Hole torn in a dollar bill with Medicaid text
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Legislation billed in part as ensuring steps to maintain access to assisted living communities for Medicaid recipients has been vetoed by Montana Gov. Greg Gianforte (R).

SB296 would have revised funding laws related to assisted living communities and skilled nursing facilities, established procedures for calculating personal needs allowances and room and board costs for assisted living residents, and required money appropriated for nursing homes services to be used only for those purposes.

Under the bill, assisted living would move from the Big Sky Waiver program to Community First Choice, a state and federally funded program that provides in-home care assistants or clinicians. 

In a letter to the leaders of the Montana House and Senate, Gianforte said he shared a commitment to investing in Montana’s senior housing and long-term care continuum, and to ensuring that Medicaid beneficiaries  have access to services. But he called SB296 a “misguided policy” brought by stakeholder organizations that highlighted potential short-term savings but did not consider the “significant, long-term fiscal impact and burden on taxpayers.”

The bill, according to the governor, established a “cumbersome process” for setting assisted living rates. He also said that moving assisted living from the waiver program to the community First Choice program is an “inefficient and obtuse way to solve for years of inadequate Medicaid providers rates.”

“Not only is there no reliable method of estimating the cost associated with making assisted living a CFC service — which could lead to major, unplanned financial obligations to the state — but also there is no provision enabling [the Department of Public Health and Human Services] to ensure that rfecipients have not exploited the eligibility system by transferring their assets,” Gianforte wrote.

He said that SB296 not only would create a new entitlement program; it also would restrict the state’s ability to serve Medicaid recipients choosing to live in a community setting instead of a nursing home. He also called the bill “unsound legislation” that undermines and ignores individuals’ personal decisions.

Rose Hughes, Montana Health Care Association executive director, previously told McKnight’s Senior Living that the legislation would go a long way toward stabilizing a senior living and care sector “hammered” by COVID-19 and the workforce crisis. Moving assisted living services under the Community First Choice option, she said, would eliminate waiting lists. She also said that the move from the waiver program would save the state money due to a 6% enhanced federal match rate.

State Sen. Becky Beard (R) introduced the bill after the state health department declined requests for emergency funding, saying that “long-term care is not financially sustainable and that it didn’t make sense to continue providing financial guardrails for the industry,” reported the Independent Record.