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Committee hears evidence medical‑respite pilot saves Medicaid dollars; department says waiver and data collection needed
Summary
Sponsor and pilots from Bozeman and Missoula described medical‑respite programs that move homeless patients out of expensive hospital beds into lower‑cost recovery settings and urged the committee to authorize Medicaid coverage; the department said a federal demonstration waiver and additional data will be needed for federal match.
Representative Ed Staffman (House District 59) opened the hearing on House Bill 274 by describing pilot medical‑respite programs in Bozeman and Missoula. He said hospitals pay roughly $1,700 per inpatient night while medical‑respite costs in pilots averaged about $140 per night; local pilot data showed avoided hospital nights and associated savings to Medicaid.
Cammy Kirchberg, manager of community health improvement at Bozeman Health, testified the Bozeman pilot prevented avoidable inpatient nights and delivered Medicaid savings. Jill Bonny, executive director of the Poverella Center in Missoula, said the Missoula pilot prevented 205 avoidable inpatient nights last year and projected larger savings if the program expanded.
Gene Hermanson, Medicaid chief financial manager, testified as an informational witness and said the department’s fiscal note did not include evidence of Medicaid cost savings because it lacked sufficient data to demonstrate federal cost neutrality for a waiver. He said the department would need to submit an 1115 demonstration waiver to CMS and show that federal costs would be cost‑neutral in order to secure federal matching funds.
Committee members asked about provider capacity, data availability, payer mix, and whether hospitals were already contributing community benefits to pilots. Kirchberg said Bozeman Health used community benefit dollars to support the pilot and that Bozeman and Missoula had supplied data the department could use for a waiver application.
Ending: Sponsors and proponents urged the committee to pass HB 274 to allow Medicaid coverage for medical‑respite services and to grow capacity; DPHHS said it could pursue a waiver but would need time and evidence to demonstrate federal cost neutrality.
