Committee backs 'presumptive eligibility' measure to speed home care for older Montanans

Senators and witnesses told the House Human Services Committee Wednesday that Senate Bill 72 would let trained local partners temporarily approve Medicaid eligibility so elderly Montanans can begin home- and community-based services while formal eligibility is determined.

Senator Mike Yakawich, sponsor, said the proposal is aimed at people on fixed incomes who rely on family caregiving and at-risk older adults who could wait 60 to 90 days for formal Medicaid decisions. "This bill is intended for people to stay at home," Yakawich said, describing the measure as a way to get services started sooner and, he argued, save the state money by avoiding expensive hospitalizations and nursing-home placements.

Advocacy and provider groups — including Ability Montana, AARP, the Montana Healthcare Association and local area-agency providers — testified in support. Wick of Ability Montana described frequent three-month waits that leave people without needed personal-care services, while Kristin Page Nye of AARP said community-based care typically costs about a third of nursing-home care and that timely access reflects both dignity and cost-effectiveness.

Testimony included personal examples of long waits for waivers and an assertion in sponsor materials that presumptive eligibility programs in other states have success rates near 99 percent. Witnesses and the sponsor cited fiscal estimates in the bill packet that put initial per-person early-service costs at roughly $5,000–$6,000, projected about 300 people could qualify in the first year and an ongoing pool of roughly 170 per year.

Lindsay Carter, Senior Long-Term Care Division administrator for the Department of Public Health and Human Services (DPHHS), appeared as an informational witness and cautioned that program rollout depends on federal approvals. Carter said the department could begin preparatory work when the bill becomes effective, but some waiver or state-plan amendments require Centers for Medicare & Medicaid Services (CMS) approval and "we likely would not be able to implement until closer to January 1," she said. Committee members discussed making the waiver-application authority immediately effective to allow prompt filings.

Committee members pressed for fiscal modeling; Yakawich and proponents urged use of "dynamic fiscal notes" to capture downstream savings from avoided hospital and nursing-home care. Legal and technical provisions in the bill set training requirements, limit presumptive eligibility to specified entities (area agencies on aging, tribal entities, hospitals, or an entity designated by the department), and include a 30–60-day presumptive window with possible department-granted time extensions.

The committee closed the hearing with a formal committee recommendation of "do pass." Next steps include possible amendments during session and final action by appropriations and the governor.