How Much Is Enough For Montana’s Health Care Systems?
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After weeks of hearings, robust public testimony, closed-door meetings and poring over binders full of budget estimates, lawmakers on the health and human services budget committee on Thursday moved to shore up one of the cornerstones of Montana’s struggling health care system: Medicaid reimbursement rates. In plainer English: the state’s payments to health care providers who work with some of the most vulnerable and low-income patients on public insurance.
A total of six legislators in Montana have supported a 4% rate adjustment for the majority of providers. However, when it comes to mental health, addiction treatment, senior care, and long-term care services, the Democratic and Republican proposals have much greater significance. After Thursday’s meeting, the plan supported by four Republican lawmakers prevailed. This plan allocates an additional $23.4 million from the state General Fund over the biennium to these specific providers, in addition to the 10% increase proposed in Governor Greg Gianforte’s budget request.
The committee’s decision represents one of the first pieces in the legislative process of hammering out the health department’s multimillion dollar budget. As the committee’s chair, Rep. Bob Keenan, R-Bigfork, said Thursday, “this is step one and we’ve got probably five or six steps to go.”
The votes of committee Republicans and Democrats were rarely unanimous, signaling plenty of turbulence yet to come. The committee’s two minority party members tried repeatedly to increase behavioral health and senior care reimbursement rates even more. Sen. Chris Pope, D-Bozeman, launched a nearly 15-minute appeal for the committee to bring rates up to the benchmarks identified by a state-commissioned study released last year. That effort flopped, as did Democrats’ attempts to include a 4% rate increase for hospitals. Those institutions were segregated from other providers to keep their rate at the same level set in 2021, a decision the Montana Hospital Association called “a blow to Montana’s community hospitals” in a Thursday statement to Montana Free Press.
If eventually adopted into House Bill 2, the state’s primary budget bill, this Republican Medicaid reimbursement strategy would fall short of what health care providers say they truly need to retain staff, keep facilities open and continue caring for patients. But the committee’s decision did illustrate the majority party’s commitment to investing in Medicaid — a sea change compared to the belt-tightening of prior sessions.
Negotiations between the party’s fiscal conservatism and a business-minded acceptance that Medicaid is the backbone of the state health care system will likely continue over the next several weeks of the session. That dynamic is mirrored in health care budget debates playing out in other parts of the Capitol, too. This week, lawmakers on a different budget committee opted to fund less than half of the requested $15.9 million for upgrades at the Montana State Hospital, infrastructure repairs the health department described as vital for regaining the federal safety and quality accreditation the Warm Springs facility lost in the turmoil of 2022.
Lawmakers often claim that the state budget mirrors the values of the state. In this regard, Republicans are facing a delicate situation: they are striving to stabilize a crucial aspect of Montana’s healthcare infrastructure, while also being cautious about excessive spending. However, health care providers and advocacy groups have the opportunity to persuade the majority party that withholding essential funds for the struggling industry would be a riskier course of action. They have the remainder of the session to present an alternative perspective.
—Mara Silvers, Reporter
By the Numbers
Days remaining to submit public comment to the state Department of Environmental Quality regarding a 20-year open-cut gravel mining permit for more than 150 acres in the Jocko Valley. The deadline for public comment is Feb. 24.
Say Again?
Utah’s Republican governor has a message for Californians looking to move to his fast-growing state: Maybe stay where you are.
On February 10, Governor Spencer Cox expressed his concern about growth-related issues in California during a press conference in Washington, D.C. He emphasized the importance of encouraging individuals to remain in California instead of seeking refuge in Utah, and stated that finding solutions to this problem is a constant priority for his administration.
Cox emphasized, “Our focus is not on attracting more individuals. We are already thriving in that aspect.”
Montanans haven’t heard rhetoric like that out of their Republican governor, Greg Gianforte. Like Cox, Gianforte leads a state with a Republican legislative supermajority, significant population growth and a painful housing shortage.
Gianforte, however, hasn’t signaled any interest in discouraging migration to Montana since he took office in 2021. Instead, he’s overseen a “Come Home” marketing campaign designed to lure Montana college graduates back to the state and has made tax competitiveness a signature issue, pushing for lower income tax rates that he says will bolster the Montana economy by making the state a more attractive destination for entrepreneurs.
Earlier this month, Gianforte stated that our plan will enhance Montana’s competitiveness with neighboring states, enticing inventive job creators who will make investments in Montana and its people.
This week in an email, Travis Hall, spokesperson for Gianforte, refuted the idea that the governor’s competitiveness agenda primarily focuses on attracting new individuals to the state. Hall emphasized that the agenda is actually aimed at enhancing opportunities for current residents.
He stated that the goal is to establish a conducive atmosphere where Montanans can flourish, succeed, and fulfill the American dream.
Hall said, “Utah remains Utah and Montana remains Montana. They are distinct entities, not interchangeable.”
—Eric Dietrich, Deputy Editor
Verbatim
“If we’re going to have an anti-bullying policy in the state, then we also need to make sure that we’re protecting self-defense because, like I said in my intro, self-defense is an inherent right.”
