Establish the Senior and Long-Term Care Home and Community-Based Services Access and Stabilization Act
Summary
HB 934 would create the “Senior and Long-Term Care Home and Community-Based Services Access and Stabilization Act” to change how Montana funds certain Medicaid long-term care services, especially assisted living. The bill directs the Department of Public Health and Human Services to seek federal approval to move Medicaid-covered assisted living services from the Big Sky Waiver program to the Community First Choice Option program, with the stated goal of using any resulting savings to reduce the Big Sky Waiver waiting list and serve more aged and disabled individuals in home and community-based settings.
The bill also establishes a new method for calculating room-and-board charges for assisted living facility residents on Medicaid, requiring annual adjustments and setting a $200 personal-needs allowance. It requires reporting to the legislative health and human services budget committee on enrollment, waiting lists, and per-capita spending, and it appropriates $56,000 for administrative work to draft waiver and state plan amendments, update rules, and revise department policies. The bill includes a contingent voidness provision if federal approval is denied and would take effect July 1, 2025.
Impact
If enacted, HB 934 would amend Montana law governing Medicaid home and community-based services by adding new statutory requirements for assisted living room-and-board calculations, directing a federal waiver/state plan amendment process, and creating ongoing reporting obligations for the Department of Public Health and Human Services. It would also shift some assisted living service costs from the Big Sky Waiver to the Community First Choice Option program, with the intent that savings remain available to serve people still waiting for Big Sky Waiver services. The bill would affect Medicaid recipients in assisted living, individuals on the Big Sky Waiver waiting list, and the department administering long-term care programs.
Sentiment
The bill’s stated purpose and structure suggest generally supportive sentiment around expanding access to long-term care services and reducing the Big Sky Waiver waiting list. The findings section emphasizes unmet need, cost savings, and the goal of serving more people in home and community-based settings rather than institutional care. However, there is no recorded committee transcript or vote history in the provided material, and the bill was ultimately withdrawn, so there is no direct evidence of floor or committee support/opposition in the available record.
Contention
The main policy issues appear to be whether Montana should seek federal approval to move assisted living services into the Community First Choice Option program and whether the proposed room-and-board formula is appropriate. The bill also raises questions about the fiscal and administrative feasibility of transferring services, preserving savings for the waiver waiting list, and ensuring federal approval from the Centers for Medicare and Medicaid Services. Potentially affected stakeholders include the Department of Public Health and Human Services, Medicaid recipients in assisted living, people on the Big Sky Waiver waiting list, and providers of assisted living services.