HELENA — The Hannaford Group Home in Helena, operated by Many Rivers Whole Health, is currently housing eight clients receiving behavioral health services – 100% of its capacity. But earlier this year, it was only housing four, due to a need for more staff. Leaders say the difference now is thanks in part to an increase in the state’s Medicaid provider reimbursement rates, approved by the Montana Legislature earlier this year.
“In that big picture, it was definitely a sigh of relief, and pleased, and with a lot of gratitude – because without that, this would be a very different conversation,” said Dr. Jen Preble, the licensed residential supervisor for Many Rivers’ Helena group homes.
During the 2023 legislative session, provider rates were a major topic of debate throughout the budgeting process. For clients on Medicaid, the reimbursement rate determines how much the state will pay providers for giving them services like behavioral health, senior and long-term care and care for people with disabilities.
Advocates have talked for a long time about the growing costs of providing these services – and the challenges of recruiting and retaining workers if reimbursement rates didn’t keep up. Providers aren’t able to simply raise prices for Medicaid patients to account for things like inflation.
Preble says Many Rivers had been dealing with acute staffing challenges for about a year. She said, as other industries in need of workers kept raising wages, it became almost impossible for them to compete in that market.
“I think for us the reduction in residential beds was moving towards closure – so if we didn't get more staff, then we were no longer going to be able to fully occupy the group home,” she said.
Having four fewer beds available at the Hannaford Home had a ripple effect, taking up additional space at their Sleeping Giant Group Home, which houses 12 clients. MTN spoke to one client, remaining anonymous, who said she had to wait six months for a spot to open up when she was ready to leave the Montana State Hospital.
“If Hannaford was not open, I would still be waiting to discharge,” she said.
BethAnn Rivers’ brother is a current group home client, and she called it “a miracle” when he found a place with Many Rivers, as he had been seriously struggling before getting a community placement. She said their family had real concerns about what would happen if the group homes went through additional reductions and he was at risk of losing of losing his place.
“It is a home-like environment; my brother loves it there,” she said. “He loves the community that he has there, the family bonds that they form there. He has people to go to and to talk to, and he feels safe, and he feels at home. All of us need that family. None of us deserve to be alone and on the street and forgotten.”
Altogether, Preble says Many Rivers’ residential program had reduced its capacity to around 40 earlier this year. After the rate increases took effect, they were able to raise salaries for group home workers to $16.50 an hour. Now, with more staff in place, they’re serving about 50 clients.
Despite the increase, Preble says their challenges aren’t over. She noted that the rate increases were largely in response to a study that analyzed providers’ actual costs – but that study is already two years old.
“It's bare minimum, right?” she said. “It's allowing us to stay open, and that's allowing us to continue providing the service, but we certainly aren't going above and beyond.”
For Youth Dynamics, which provides children’s mental health services across Montana, the provider rate increase didn’t lead directly to higher salaries. CEO Dennis Sulser told MTN they had seen the staffing challenges building for a long time – losing nearly 50 full-time staff since 2021. He said leaders decided they had to offer higher pay immediately to be competitive – even before the state approved additional reimbursement. He said the increases were a big help, but it’s still hard for them to find any margin in their budget.
“The challenge for us is our rates are set outside of us, our rates are set by our Medicaid program partners,” Sulser said. “We are truly thankful for additional rates; it's keeping us in the game – but yet still very challenging.”
Sulser said the rate increase was particularly helpful in bolstering their family support program, which provides therapists and social workers to engage with kids and their families, both in the community and in their youth group homes.
“The Home Support Service is truly designed to keep the family intact, and we truly believe that children in the family, that engagement with the family is our best fundamental result,” he said.
Youth Dynamics has four group homes on its Alternative Youth Adventures campus in Boulder, four in Billings, one in Great Falls and one in Helena – but some remain closed because of staffing needs. Sulser said two years ago, they had about 80 children placed in those homes, and they’re now down to about 45.
Sulser said they have to look to things like community and philanthropic support to allow them to remain competitive in attracting workers.
“We're all going to have to be a little creative about how we go into the future, and changes are absolutely necessary in our ongoing business model, if you will, no matter what that looks like,” he said.
The reimbursement rate is only part of the picture these providers are facing. Many also identify needs to repair, update or expand their facilities in order to keep up with the needs for service.
Sulser said he’s excited about a $10 million program, recommended by a state commission and signed off on by Gov. Greg Gianforte this week, that will provide one-time grants to cover some of the costs of repairing existing residential care facilities, opening or reopening new ones or training new staff.
Youth Dynamics broke ground this week on a new group home building at the Boulder campus, one of two they’re planning to build to replace the current aging facilities. Sulser said it will be valuable to have a building designed specifically for the type of youth care they provide.
“The facilities have been challenging at best, and we're working to improve that,” he said.
They’re also in the process of moving their Helena group home into the former Florence Crittenton facility on Harris Street.
Preble says Many Rivers is also looking at what needs to be done to facilities like the Hannaford home.
“I mean, homes require new window coverings, they require new flooring, new cabinetry, especially in high use areas like a kitchen, for example,” she said. “When you're talking about eight or nine people, counting staff, in or out of a house every day, that's far more use and wear on a home.”
Despite the ongoing challenges, the successes so far have been good news for people like the Many Rivers client MTN spoke to. She said she’s grateful for the calming environment at the group home, the support she gets from staff, the skills she’s developing and the activities she’s able to enjoy.
“I think it's huge that these people care enough to keep trying and keep pushing forward and keep trying to get funding for Many Rivers to have more stuff – to have more fun stuff like the river, like going to the farm, therapeutic things that are very helpful to mental illness,” she said.
The client told MTN, in her time at the home, she hopes to be a role model for those going through mental health challenges.
“I am here to set an example that you can recover and heal with every step you take on your journey through mental illness,” she said. “You just have to be stronger than the storm and rise with all you've got.”