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Late last month, nursing home administrators for The Ivy at Great Falls, the state’s largest senior care facility, announced to patients and staff that The Ivy would be closing within weeks.
The facility recently received news that it had been removed from the federal Centers for Medicare and Medicaid program because of a number of safety and care violations. That notice meant patients would soon become ineligible for financial reimbursements that are critical to keeping nursing homes solvent.
When a facility begins the process of shutting down, patients and families are forced to grapple with a difficult question: where to go next?
As of Wednesday afternoon, the state health department said that 65 of The Ivy’s 106 current residents “have either been relocated or accepted (but not yet moved) to a new facility.” The 41 patients remaining have been referred to other facilities.
But the long-term availability of other nursing homes is not necessarily guaranteed. Montana has struggled with a spate of closures in recent years as facilities navigated blows from the pandemic and staffing shortages. More recently, nursing home administrators and advocates have raised concerns about inconsistent reimbursements from the state-administered Medicaid program digging into their bottom lines.
During Montana’s mass review of Medicaid enrollees’ eligibility in 2023, many nursing home residents were kicked off the rolls, often because they failed to respond to paperwork requests in a timely manner or due to confusion about their eligibility.
According to a July survey of facilities by the Montana Health Care Association, 25 said they were awaiting payments related to new or pending Medicaid applications. The survey found that, in total, those unpaid reimbursements amounted to $8.8 million.
“There are some systemic problems here,” said Rose Hughes, executive director of MHCA, in a Wednesday meeting of state lawmakers. “It’s not that individual workers aren’t working hard. It’s not that the people in the agency aren’t working. It seems that maybe there aren’t enough people processing these applications or getting them done quickly enough to get this bad backlog caught up and then to stay caught up.
“It’s just a real concern for these facilities because they’re providing an awful lot of service without getting paid in a timely fashion,” Hughes said.
State health department Director Charlie Brereton cast some doubt on the accuracy of Hughes’ presentation but generally acknowledged the state’s backlog of Medicaid cases.
“It’s multifaceted, and I don’t believe that it’s just the department being under-resourced and not having enough people or enough trained people,” Brereton said, adding that communication between providers and the state is “a two-way street.”
As Gov. Greg Gianforte’s administration prepares its executive budget proposal, Brereton hinted the department is considering requesting more funding to hire additional staff.
“Right now, the department is working within the confines of the resources that the Legislature grants us,” Brereton said.
—Mara Silvers
Verbatim 💬
“We’ve had business people down there. And we made a strategic decision to go back to, ‘This is a patient health care facility.’ So our new CEO is an MD. We have a new chief medical officer coming in who has extensive experience with dementia and all of these things.”
—State Medical Officer Doug Harrington, speaking at the July 15 meeting of the Transition Review Committee, a group of lawmakers and appointees overseeing the protracted effort to transfer patients with Alzheimer’s, dementia and traumatic brain injuries out of Montana State Hospital in Warm Springs. The state has announced that the facility’s incoming CEO, Dr. Kevin Flanigan, will begin in August.
Harrington is temporarily overseeing operations at the adult psychiatric facility after the state health department abruptly removed interim CEO and Health Facilities Division administrator Jennifer Savage from both of her roles earlier this month.
Savage, who has an MBA and worked as a business director in North Carolina for state health facilities, had been the hospital’s interim CEO since January. She took over after the state prematurely ended its contract with David Culberson, a hospital administrator from California who served as interim CEO beginning in early 2023.
READ MORE: State hospital shuffles top leadership, again
—Mara Silvers
Public Comment 🗣️
Montana Fish, Wildlife and Parks is seeking public input as it overhauls mule deer management and works to understand what’s driving down mule deer populations in eastern Montana.
In a Wednesday news release, FWP solicited public input on 11 guiding principles that the Mule Deer Citizen Advisory Council has developed to form the foundation of a new mule deer management plan. The principles include increasing mule deer populations, using the best available science to inform management, managing chronic wasting disease, improving the quality of the hunting experience, improving landowner relationships and maximizing opportunities for public input.
Mule deer are a hallmark species valued for the economic and ecological role they play in the state. Resident and nonresident hunting expenditures fill the tills of many Montana businesses, and license sales support FWP’s operating budget. Mule deer hunting also underpins important cultural and recreational traditions.
In some parts of southeastern Montana, the mule deer population is estimated to have fallen 40% below the 10-year average. The statewide population in 2023 was estimated at 256,000 animals, down 17% from the long-term average.
The advisory council identified a number of issues that may be contributing to that drop, including declining habitat quality, increasing hunting pressure, weather and climate effects, and the spread of chronic wasting disease, a fatal neurological disease that has become increasingly common in pockets of southwestern Montana and along the state’s northern border.
“Many of these concerns could benefit from further research, increased precision of monitoring and incorporation of results into management actions,” the advisory group wrote in its problem statement. “A lack of data could result in management decisions being driven by public opinion rather than by science. FWP needs to commit to and fund research priorities and management actions to achieve the mule deer plan objectives, while maintaining transparency.”
The public comment portal closes on Aug. 15.
—Amanda Eggert
Viewshed 🌄
On the Record 📣
Montana Secretary of State Christi Jacobsen was in Milwaukee this week for the Republican National Convention, where she stepped forward to announce the state party delegates’ unanimous votes for the now-official Republican presidential nominee, Donald Trump.
