Andrew Johnson lets his customers choose the music to play in the car.
As an employee of Family Outreach in Helena – an organization that helps people with developmental disabilities – part of his work day is driving, picking up clients and taking them to work or running errands.
“What’s up, gangsta?” Johnson said as a customer got into the car one day in March.
The pair gave a thumbs up and Johnson asked what kind of music the customer liked.
“Gangsta stuff,” was the reply. Mainly rap.
Snoop Dogg performed in the background as Johnson and his client drove to McDonald’s, where Johnson helps his client work. The duo did the dishes for two hours in the back of the fast food restaurant, where it smelled of maple syrup and sulfur.
About two weeks earlier, Johnson had testified at a hearing at the Montana Capitol in support of a bill to increase Medicaid reimbursement rates for health providers to levels aligned with the average cost of care that ‘They provide. The bill is informed by a 2022 study that recommended referral rates after its authors found that Montana Medicaid providers like Family Outreach were significantly underpaid.
“Vendor rates need to be funded so that people who work in that field or who work in adjacent fields can have a solid base, a place where you can build a career,” said Johnson, who earns $16.24. time in his position as an individual. life specialist.
Republican Gov. Greg Gianforte and lawmakers agree 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 study benchmark levels — to Gianforte’s plan to fund 91% of that level of reference in 2024 and 86% in 2025.
Meanwhile, Republicans leading the House Appropriations Committee, a key budget panel, are proposing an average increase of 92% for fiscal year 2024 and 97% in 2025.
Providers and leaders who work in behavioral health, developmental disability, long-term care and family support services attended the multiple hearings on rate adjustments, giving thanks for the proposed increases but asking for more. Many providers said the study’s benchmark rates are already out of date.
According to Shawn Coughlin, president of the National Association for Behavioral Healthcare, providers across the United States say they haven’t seen a significant increase in reimbursements in more than a decade. Behavioral health can be an afterthought for policymakers, resulting in lower rates than medical or surgical reimbursement, he said.
Michael Barnett, associate professor of health policy and management at Harvard TH Chan School of Public Health, said the supply of personnel is insufficient to meet the demand for behavioral health care in the United States.
“And it’s not clear that we’re going to meet all of that without paying people more,” Barnett said.
Some health providers have raised salaries but are still struggling to attract workers and keep those they have. Family Outreach has raised wages for some direct care workers from $11 an hour to $12.20 an hour this year, and more in places with higher costs of living, such as Bozeman. But even starting wages of $16 or $18 an hour aren’t attracting enough people to work there, said Family Outreach program manager Tyler Tobol.
“It’s a field that not many people want to get into, so the ones we can find, I think being able to pay a higher salary, a living wage, I think that would be the best benefit we get from the rate. increase,” Tobol said.
The organization has grown from 153 employees in 2020 to 128 today. Staff shortages mean staff now focus primarily on making sure clients have the basics – medicine and meals – instead of providing additional community living and business support services.
At Florence Crittenton in Helena, where mothers aged 18 to 35 with substance use disorders can live with their young children while undergoing treatment, a mother walked into the kitchen where women learn cooking skills. life like learning to cook dinner. The woman told a staff member that she was making juice for her child.
“This is where life happens,” said Daniel Champer, director of clinical and residential services at Florence Crittenton.
Executive Director Carrie Krepps said the organization’s two main sources of revenue are Medicaid reimbursements and fundraising. Fundraising, which used to represent 30% of revenue, now represents between 60% and 70% of revenue.
“That’s why we’re always open,” Krepps said.
At any given time, an average of 15 to 18 of Florence Crittenton’s 50 positions are vacant. If Medicaid rates don’t increase, she said, the organization will have to consider whether it can continue to operate the recovery home at its current capacity.
“Full rates would barely cover where we are today,” Krepps said of raising Medicaid reimbursement rates to baseline levels.
In 2021, Florence Crittenton closed a maternity ward for young pregnant and young mothers aged 12 to 15, the only home in the state that took in teenagers under the age of 16. Krepps said Florence Crittenton didn’t take Medicaid costs there because the rates were too low.
“It’s heartbreaking,” Champer said. “It’s like clockwork on Monday mornings. I come to see inquiries and referrals for mothers who need treatment and we can’t operate at full capacity because we don’t have staff.
Dennis Sulser, CEO of Youth Dynamics, which provides home support, case management and community psychiatric rehabilitation statewide, said his organization was paying its staff more than it could afford. Even with the increase in rates, he said, they would only break even.
Over the past three years, Youth Dynamics has lost 56 full-time employees. The COVID-19 pandemic has made people realize that they can find other better-paying jobs and even afford to stay home, Sulser said.
Two years ago, the entry wage for Youth Dynamics was $10.70 an hour, and it now averages $13.70. Still, staffing shortages led to the closure of one group home in Boulder and another in Billings, reducing the organization’s capacity from 80 to 64 beds statewide.
Ashley Santos, program manager for the organization’s three remaining group homes in Boulder, said she was trying to find a way to attract enough staff to reopen the gated home there. A pay rise backed by increased supplier rates could give her the ability to provide additional incentives, she said.
But it’s hard to attract workers when Hardee’s has a starting wage of $18 an hour compared to Youth Dynamics’ $16, she said. And fast food jobs don’t come with the emotional burden of working with kids who are diagnosed with serious emotional disorders like PTSD or depression.
Back in Helena, Johnson made his final stop of the day for Family Outreach. He sat next to a client on the sofa in the house where the client lives with his mother. Johnson called the number on the back of his client’s debit card to see how much money was left on it before heading out for errands.
Johnson and the customer then headed to a local supermarket. Trips like these give her client a chance to interact with other people, while her mother has time for herself.
“You look good,” Johnson told the client as they got into the car, the folk music of Dougie Poole, Johnson’s former client’s choice, playing in the background.
