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Providers report redetermination delays, capacity strains and call for continued provider-rate attention
Summary
Multiple assisted-living, nursing-home and home-care providers told the subcommittee that Medicaid redetermination delays have left facilities unpaid and that reimbursement and workforce pressures continue despite recent rate increases; industry groups urged continued attention to rates and capacity building.
Providers and associations testifying during the Section B hearing described ongoing operational challenges tied to Medicaid eligibility redeterminations, workforce shortages, and the continuing need to monitor and adjust provider rates.
Testimony highlights - Assisted-living and nursing-home operators said redetermination and billing delays at the Office of Public Assistance (OPA) have caused unpaid receivables and, in at least one testimony, an eviction because a resident’s eligibility was not processed. - Several providers noted that while last session’s rate increases were substantial and helped stabilize staffing and operations, costs continue to rise. The Montana Healthcare Association cited a Myers & Stauffer cost report showing an average nursing-home cost per day of about $337.81 and observed that average daily reimbursement, including some add-on payments, remains lower for many facilities. - Rural critical-access hospitals that provide swing-bed and nursing services reported operating losses tied to travel-nurse costs and delayed Medicaid reimbursement; some said they had to reduce home-health operations as a result. - Providers also said they face capacity constraints for certain high-acuity services (ventilator-dependent patients, pediatric nursing facility needs) that sometimes require out-of-state placements; DPHHS said eight out-of-state facilities were contracted as of November 2024 and that out-of-state placements in FY24 numbered in the low double digits.
Industry asks and department responses - Providers and the Montana Healthcare Association urged the legislature to continue monitoring rates and consider further adjustments when the post-rate-increase data justify them, rather than allowing rates to erode again. - Several speakers asked for faster Medicaid redetermination processing and clearer communication between OPA, providers and facilities when eligibility is being reviewed; DPHHS invited providers to send specific cases to the Director’s office for follow-up and indicated staff would route individual issues to the proper unit.
Ending Providers emphasized that the sector remains fragile despite recent improvements and asked lawmakers to retain a focus on reimbursement adequacy, workforce recruitment and redetermination reliability. No formal committee action was taken at this hearing.
