It is a well-known fact that when we reach our 80s, many of us will begin to need a little extra help. We become more susceptible to falls or cognitive challenges. We’re more frail and more likely to need some support, whether we live independently in our own homes or in assisted living or skilled nursing settings.
The number of Montanans in their 80s is growing exponentially.
- Between 2010-2019, 60,000 Montanans turned 80.
- Between 2020-2030, nearly 100,000 Montanans will reach our 80s.
And Montana is not ready! In fact, the governor’s proposed budget in House Bill 2 substantially reduces funding for senior long-term care.
Who will be affected by the cuts? For the most part, it’s folks like you and me – nurses, teachers, farmers, homemakers, clerks, or laborers – who worked their whole lives but weren’t able to retire with significant savings or assets. It affects the vast number of older Montanans who are not wealthy, who, if they require skilled nursing or even assisted living, will eventually deplete their savings and assets.
This is the population whose long-term care is paid for by Medicaid.
So why does the proposed budget reduce funding for senior long-term care? State budget planners and the Department of Public Health and Human Services (DPHHS) cite a lower number of Medicaid patients in Montana’s skilled nursing and assisted living facilities over the past two years. They built the budget for the next two years based on those numbers.
But those numbers are deceptive and require a closer look. There are three reasons why the number of Medicaid patients in these facilities dipped in the last two years:
- The state sets Medicaid reimbursement rates for providers who care for folks in these facilities. Provider rates set by the state in 2023 were lower than what it actually costs to provide the care, causing significant financial losses to skilled nursing homes and assisting living facilities.
As a double-whammy, this has happened during a highly competitive labor market. As a result, neither facilities nor community providers can afford to hire or retain nurses to provide care needed by Montanans. In short, Medicaid care numbers were lower not because fewer folks needed this care, but because other employers like big box stores and fast-food chains were out-competing for workers. All because the Legislature budgeted too little money for Medicaid care. - The state’s Medicaid redetermination process kicked hundreds of qualified seniors in nursing homes and assisted living settings off of Medicaid. The process to reinstate their insurance took months. It was impeded by bureaucratic roadblocks resulting from understaffing at the DPHHS, such as the notorious 5-7 hour wait times seniors or their families experienced when calling to get reinstated.
- Late in 2024, providers reported over $8 million in Medicaid “pending” – services provided but unreimbursed. Providers continue to report having to write off significant amounts of care uncompensated by Medicaid as well as continued high amounts of “Medicaid pending.” It is important to note: this is care that was provided that does not show up in Medicaid utilization because of redetermination problems as well as initial Medicaid determinations.
For these reasons, just as in 2023, lawmakers in 2025 are faced with the deterioration of the state’s critical caregiving infrastructure in every setting: community, assisted-living, and skilled nursing care.
“Low utilization” of skilled nursing and assisted living beds doesn’t mean people aren’t seeking assistance. Consider the following:
- Home and community-based service providers are also struggling with the same funding and workforce issues.
- Family caregivers are particularly burdened when other options are unavailable.
- The lack of access to care can put older adults at high risk of hospitalization, homelessness, abuse/neglect/exploitation, and other crises.
Montana lawmakers need to increase the budget for senior and long-term care and community services provided by Area Agencies on Aging to meet the needs of Montana’s aging population.
Please tell legislators: Montana seniors and their families are relying on them to address this crisis in care now! Don’t let our beloved seniors struggle through the last years of their lives without the care and assistance they need.
Margie MacDonald served 12 years in the Montana Legislature. A lifelong Montanan, she lives in Billings. Currently, she is representing Big Sky 55+ in Helena as an advocate for policies that bring people together to find solutions that make life better for Montanans of all ages.