—Rep. Jed Hinkle, R-Belgrade, speaking about his proposal to allow students to defend themselves or others against physical attacks in public schools. Hinkle clarified that House Bill 450 would not authorize two students who “go behind the bleachers and duke it out,” nor would it permit students to use physical force in response to verbal bullying — a topic recently raised by opponents of a proposal affecting transgender students. The bill received opposition from the Montana Federation of Public Employees and the Montana School Boards Association, both of which noted that local districts already have policies addressing such behavior. However, the latter did propose changes to the bill inspired by those policies.
—Alex Sakariassen, Reporter
Happenings ️
The Big Sky Documentary Film Festival kicks off its 20th year in Missoula this Friday, and with nearly 150 films slated to screen over the next 10 days, there’s a lot to choose from. We checked in with the festival staff for some can’t-miss Montana-themed options.
Jim Markel Sr. and Jim Markel Jr. visited the Khe Sanh War Memorial in Vietnam in 2018 as part of the filming of “Return.” Credit: Courtesy of “Return.”
Feb. 18: Your friendly neighborhood newshounds at Montana Free Press are sponsoring the Montana premiere of “The Grab,” which follows a journalist’s seven-year investigation into a global power struggle for land and water. The showing starts at 8 p.m. at the Wilma Theater, followed by a Q&A with director Gabriela Cowperthwaite (of “Blackfish” fame).
Feb. 19: Montana resident Jim Markel Sr. revisits his past as a Green Beret stationed in Vietnam in “Return,” a documentary from Billings-based filmmakers Pete Tolton and Stan Parker screening at 5:30 p.m. at the Wilma.
Feb. 20: Blackfeet actress Lily Gladstone appears in her latest film — a 14-minute documentary about Gladstone herself on the eve of a major Hollywood release. “Lily Gladstone: Far Out There” screens in a slate of short docs at 8 p.m. at the Wilma, followed by a Q&A with director Brooke Pepion Swaney.
Feb. 23: “Native Ball: Legacy of a Trailblazer” looks back on the legacy of Malia Kipp, a Blackfeet basketball legend who was the only Indigenous woman in the country to earn a full-ride Division I scholarship in 1992. The 27-minute doc screens at 4 p.m. at the Zootown Arts Community Center, followed by a Q&A with Kipp and director Megan Harrington.
Feb. 23: Director Nic Davis takes a deep look at the life and literary contributions of one of Montana’s most acclaimed authors in “Ivan Doig: Landscapes of a Western Mind.” Showing starts at 8 p.m. at the Wilma, with a Q&A with Davis and his team after.
—Alex Sakariassen, Reporter
Wildlife Watch
Two years after he sponsored a bill loosening regulations around killing grizzly bears, Sen. Bruce “Butch” Gillespie, R-Ethridge is sponsoring another grizzly-related measure. Among other items, the new bill seeks to put some sideboards around the earlier measure, which Gov. Gianforte signed into law in May of 2021.
Senate Bill 295 would allow a livestock owner who’s encountered a bear “threatening” livestock to make a complaint to Montana Fish, Wildlife and Parks’ director. After an investigation, the department would have the option of either sending someone in to “control, trap or remove” the grizzly, or issuing the livestock owner a permit to kill it. A Fish and Wildlife Commission-established quota on grizzly bear mortalities would be taken into consideration in the latter scenario.
Grizzly management is a particularly hot topic right now, given the U.S. Fish and Wildlife Service’s Feb. 3 announcement that it’s taking the next year to consider whether Northern Continental Divide and Yellowstone-area grizzliesshould be removed from the federal government’s list of endangered and threatened species.
Among other provisions, SB 295 directs the state to “manage grizzly bear populations at levels necessary to maintain delisted status.” How the state proposes to manage intentional and unintentional grizzly mortalities has been one of the focal points of the draft management plan FWP put out for comment late last year.
The Senate Fish and Game Committee’s hearing on Tuesday primarily revolved around the interpretation of “threatening” and the question of whether SB 295 aligns with a “managing to the minimum” strategy for grizzly conservation.
Caryn Miske, director of the Sierra Club’s Montana chapter, questioned, “Does the mere presence of a bear running across a meadow automatically make it a threat?” Miske further contended that permitting the hunting of grizzlies on public land goes against the principles of the public trust doctrine of wildlife management.
When questioned about how she determines what qualifies as threatening behavior, Trina Bradley, a Valier rancher and supporter of SB 295, explained that she considers her understanding of the bear’s behavior and her cattle’s behavior. According to Bradley, certain bears can be near her livestock without causing much concern, whereas others pose a greater risk.
Bradley, the executive director of the Rocky Mountain Front Ranchlands Group, confidently stated, “We possess the expertise to handle our operations, understand our livestock, and are well acquainted with the resident bears.”
Rancher Dave McKeon, testifying before the Senate Fish and Game Committee on Tuesday, stated that if he observes signs of grizzly activity and witnesses negative impacts on his livestock and family due to the bear’s presence, he considers the bear to be a threat.
