HELENA — Senator Mike Yakawich (sponsor) told the Senate Public Health Committee on Jan. 15, 2025, that Senate Bill 72 would establish a presumptive eligibility process so Montanans who appear to qualify for Medicaid-funded home- and community-based services can begin receiving care immediately while their formal Medicaid applications are pending.

Supporters told the committee the change would make services available faster, avoid unnecessary hospitalizations and nursing home placements and likely reduce long-term state Medicaid costs by shifting care to less-expensive home- and community-based services.

Yakawich, the bill sponsor, said the measure is aimed at helping "long-term care for the elderly" stay in the community: "This bill is intended to provide a focused effort at helping elderly who are in need and qualify, and ... to keep mom or dad at home." He described a scenario in which a family member is suddenly unable to provide care and a short delay in eligibility can lead to a preventable fall or hospital admission.

AARP government relations director Kristin Paige-Nye told the committee that fast access to home- and community-based services matters to Montanans: "Survey show that 96% of Montanans age 45 and older want to remain in their home as they age," and presumptive eligibility helps do that by providing quicker access to services that would otherwise take 45 to 60 days to begin, she said.

Rose Hughes, executive director of the Montana Health Care Association, emphasized the bill’s intent to limit services to non‑institutional care and said the conceptual amendment under development clarifies that the program should not include nursing-home services. "The amendment does that," Hughes said, adding that excluding nursing-home costs from fiscal calculations substantially lowers the bill’s estimated program cost.

Witnesses representing disability advocacy groups and providers — including Ability Montana, Opportunity Resources Inc., Big Sky Senior Services and statewide aging and labor organizations — said their clients already qualify for services but face long waits for eligibility determinations. Cassie Wicks of Ability Montana described frequent cases in which personal-care applicants waited months for processing: "Once paperwork is submitted, eligibility determination can take 2, 3, 4 months, leaving these folks in need without the care that they so deserve and require." She asked lawmakers to approve SB 72 to allow needed care to begin sooner.

Department of Public Health and Human Services staff participated as informational witnesses and described implementation issues the committee raised. Lindsey Carter, administrator for the Senior Long Term Care Division, told senators that presumptive eligibility would more quickly place applicants into the processing pipeline but that some program differences — especially between the Big Sky waiver and state-plan Community First Choice services — affect how quickly a person can begin receiving particular services. She explained that Community First Choice services are state-plan entitlements (no wait list once eligibility is established), while Big Sky waiver services can be subject to wait lists and slot availability.

Committee members asked for detail on how much time the proposal would save for both Community First Choice services and Big Sky waiver placements and on the fiscal note’s assumptions about program costs and federal/state shares for any payments made before final eligibility determinations. Several advocates and the sponsor agreed to provide comparative data from other states and additional fiscal detail and to supply a clarified amendment that would explicitly limit presumptive eligibility to home- and community-based services and exclude nursing-home coverage from the program’s presumptive benefits.

No formal votes were taken. The committee closed the hearing on SB 72 and asked the sponsor and agency staff to supply additional materials — including data on time saved for eligibility and clarifications to the fiscal note — before executive action.