Travis Hoffmann asked lawmakers Friday how many times they would like him to shower.
The Missoula man, a U.S. Army veteran and a person with disabilities, said he already needs help showering, and because of limited resources is limited to three times a week. More cuts to what he already considers the struggling health and human services sector would mean that very basic services, like showering, would be cut back.
“I am assuming you can all shower whenever you want, but I can’t,” he said.
On Friday, as the Joint Appropriations Subcommittee for the Health and Human Services got to work on budget bill, the Republican-dominated group voted 5-2 to use the actual expenditures from 2019 as the baseline to build the 2021-2022 biennium budget for the Department of Health and Human Services. That department alone makes up more than 40 percent of the state budget.
However, using the 2019 budget as a starting point would mean nearly $1 billion less for the agency than what is being proposed by Montana Gov. Greg Gianforte. Democrats and members of the public argued that such a cut, if the measure passes, would cause an implosion of services from memory care to treating those with addiction.
Brooke Stroyke, a spokeswoman for Gianforte, said the governor intends to work with the Legislature, but plans to hold the line on spending while also not cutting essential services.
Republicans pointed out that the numbers they proposed were merely a starting point to begin discussions, and no one during the committee testimony believed the 2019 numbers would be the budget that is adopted in 2021.
The proposed rollbacks that will establish a baseline for the new budget are spread over the DPPHS’ 16 different divisions, sometimes referred to as “programs,” with each of those divisions administering different services. Democrats pointed out in a press release the proposal, if enacted, would mean a $96 million cut from Disability Services, $96 million cut from Senior Long Term Care, and $34 million cut from Addictive and Mental Health Disorders.
“This is simply voting on where we start to build a budget,” said Subcommittee Chairman Sen. Keith Regier, R-Kalispell. “We’re not appropriating any money today.”
Republicans argued that 2019 was the last actual numbers that have been completed and therefore the best choice to make a “reality-based” budget. Democrats and members of the public argued that those numbers are not an accurate reflection because there were many cuts during that budget cycle to get legislation passed, and that many health care services and agencies have still not been made whole from the cuts in 2017.
“They can build back the budget now. But in my mind, this is a cut right out of the gate and an approach that we are hearing other subcommittees do not intend to make,” said Heather O’Loughlin, the co-director of the Montana Policy and Budget Center.
O’Loughlin said actual numbers are available from more recently.
“We’re going back to three years ago which may or may not make sense,” she said. “But, we’re going to be spending a fair amount of time justifying expenditures without addressing what is need in our community now and what is emerging.
“You don’t typically start three years back.”
Rep. Mary Caferro, D-Helena, said she would like to see how many jobs would be impacted by these proposed cuts.
“I have seen this rodeo before. My opposition is not to transparency but I have spearheaded programs – lots of programs – where we cut services or even had to cut employees,” Caferro said. “I don’t have a problem with cutting programs and eliminating ones that don’t work.
“But we can’t go back to 2019. I cannot vote in hypotheticals when so much is on the line. This is a cut – and I know you don’t see it that way, but this means a loss of jobs, cuts to thousands of people including those children affected by abuse or neglected,” she added. “There’s nothing hypothetical about that.”
Regier responded that the proposal, which Sen. Mary McNally, D-Billings and Caferro ultimately voted against, was doing its intended purpose by spurring on discussion and “[shining] a light on where all the money is going.”
Healthcare providers and advocates turned up in person and via video to voice concern. Lobbyist Joel Peden of the Montana Association of Centers for Independent Living, which represents three nonprofit organizations, including those in Helena and Billings, said even modest cuts may have an outsized impact.
“In 2020, we received a small increase for services,” Peden said. “That is the difference between us offering some services and not.”
Former legislator Pat Noonan, who was representing the Behavioral Health Alliance, which includes 30 Montana communities, put it in even more dire terms.
“Community behavioral health providers are scared. They are scared about what is going to happen and they’re even more scared today,” Noonan said.
After cuts to DPHHS in 2016, Noonan said many small providers shut their doors in rural Montana. Now, he said there are few providers for mental health services east of Billings, the state’s largest city.
“They need a substantial increase, but that may not be possible,” Noonan said. “But if there are cuts, we won’t all survive.”
O’Loughlin also said the department doesn’t have as much flexibility as may appear at first glance.
“The reality of health and human services is that there is only so much you can cut,” O’Loughlin said. “There are services that the state is obligated to provide.”
Often lawmakers wind up making cuts to essential services by continuing the service, but doing so at a lower reimbursement rate. When providers get paid less to do the same job, it can force them to make one of two dangerous choices — either close or refuse to accept state payments.
“The reality is it means a loss of service and providers,” O’Loughlin said.
The other option is to cut what the state considers “optional services,” O’Loughlin said.
“That’s what they’re called, but in my mind and in the minds of many, they’re not optional,” O’Loughlin said.
Often optional services are the most efficient and also help save money in other areas, she said. For example, in-home care services are often considered optional, but they run more efficiently than placing individuals in facilities.
Mary Windecker of the Behavioral Alliance for Montana, said that Montana is stands out for its treatment of mental health, and not for the right reason.
“We have fallen from No. 1 in the country in suicides to No. 3,” she said. “But that’s because those other states have done such a horrible job, not because we’ve necessarily done better.”
Montana already leads the nation in most children in protective services per capita, and the number of children in foster care has doubled in a less more than a decade.
Windecker said Native Americans in Montana die one generation earlier than their non-Native counterparts. She told lawmakers that one week of incarceration often costs more than a year of community-based services.
“You can either pay now or pay later,” she said.
Many of those who testified said that COVID has added to the strain on social services, whether that is assistance with housing or mental health.
Diane Reidelbach, who runs the Job Connection in Billings, has seen a 60 percent increase in number of people who need her organization’s service.
“We’re holding on,” she told lawmakers. “But by a thread.”
The committee will meet again on Tuesday to hear a biennial Medicaid report.