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Taking the public out of human services

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Taking the public out of human services

Sep 21, 2023 | 6:35 am ET
By Darrell Ehrlick
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Taking the public out of human services
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Charlie Brereton, Montana's Director of the Department of Public Health and Human Services (Photo screenshot from Montana Public Affairs Network).

The Montana Department of Public Health and Human Services has a strange way of working.

It seems like every time the department is asked to do something to help, you know, public health or human services, it looks for a way to stop.

Remember when the only thing the Gianforte administration had to do was apply to the federal government in order to receive $10 million to help feed hungry children? You may also recall that it opted not to do that, despite overwhelming evidence that the state needed help feeding hungry children.

Apparently, the administrative burden was too much.

But administrative burden sounded a lot like bureaucratic-speak for “work.”

The Gianforte administration has also not disclosed much about the fact that Montanans are losing health insurance at an alarming rate. The DPHHS said that most people who were getting booted from Medicaid were being rejected because of they wouldn’t return paperwork. Later, the Biden administration revealed that paperwork was really code for people who couldn’t stay on hold for hours after the state or its vendor couldn’t handle the call volume.

In other words, Montanans are losing health insurance because DPHHS can’t figure out how to do its job.

And just this week, we learned that the state wants to issue a single contract to a vendor to administer the Temporary Assistance for Needy Families program. It turns out families in crisis, in need of cash or who need job training are just too much work for the DPHHS.

To be fair, the department didn’t really deal with the families. That was done by several dozen different providers throughout the state. But even that seems like too much work for our friends at the department.

The contract the DPHHS is putting out to bid also smells fishy: Lawmakers heard from different groups which administer the TANF program that suggest it’s written in a way to preclude almost any current agency because of the administrative structure the potential vendor needs to have. From that, we can probably deduce that wherever the contract is going, it’s heading out-of-state, and it’s going to require more bureaucracy and administration.

To break that down even more: The state doesn’t appear to be giving more resources to families in need of temporary assistance, so that means the current providers will have to figure out how to do more with less, while the state is adding another layer of bureaucracy. That means some administrator-type business can skim money from a program that seems to be working just fine.

Except that the Montana DPHHS doesn’t want the hassle of … helping needy families or working with the vendors who do. DPHHS Director Charlie Brereton told lawmakers that it would “reduce administrative burden.”

I don’t doubt that managing the state’s largest agency, complete with health and welfare programs, is challenging. But the DPHHS arguing that they need less work is like a hospital that refuses sick patients because they require so much care, or schools shunning students because education requires the administrative burden of teachers, schools, and technology.

If the DPHHS doesn’t have enough time to help families struggling to find food, housing, health insurance or jobs, what exactly is the DPHHS doing?

And remember that many of these organizations, whether they’re helping with families or providing mental health services, face an already tough environment of rising need and rising costs. If the state’s DPHHS undermines or destabilizes this already overtaxed sector, it risks doing a lot more than letting some vendor take cash from organizations already running on a shoe-string budget.

Remember, the state’s largest public health dumpster fire, the ongoing saga at Warm Springs, the state’s mental hospital, was also outsourced to an out-of-state firm which charged millions, only to have the Gianforte administration re-up the contract … adding more millions to the equation.

Ruth Burke, of Human Resource Council District 11, told lawmakers last week:

“If the state hires them to do the contract, and they hire us to do the contract, we are doing the work and there’s just an extra layer of bureaucracy between us. If the state chooses to go out for one provider, you’re either adding administration or you are reducing the services that are available, particularly in rural counties.”

Whether it’s the increasing demand for mental health, food assistance or housing, it’s clear that Montana can’t outsource poverty or social challenges.

So why are we trying to outsource the help?

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