Balancing the budget shouldn't come at the expense of MT's most vulnerable | Jason R. Cronk

Every day across Montana, nursing homes care for some of our state's most vulnerable citizens — seniors recovering from illness, veterans, individuals living with disabilities, and older adults who can no longer safely live on their own. Families trust these providers to deliver compassionate, quality care when they need it most.

That is why the recent decision by the Montana Department of Public Health and Human Services (DPHHS) to withhold most Medicaid provider rate increases approved by the 2025 Legislature is so concerning.

The Legislature approved these increases because lawmakers recognized Medicaid reimbursement often falls well short of the actual cost of providing care. The approved 3% increase was not a windfall or a bonus. It was a modest adjustment to keep pace with inflation.

Now, those increases will not occur for most Medicaid providers on July 1.

This affects nursing homes, hospitals, assisted living communities, behavioral health providers, and others. But ultimately it affects the people who depend on these services.

Montana's nursing homes have spent years navigating extraordinary challenges. Inflation, workforce shortages, rising healthcare costs, and increasing complexity in caring for residents. Yet providers have continued to show up.

They have recruited and trained caregivers, invested in quality improvements, and worked collaboratively with state leaders to strengthen Montana's long-term care system. While facilities across the country have struggled or closed, Montana providers have fought to preserve access to care in the communities that depend on them.

At Immanuel Living's skilled nursing community in Kalispell, our average cost of providing care is about $481 per resident per day. Medicaid reimbursement averages just $292 per day. That means we lose $189 every day for every Medicaid resident served.

We are not alone. Nursing homes across Montana absorb similar losses daily because caring for vulnerable seniors is not optional. Providers make up the difference through fundraising, private-pay revenue, operational efficiencies, and an unwavering commitment to the people entrusted to their care.

Healthcare providers did not create the state's budget shortfall. We do not determine Medicaid enrollment projections, establish state budgets or decide legislative appropriations. Yet we are now being required to absorb the financial consequences.

The timing could not be worse. Wages have increased substantially, as have the costs for food, utilities, insurance, pharmaceuticals, supplies, and regulatory compliance.

When state reimbursement rates fail to keep pace, providers have fewer resources to invest in staff, services, and facility improvements.

The long-term consequences should concern every Montanan. Access to care is threatened, especially in rural communities. If providers are forced to reduce services, limit admissions, or close programs, families may find themselves traveling hours to find care for a loved one.

We should be strengthening the network of providers that serve our parents, grandparents, veterans, neighbors, and individuals with disabilities, not weakening it.

I recognize that balancing a state budget requires difficult decisions. I do not underestimate the challenges facing DPHHS or the Governor's Office. However, balancing the budget on the backs of nursing homes and other Medicaid providers ultimately just shifts costs onto seniors, families, hospitals, local communities, and the very people these programs are designed to protect.

Montana's healthcare providers are not asking for special treatment. We are simply asking the state to honor the commitment that was already made.

For the sake of Montana's seniors and vulnerable citizens, I urge state leaders to revisit this decision and preserve the rate increases approved by the Legislature. The future of healthcare access in Montana depends on it.