “sex” in state law as only male or female, finding that it was unconstitutional.
District court judge Shane Vannatta in Missoula ruled the law, passed last year, violated the state constitution because the description of the legislation did not clearly state its purpose.
Transgender, nonbinary, intersex and other plaintiffs challenged the law, similar to ones passed in Kansas and Tennessee, because they said it denies legal recognition and protections to people who are gender-nonconforming.
Vannatta did not address that argument, simply finding that the bill’s title did not explain whether the word “sex” referred to sexual intercourse or gender, and did not indicate that the words “female” and “male” would be defined in the body of the bill.
“The title does not give general notice of the character of the legislation in a way that guards against deceptive or misleading titles,” Vannatta wrote.
The bill was approved during a legislative session that also passed a ban on gender-affirming medical care for transgender minors and saw transgender lawmaker democratic rep Zooey Zephyr expelled from the house floor, following a protest against republican lawmakers who had silenced her.
The law that was struck down by Vannatta was sponsored by republican senator Carl Glimm, who said the legislation was necessary after a 2022 court ruling in which a state judge said transgender residents could change the gender markers on their birth certificates.
A spokesperson for republican governer Greg Gianforte, who signed the bill into law, did not immediately return an after-hours email seeking comment on the ruling.
The American civil liberties union of Montana praised it.
“Today’s ruling is an important vindication of the safeguards that the Montana constitution places on legislative enactments,” the group’s legal director, Alex Rate, said.





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Organizations request Montana health department investment following Medicaid redetermination • Idaho Capital Sun

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Organizations request Montana health department investment following Medicaid redetermination • Idaho Capital Sun


Thousands of Montanans lost Medicaid coverage, not because they weren’t eligible, but due to “unapproachable and unmanageable” administrative barriers at the state health department.

That’s according to a letter signed by 66 national and state organizations sent to Gov. Greg Gianforte last week asking him to include money to add additional staff to the Department of Public Health and Human Services and update outdated software, among other requests, in his budget proposal for the 2027 biennium.

The Medicaid redetermination process took place following a freeze on disenrollments during the Covid-19 pandemic, and took a total 135,000 enrollees off of Medicaid. The state’s redetermination dashboard cites the most frequent reason for disenrolling as a lack of correspondence with the department. Many former enrollees who may still be eligible now have to apply for Medicaid again for health coverage, with longer-than-usual wait times and Medicaid providers struggling to make ends meet as applications are processed.

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Health department in preliminary budget planning

The letter suggested consumer advisory groups, focus groups, surveys, and end-user testing to improve the state’s communication with clients – and said health department staffers should use plain language with clients to help reduce delays.

The state health department previously told the Daily Montanan it meets all federal standards for processing both redeterminations and new applications. Spokesperson for the department Jon Ebelt said Monday it is taking the requests in the letter under consideration in its budget planning.

“The letter makes specific budget requests, and at this time, DPHHS is in the preliminary stages of the executive budget planning process for the upcoming legislative session,” Ebelt said in a statement. “DPHHS appreciates the feedback and suggestions included in the letter and will consider them.”

The letter was addressed to Gianforte, but the Governor’s Office on Monday deferred to DPHHS in response to questions. DPHHS Director Charlie Brereton, as well as Human Services Executive Director Jessie Counts, Medicaid Chief Financial Manager Gene Hermanson and Director of Budget and Program Planning Ryan Osmundson were copied on the letter as well.

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Jackie Semmens with the Montana Budget and Policy Center, told legislators Thursday the organizations who signed onto the letter included food pantries, healthcare providers and faith organizations – places people turn to when they “can’t get the benefits they qualify for in a timely manner.”

“These organizations see people coming to food pantries when they are forced to choose between paying out of pocket for prescription or feeding their family because their Medicaid determination is delayed,” Semmens said. “These 60 plus organizations have seen firsthand how strapped the department has been during the past year, which is why they have joined together to ask the governor to improve access to public assistance.”

Organizations include the Montana Food Bank Network, the Fort Peck Tribal Health Department, Montana Head Start Association and the American Heart Association.

The letter, sent June 17, said the health department cuts made in 2017 led to 19 public assistance offices across the state to close and resulted in pressure on the staff that was left.

