HELENA — Some of the state's proposed cuts in Medicaid reimbursement will harm children and leave the state responsible for more expensive services, opponents said Thursday.

The Department of Public Health and Human Services took public comment on its proposal to implement about $12.5 million of $49 million in state budget cuts it must make due to lower-than-expected state revenue and a record fire season. The $12.5 million in state cuts over the next 18 months means the loss of another $22.2 million in federal matching funds.

Health department director Sheila Hogan said the agency was required to make the cuts because Republican lawmakers opposed increasing taxes.

Most of the comments at the hearing were against proposed cuts to targeted case management for children with medical needs as well as home support and education and training for therapeutic foster homes. Opponents said they doubted they would be able to provide the services under the proposed reimbursement rates.

Beth Cogswell, the executive director of Youth Homes, said home support and therapeutic foster care services provide families with comprehensive training and 24/7 support as they try to help children recover from trauma.

"I believe it's unethical to discontinue it," she said.

The state proposes cutting $234,000 from the home support services and the therapeutic foster care program, which will cost another $655,000 in federal matching funds.

Foster parent Tom Bourguignon of Missoula said reducing support for therapeutic foster care will cost the state more in the long run for mental health and substance abuse treatment for those children.

Doug Anderson with Riverstone Health in Billings questioned the logic of eliminating effective case management, then listed the possible medical, social and legal costs for a shaken baby case.

The state proposes cutting $200,000 from targeted case management through June 2019, which would eliminate another $375,000 in federal funds.

Matt Kelley, health officer for the Gallatin County health department, said state child protective services workers were recently in his office asking about expanding home visitation for children with health care needs while the state was looking at cutting funding for the program.

Others said the therapeutic foster care program also supports the Division of Child and Family Services, whose workers are overwhelmed with abuse and neglect cases due to parental drug use.

Some commenters opposed elimination of Medicaid coverage for some dental services, including dentures, for recipients over the age of 21.

Not having needed dentures limits a person's ability to get a job and provide for their family and may leave them needing more state services, said Destiny Richards with Hi-Line Denture and Flathead Denture.

Other proposed Medicaid cuts will reduce payments for hospital stays, durable medical equipment and substance abuse treatment.

The department is taking public comment through Feb. 9.

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