Bills would help families with nursing home closures, backfill for losses in current year

The Montana Legislature has spent hours trying to figure out the right reimbursement rates for nursing homes in the future — and Tuesday, they looked at a couple of ways to fix problems left in the wake of past closures.

House Bill 899, sponsored by Rep. Paul Tuss, D-Havre, would reserve one-time money to help communities and families that already have been affected by nursing home closures.

“A 90-year-old woman who was in the nursing home in Malta is now in Havre, in a very unfamiliar situation,” Tuss said. “It’s heartbreaking.”

Families who have moved loved ones to a different city could apply to be reimbursed for up to $1,000 for moving expenses related to the closures, according to the bill.

Community organizations or nonprofits could apply for up to $25,000 to help reopen a facility that was operating on July 1, 2021, and closed before July 1, 2023, as currently proposed.

No one testified against HB 899 in the House Appropriations Committee, and only proponents spoke for another bill related to nursing homes that was heard Tuesday as well.

House Bill 891, sponsored by Rep. Jennifer Carlson, R-Churchill, would provide nursing homes with $40.9 million to help backfill losses for the current fiscal year. She estimated $14.9 million would be general fund dollars and $27 million would be federal money after the state receives its match.

Every day, someone uses COVID-19 as an explanation for why positions are vacant or budgets need to go up, she said.

“But when it comes to the nursing home issue, we’re trying to figure out what the nursing homes did wrong,” Carlson said. “Nursing homes didn’t do anything different than the rest of the programs that the state manages.”

Legislators have debated a per diem reimbursement of $279 for nursing homes based on a recommendation from a national consultant. By comparison, Carlson said the state mental health hospital costs $900 to $1,000 a day, and it doesn’t include federal money.

As written, the amount of money each nursing home would be eligible for is linked to the number of Medicaid beds they had filled in the fiscal year and the consultant’s recommended per diem minus one year of inflation.

House Bill 899: Lost nursing homes, lost jobs in rural Montana

Many committee members asked Tuss questions about ways to tweak his bill, and Tuss said he was open to anything that would get it across the finish line.

Generally, he said he thought it would be more helpful to small communities, where nonprofits ran a facility. Montana has lost 11 nursing homes in roughly the past year.

Currently, the bill would appropriate $850,000 for grants to individuals and $300,000 for communities to try to reopen nursing homes.

It also notes a community recipient must make up to 40% of the facility’s beds available to people on Medicaid, although Tuss noted he was open to a number the committee could support.

In response to questions from Rep. Jane Gillette, R-Bozeman, Tuss said he was open to any source of money that would be available, not just the general fund.

He also said he tied the total for families to the number of lost beds, 857, although he noted it didn’t equate to patients. Tuss also said in hindsight, it might make sense to simply have one pot of money.

In response to questions from Rep. Bill Mercer, R-Billings, and Rep. Jim Hamilton, D-Bozeman, Tuss said he worried the $25,000 allotted to a community applicant might be too low, although he didn’t want the bill to have a significant fiscal impact.

He told Hamilton he was open to switching the pots of money too, so the bigger one went to communities instead of families, and vice versa.

During his closing remarks, Tuss said when small communities lose their nursing homes, the closures not only affect families, they affect the local economy. When the Hi-Line Retirement Center in Malta closed, he said 40 jobs disappeared in a town of 1,300, maybe 1,400 people.

“We’ve lost a lot of jobs in rural Montana,” Tuss said.

House Bill 891: ‘Just good enough’

Carlson said the legislature agrees as a body that Medicaid reimbursement rates need to go up, but the work they’re doing won’t take effect until the summer.

So her bill would help facilities make up some ground they’ve lost by continuing to stay open in the meantime.

No one opposed the bill, but committee members asked questions about how the money would be spent, if nursing homes had received other help since the pandemic hit, and how much they were losing in the meantime.

Proponents argued the money was necessary given increases in costs, and they noted labor in particular.

Wes Thompson, of Valley View Home in Glasgow, said his nursing home is losing $120,000 to $200,000 a month. He said the facility broke even in 2019 and was hoping for a repeat in 2020.

“The pandemic tore us a new one,” he said.

David Trost, of St. John’s United in Billings, said labor costs were $700,000 in 2019, and last year, they were more than $3 million.

Rose Hughes, with the Montana Health Care Association, said she’s getting calls from providers asking if the legislature has made its decision on funding yet so they can make their decisions about the future. She said 60 nursing homes are still operating.

In response to a question from Rep. John Fitzpatrick, R-Anaconda, about how nursing homes can continue to lose money, Hughes said in part, they were helped by state and federal COVID-19 relief money. Since then, administrators said they have spent down reserves and taken on debt.

Now, Hughes said some are doing their best to “juggle what they have” as they wait for a decision on updated rates, and some out-of-state companies are looking to “rescue” some in Montana if new rates make sense.

In response to a question by Rep. Bob Keenan, R-Bigfork, the a Department of Public Health and Human Services representative noted the agency had dispersed $15 million in federal COVID-19 relief money to nursing homes in June 2021.

Rep. David Bedey, R-Hamilton, said it would be important to understand where that $40 million would be going.

In her closing remarks, Carlson asked members of the committee not to overthink the details. If Montanans want nursing homes to remain available to the most vulnerable Montanans, she said her bill offered one solution.

“We have to solve this problem. And do I have the best idea on the planet? I don’t know. Maybe not. Statistically no,” Carlson said.

But also, she said lawmakers need to move forward with a plan: “Maybe the idea needs to be something that’s just good enough.”

The committee did not take immediate action on the bills.