Medicaid unwinding exacerbated these existing issues, the letter said, and “highlighted the ways in which Montana’s safety net is outdated, inaccessible, and cumbersome for those most in need.” The organizations asked that as the governor’s administration develops its 2027 biennial budget, they invest and modernize access to Montana’s safety net services.

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Prior to each legislative session, the governor releases a budget with proposals for spending for the upcoming two fiscal years. The legislature ultimately has the power to appropriate funds, but the budget is a public statement of the investments the executive office wishes to make and approve. The legislature will meet again in January 2025.

Letter: state website is hard to navigate, more in-person assistance options needed

The organizations want to see more options for in-person assistance, which could include the reopening of rural public assistance offices. Applications completed in person are less likely to contain errors, the letter said, and would reduce procedural delays.

“In-person assistance is an essential lifeline for elderly, disabled, and rural individuals,” the organizations said.

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The state health department’s website to apply for safety net services like Medicaid or food assistance is hard to navigate, the letter said, and during the unwinding process, phone lines were jammed with people having to wait hours to speak to someone. The organizations believe the solution to the problems is better staffing at the department, although their letter did not specify how many more employees they believe are needed.

“With rural Montanans relying on these means of application, Montana should make significant investments to improve their functionality,” the letter read.

The letter said understaffing was what led to procedural delays during the Medicaid unwinding. Ebelt previously listed limited staff as one reason for Medicaid delays, along with prioritization for individuals with current inactive coverage as well as verifying previously unreported resources. He said the state meets the federal standard of paying 90 percent of “clean claims” (claims not needing additional verification) within 30 days, and 99 percent of “clean claims” in 90 days.

About 9% of cases are still pending eligibility, Counts told legislators, translating to a little under 20,000 cases.

Daily Montanan is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Daily Montanan maintains editorial independence. Contact Editor Darrell Ehrlick for questions: [email protected]. Follow Daily Montanan on Facebook and X.

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Briefs: Going to the Sun Road; Glacier Park death; Browning tax relief

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Briefs: Going to the Sun Road; Glacier Park death; Browning tax relief


GNP’s Going to the Sun Road opens for the season

Aaron Bolton | Montana Public Radio

Going to the Sun Road in Glacier National Park has fully opened for the season. Park officials opened the road Saturday.

The visitor center at Logan Pass is open, but drinking water isn’t yet available.

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The road is opening with some changes to the vehicle reservation system. A reservation is required from 6 a.m. to 3 p.m. for cars entering through West Glacier. Reservations aren’t required at the St. Mary entrance on the east side of the park.

Shuttle services along the road will begin July 1.

Woman dies after falling into St. Mary Falls in GNP

Edward O’Brien | Montana Public Radio

A Pennsylvania woman died yesterday Sunday afternoon after falling into the water in Glacier National Park.

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Park officials say the 26-year-old woman fell into the water above St. Mary Falls on the park’s east side.

According to witnesses, the woman was washed over the falls and trapped under the very cold and fast water for several minutes.

A park news release says bystanders pulled her from the water and administered CPR until emergency responders arrived.

Park rangers and an ambulance team from Babb took over CPR upon arrival.

An ALERT helicopter crew also assisted with resuscitation efforts, but the victim never regained consciousness.

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The victim’s name has not yet been released pending notification of next of kin.

The death is under investigation. It is Glacier’s first fatality of the summer season.

Browning residents to see relief after being overcharged on tax bills 

Shaylee Ragar | Montana Public Radio

State officials are working to get refunds to Browning residents who were overcharged on their property tax bills.

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Lee Montana first reported homeowners in Browning received unusually high appraisal values and property tax bills last fall — some four times the amount they paid last year.

That led the state Department of Revenue to re-evaluate the homeowners’ properties. The agency says a computing error miscalculated the values of 385 properties in town.

Bryce Kaatz with the department told lawmakers on Monday that all affected residents should receive letters with their updated appraisals this week. He said the department is working with Glacier County to issue refunds to homeowners as quickly as possible.

Kaatz says the agency is looking at safeguards to prevent the error from happening again.

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