by William Skink

Medicaid in Montana is a multi-headed beast targeting different populations, expanded under the ACA. No one really knows everything there is to know about the various programs, even the institutions that should know, like the Office of Public Assistance.

I even suspect supporters of Medicaid expansion are somewhat ignorant as to how those dollars get used.

There are a few informed critics, like James Conner at Flathead Memo. I greatly appreciated this post questioning the Medicaid snatch and switch scheme by Bullock to fund pre-school education. And I agree whole-heartedly with this statement:

Medicaid money should be used to pay for Medicaid services and nothing else, and all of it should be spent. A state government that runs a Medicaid surplus isn’t helping as many people as it could.

I hope an advocacy group for Medicaid sues to stop this if the bill passes and Bullock signs it into law.

One of the most critical needs that continues to be underfunded is long term care services in Montana. There is a significant waitlist for aging Montanans who can’t afford the cost of in-home care, the kind of services needed to keep someone in their home instead of a nursing home.

Unless you have had direct experience, you probably don’t know how cruel Medicaid is for people who need these services. You don’t know the harsh income requirements, like how over $2,000 in savings and more than $640ish a month means you get too much to qualify for Medicaid.

With that reality in mind, this Missoula Current piece about Consumer Direct opening its 23 million dollar national headquarters in Missoula requires a little scrutiny. Why? Because they are sad they aren’t getting more of the Medicaid pie:

Despite the company’s rapid growth and its future plans in Missoula, Woody said he considered several other states when looking to establish a national headquarters, including Boise and Denver.

While there are benefits to locating in Montana, he said, the state’s Department of Health and Human Services – and Montana’s partisan politics – continue to challenge the company’s potential for growth within the state.

Among the issues, Woody named state cuts to caregiver wages and a low reimbursement rate for skilled nursing services. The later prompted the company to cancel a contract for skilled nursing services for people with developmental disabilities in Montana.

“We’re not reimbursed enough through Medicaid to find caregivers or nurses,” Woody said. “I seriously considered moving it (headquarters) to another state that’s more business friendly. With regard to Health and Human Services, it’s not the best state. It’s one of our weaker performers.”

“But at the end of the day, we all live here and we’ve got the momentum,” Woody added. “We’re here because we like Montana, not because it’s the best place to run a business. Montana needs to work on that, very hard.”

I’m not sure a company opening a 23 million dollar headquarters should be panhandling the State of Montana for more Medicaid dollars for their caregivers. If you can’t find labor at the price you are willing to pay, Consumer Direct, then maybe you should consider offering your workforce better wages for the difficult work they do.

Medicaid dollars shouldn’t be a part of state funding shenanigans, but they are. And companies that can toast a multi-million dollar headquarters grand opening shouldn’t immediately try to use their economic leverage to shake down Montana’s state government for more Medicaid loot.