Senate committee hears fiscal case for shifting some assisted‑living funding to Community First Choice

The Montana Senate Finance and Claims Committee heard testimony on Senate Bill 100, the Senior Care Facility Access Stabilization Act, which would move some assisted‑living funding from the Big Sky waiver into the Community First Choice (CFC) program and change how related case management is paid.

Senator Becky Beard, sponsor and senator for District 38, told the committee the bill would “transfer assisted living individual…from the waiver to CFC” and that 124 people on the current Big Sky waiver waitlist would qualify for CFC if the bill is implemented.

The hearing focused on the fiscal note and implementation details rather than policy debate. A fiscal analyst who presented materials to the committee documented multiple offsetting figures: an initial administrative cost of about $80,000 in the first year and roughly $125,000 annually thereafter; estimated savings from shifting assisted‑living services from the waiver to CFC of about $1.2 million in the first partial year rising to roughly $2.5 million in subsequent years; and savings from eliminating some case‑management costs estimated at about $750,000 the first year and $1.5 million thereafter. The analyst also showed a cost to serve people already on waiting lists of roughly $1 million the first year and about $1.8 million each year after that, producing a projected net General Fund savings that was small in the first year and larger thereafter.

Gene Hermanson, Medicaid chief financial manager at the Department of Public Health and Human Services (DPHHS), and Lindsay Carter of DPHHS’s senior long‑term care group answered technical questions about the fiscal assumptions. Hermanson told the committee that the per‑person annual cost could be approximated by multiplying the daily assisted‑living rate by 365 days, and that each additional person served would therefore add a “pretty significant cost” to the fiscal estimate.

Advocacy groups supported the bill on the basis that it would expand access to assisted living and reduce higher‑cost nursing home placements. Kristen Page‑Nei, representing AARP Montana, said the group “rises in strong support of Senate Bill 100,” and warned the committee that the waitlists will grow as Montana’s population ages. Margie Macdonald of Big Sky 55 Plus and Tyler Amundson of Big Sky Senior Services urged passage on the grounds that assisted‑living services provide a less‑costly level of care than skilled nursing for many people.

Committee members pressed staff and sponsors on key fiscal assumptions: the DPHHS fiscal note assumes a 1% annual caseload growth and limits on expansion based on available beds and workforce. Senator Ellis and others questioned whether 1% growth understates future demand because Montana’s older population is growing faster than the general population. DPHHS staff replied they lack precise data on average length of stay in assisted living and on how many current waiver clients would shift to CFC; the department noted those uncertainties complicate longer‑term cost projections.

In executive action the committee first voted on a motion to pass Senate Bill 100; the roll call resulted in an 11‑11 tie and the motion did not pass. Committee members then moved to table the bill; the motion to table was approved and Senate Bill 100 was tabled.

Why it matters: supporters said the funding shift would allow the state to serve people at a lower level of care and reduce pressure on nursing homes; opponents and some members warned the move could create an entitlement that increases caseload and costs beyond current estimates if demand rises or if capacity expands.

Votes at executive action: the motion to pass resulted in an 11‑11 tie (motion failed). A subsequent motion to table the bill passed (bill tabled).