Clients of Andrew Johnson are given the freedom to select the music they want to listen to during their car rides.
As a staff member at Family Outreach in Helena, a nonprofit organization dedicated to supporting individuals with developmental disabilities, he spends a portion of his workday engaged in transportation duties. This entails driving to various locations, collecting clients, and assisting them in commuting to their workplaces or completing necessary errands.
“Inquiring about your well-being, gangsta?” Johnson greeted as a client entered the car on a March day.
Johnson and the client exchanged a fist bump before Johnson inquired about the client’s musical preferences.
The reply was, “Gangsta stuff,” mostly referring to rap.
As Johnson and his client made their way to McDonald’s, the tunes of Snoop Dogg filled the air. Their destination was where Johnson assisted his client with work. In the depths of the fast-food establishment, an aroma blending maple syrup and sulfur lingered, where the duo diligently washed dishes for a solid two hours.
About two weeks earlier, Johnson testified at a hearing at the Montana Capitol in support of a bill that seeks to raise health providers’ Medicaid reimbursement rates to levels aligned with the average cost of the care they provide. The bill is informed by a 2022 study that recommended benchmark rates after its authors found that Montana Medicaid providers like Family Outreach were being significantly underpaid.
Johnson, an individual living specialist earning $16.24 per hour, emphasized the importance of funding provider rates. He believes that this funding is necessary to ensure a stable foundation for people working in this field or related fields, providing them with opportunities to establish successful careers.
Republican Gov. Greg Gianforte and legislators agree that Medicaid rates need to rise; where they disagree is by how much. The proposals range from the bill Johnson testified for — Democratic Rep. Mary Caferro’s bill to raise rates to the study’s benchmarks — to Gianforte’s plan to fund 91% of that benchmark in 2024 and 86% in 2025.
In the meantime, the House Appropriations Committee, led by the Republicans, is suggesting a substantial average boost of 92% for fiscal year 2024 and an even higher increase of 97% in 2025.
Several providers and leaders in the fields of behavioral health, developmental disability, long-term care, and family support services have expressed their gratitude for the proposed rate adjustments while requesting additional increases. Numerous providers have argued that the benchmark rates mentioned in the study are already obsolete.
Providers across the United States say they haven’t seen significant reimbursement increases in more than a decade, according to Shawn Coughlin, president of the National Association for Behavioral Healthcare. Behavioral health can be an afterthought for policymakers, resulting in lower rates than for medical or surgical reimbursement, he said
Michael Barnett, associate professor of health policy and management at the Harvard T.H. Chan School of Public Health, said the supply of staff is inadequate to meet demand for behavioral health care across the U.S.
Barnett stated that it is uncertain whether we can achieve any of our goals without increasing people’s salaries.
Despite increasing wages, certain healthcare providers continue to face challenges in recruiting and retaining workers. Family Outreach, for instance, recently raised the hourly wages of some direct care workers from $11 to $12.20, with even higher increases in areas like Bozeman where the cost of living is higher. However, these efforts have not been successful in attracting a sufficient number of workers, as even starting wages of $16 or $18 per hour are not enough to entice individuals to join the workforce at Family Outreach, according to Program Manager Tyler Tobol.
Tobol mentioned that since there is a lack of interest in this field, he believes that offering a higher wage, a living wage, to the few people we can find would be the most advantageous outcome from the rate increase.
The organization’s employee count has decreased from 153 in 2020 to the current number of 128. As a result of this staffing shortage, employees have shifted their primary focus towards ensuring clients’ fundamental needs are met, such as medications and meals. This has led to a reduction in the provision of additional community integration and activity support services.
A mom at Florence Crittenton in Helena, a facility that provides housing and treatment for mothers aged 18 to 35 with substance use disorders, walked into the kitchen. This kitchen serves as a space where women learn important life skills, such as cooking dinner. The woman approached a staff member and informed them that she was preparing juice for her child.
“This is where life happens,” said Daniel Champer, Florence Crittenton’s clinical and residential services director.
Executive Director Carrie Krepps said the organization’s two main sources of revenue are Medicaid reimbursements and fundraising. Fundraising, which used to account for 30% of revenue, now makes up between 60% and 70% of the money coming in.
Krepps stated that it is the reason they are able to remain open.
Florence Crittenton consistently experiences a vacancy rate of 15 to 18 out of its 50 staff positions. Without an increase in Medicaid rates, the organization will have to assess the feasibility of maintaining the recovery home at its current capacity.
“Raising Medicaid reimbursement rates to benchmark levels would only marginally suffice to meet our current needs,” stated Krepps.
The youth maternity home for pregnant youths and young moms aged 12 to 15, which was the sole facility in the state serving teens under 16, was closed by Florence Crittenton in 2021. According to Krepps, the decision was influenced by the low Medicaid fees that the organization received for their services.
Champer expressed sorrow, stating that the situation is deeply saddening. Every Monday morning, without fail, Champer witnesses an influx of inquiries and referrals from mothers in need of treatment. However, their ability to provide full capacity support is hindered due to the lack of staff.
Dennis Sulser, the CEO of Youth Dynamics, which provides home support, case management, and community-based psychiatric rehabilitation across the state, said his organization is paying its staff more than it can afford. Even with the rate increase, he said, they’d only break even.
According to Sulser, Youth Dynamics has experienced a loss of 56 full-time employees over the past three years. The COVID-19 pandemic has prompted individuals to recognize alternative job opportunities that offer higher pay and the convenience of remote work.
Youth Dynamics’ entry-level pay was $10.70 per hour two years ago, but it has currently increased to an average of $13.70. However, due to insufficient staff, a group home in Boulder and another in Billings had to be closed, resulting in a reduction of the organization’s statewide capacity from 80 to 64 beds.
According to Ashley Santos, the program manager responsible for the organization’s three group homes in Boulder, her main goal is to find a way to attract sufficient staff members in order to reopen the closed home. She mentioned that if there is an increase in pay supported by the provider rate increase, it would allow her to offer additional incentives, giving her more flexibility in attracting potential staff members.
According to her, it is challenging to attract workers because Hardee’s offers a starting wage of $18 per hour, while Youth Dynamics only offers $16. Additionally, fast-food jobs do not carry the emotional burden of working with children who have a severe emotional disturbance diagnosis such as PTSD or depression.
In Helena, Johnson concluded his day by making a final visit for Family Outreach. Taking a seat beside a client on the couch in their home, where they reside with their mother, Johnson dialed the number listed on the back of the client’s debit card. His intention was to check the remaining balance before they embarked on their errands.
Johnson and the client proceeded to a nearby supermarket, providing the client an opportunity to engage with others, while affording his mom some personal time.
Johnson complimented the client on their appearance as they entered the car, accompanied by the folksy tunes of Dougie Poole, the very music enjoyed by Johnson’s previous client.