SB 295 did not receive immediate action from the committee.
—Amanda Eggert, Reporter
The Gist
For all the heated floor debates and packed committee hearings, there’s a lot of policy at the Legislature that drifts through the halls without much, if any, contention. These days, House Bill 15 is solidly in that camp. The proposal may not sound that exciting: approving a 3% inflationary adjustment to the state’s share of public education funding. But for local school officials racing to adopt the next academic year’s budgets in March, knowing that money will be there is critical to their calculations.
HB 15 is smoothly progressing this session, moving forward without any obstacles. It successfully passed the House last month and recently secured its final Senate vote with minimal opposition, only receiving five dissenting votes. Lance Melton, the Executive Director of the Montana School Boards Association, reports that this progress is ahead of schedule compared to the corresponding bill in the previous session of 2021, which itself had the earliest timing in recent memory for reaching the governor’s desk. It is highly likely that HB 15 will be passed to Gov. Greg Gianforte for approval next week.
Melton commented, “It seems like it’s almost become automatic now, and just to clarify, I never overlook or underestimate that fact.”
Why is the bill’s progress such a big deal? Up until 2015, the adjustment was something of a political football in the Legislature’s budget deliberations. Melton — unshakeable in his view that adequate funding for public schools is a “constitutional commitment” — recalled numerous instances when a “dogfight” over an inflationary increase for schools extended “literally until the last minute of the session.” He credits the shift to an exhaustive 2013 revision of school finance laws carried by then-Sen. Llew Jones, the Republican from Conradwho now chairs the House Appropriations Committee. Since then, Melton said, Montana has experienced “a consistent 10-year period” when inflation has become an increasingly nonpartisan part of education budgeting with very little dissent.
According to him, it has had a significant impact on schools over the years by enabling them to sufficiently remunerate, attract, and retain staff, among other benefits.
—Alex Sakariassen, Reporter
3 Questions For
Taylor Crawford, an English teacher at Browning High School located on the Blackfeet Indian Reservation, has been a part of the district’s faculty since 2017. Recently, she initiated an elective journalism class that has breathed new life into the once-inactive student newspaper, Etumoe, with a total of 21 students participating in the endeavor.
MTFP: How did you start the journalism class?
Crawford: This semester we had an opportunity to add English electives, and so each of us English teachers kind of chose one that interested us and what we thought would interest our students, and so immediately I was like, journalism, we need to bring back a paper or something like that.
MTFP: What does a day in the classroom look like for you?
Crawford: I’ve pretty much just been covering ethics and journalism, especially like starting off, and I think that would be something I would cover with every new class as new students join it if we do it in the future. I think it’s important so that we know we’re not putting out anything harmful or false, you know what I mean? So that’s pretty much what we do. I have press passes, so if we have time, they can leave and go work on things for the newspaper, come back, type it up, do like a writer’s workshop type of thing.
MTFP: What have you learned from starting the class and reviving the newspaper?
Crawford: I think what surprised me the most was just seeing how self-motivated they are to get articles done for the newspaper compared to writing essays in my classroom. I thought I was going to have to force them to go out and, you know, talk to people and get information, but they were all willing, and they’re really excited about the class and the opportunity to share their thoughts and ideas on their own terms or subjects that interest them.
—JoVonne Wagner, Legislative Fellow
On Our Radar
Amanda — I stumbled on a story earlier this week about the Flathead Electric Cooperative, which is set to double the electricity-generating capacity of a project that turns landfill-generated methane gas into enough electricity to power 3,200 homes. Who knew?
Alex — With the one-year anniversary of Russia’s initial invasion into Ukraine just around the corner, there’s a short film at the Big Sky Documentary Film Festival that’s pretty high on my must-see list. “Her War” is a self-shot portrait of a Ukrainian sniper, the lone woman in her regiment, and it’s streaming online throughout the festival’s full run.
Mara — The New York Times has been under fire for several months from many transgender advocates for the paper’s generally dubious coverage of that marginalized community. That critique escalated this week with two letters from a prominent LGBTQ organization and another from a long list of the Times’ own contributors. The Gray Lady has so far been standing by its coverage.
Arren — I’m choosing to practice some zen with this week’s radar pick: the New York Times has this list of 25 essential dishes to eat in Paris. Will I ever be in a position to eat any of them? Probably not, but a boy can dream.
Eric — A sobering note to ponder as Montana lawmakers gear up to discuss pro-housing regulatory reforms: As NPR reports, Turkey’s president touted his efforts to relax building codes so developers could rapidly build tens of thousands of homes for Turkish citizens. Then came the Feb. 8 earthquake that killed at least 35,000 people in the region.
JoVonne — Last weekend’s Super Bowl displayed the nation’s love of the game, but the event was also an opportunity to showcase Indigenous representation both on the field and off. ICT’s Kolby KickingWoman and Noel Lyn Smith previewed the game with special attention to the Kansas City Chiefs’ two Native players, the first Cherokee Nation citizen to help referee the game, and the intricate and colorful Indigenous artworks commissioned by the NFL.
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