According to a press release from her re-election campaign, Jacobsen also took time at the RNC to sign a statement alongside five other Republican secretaries of state emphasizing “areas of concern” in the effort to restore voter confidence in the electoral process. At the top of their list is a staunch reassertion of states’ rights to control the time, place, and manner of their elections.
The “Statement on Election Integrity & Opposing Federalization of State Election Processes” included a nod to a three-year-old executive order from President Joe Biden directing federal agencies to do more to register voters. The order helped establish voter registration opportunities in certain Veterans Affairs facilities and tribal colleges but has fueled allegations from conservatives about federal overreach. The statement Jacobsen signed this week calls for the order to be “rescinded immediately.”
Other stated areas of concern have been at the center of disputes over Republican-backed policy for years, among them voter identification and third-party ballot collection. The Montana Legislature’s adopted approach to both those issues in 2021 was ultimately declared unconstitutional by the Montana Supreme Court — a case that featured Jacobsen as the new laws’ primary defender. The statement also declared that “drop boxes for election ballots should not be used” and asserted that the safest, most secure way to cast a ballot is at the polls on Election Day.
Jacobsen’s campaign did not immediately respond to an email Thursday asking whether the statement is related to any specific policy goals Jacobsen may pursue if elected to a second term. She will square off against Democrat Jesse Mullen and Libertarian John Lamb on the Nov. 5 general election ballot.
—Alex Sakariassen
Following the Law ⚖️
Debate about exactly how Montana election administrators are supposed to verify signatures for ballot initiatives has thrown the longstanding administrative process into legal disarray this month. And critics on both sides of the aisle are laying blame squarely at the feet of Montana’s top election administrator, Secretary of State Christi Jacobsen, in the form of a flurry of lawsuits.
Last week, backers of constitutional initiatives to alter Montana’s primary election system and to ensconce abortion rights in the state Constitution sued Jacobsen over her office’s rejection of signatures submitted by inactive voters. The plaintiffs argued that the rejections disenfranchised thousands of legally registered voters whose classification as “inactive” did not disqualify them to sign petitions to put CI-126, CI-127 and CI-128 on the ballot this fall. In a novel interpretation for Montana, Jacobsen’s attorneys countered with the theory that those voters are not, in fact, “qualified electors” at all.
After a lengthy hearing Tuesday, District Court Judge Mike Menahan signed a restraining order crafted by both state and plaintiff group attorneys requiring Jacobsen to accept inactive voter signatures forwarded by county election officials through July 24. Then, on Thursday, Jacobsen’s office appealed that order to the Montana Supreme Court, despite having helped write it.
Separately, and unbeknownst to the groups sponsoring the three constitutional initiatives, another lawsuit about Jacobsen’s signature verification process unfolded this week in Lake County District Court. There, a group of Republican plaintiffs including Montana House Speaker Matt Regier sued Jacobsen in an effort to block her from certifying Constitutional Initiatives 126 and 127, which they described as a “back door ranked choice voting scheme.” The parties accused Jacobsen of not properly policing the certification process or taking adequate steps to exclude inactive voter signatures.
On July 15 — one day before Menahan issued his order requiring Jacobsen to include inactive voter signatures — Jacobsen’s office signed a stipulation in Lake County agreeing that those same signatures were ineligible. The document barred Jacobsen from certifying CI-126 and 127 pending further legal proceedings. But the next day, Lake County District Court Judge Molly Owen vacated her order, citing Menahan’s ruling on the same topic.
Plaintiffs in the Lewis and Clark County case have since alerted Menahan to the Lake County proceedings. In a Thursday brief, attorneys noted that while they did not know about the case during Tuesday’s hearing, two attorneys from Jacobsen’s office who testified on the stand did. The ballot initiative groups said that while they “do not seek remedial action from the court at this time,” they reserve the right to seek judicial remedy at a later date for the witness’ “failure to candidly disclose” the Lake County agreement. Jacobsen’s office did not respond Thursday to emailed questions from MTFP.
Both district court judges have scheduled additional hearings in the respective cases next week. As of Friday morning, the Montana Supreme Court had not responded to Jacobsen’s appeal.
—Alex Sakariassen
Highlights 🔆
In other news this week —
- In last week’s Lowdown we welcomed summer environmental reporting intern Zeke Lloyd to our newsroom, and I’m happy to report that Zeke has hit the ground running like his feet are on fire. One early result of his enthusiasm for the work is the summer’s inaugural The Week in Wildfire review, the first of up to three months’ worth of weekly summaries of statewide fire news that will augment our data-forward Montana Fire Report.
- When the state’s largest nursing home closes without warning, you realize the benefit, again, of having boots-on-the-ground reporters in the community where the news is. We were lucky this week to have the combined beat expertise of Great Falls Local reporter Matt Hudson and Helena-based health care reporter Mara Silvers on the story.
- Speaking of Mara, she’s ahead of the curve again this week with her reporting, in collaboration with our partners at KFF Health News, on a new opioid overdose prevention strategy awaiting the approval of Gov. Greg Gianforte.
- And speaking of deadlines — what, we weren’t speaking of deadlines? — political reporter Tom Lutey kept me after hours last night to make sure we had the timely news of Sen. Jon Tester’s notable change of heart about whether President Joe Biden should continue his re-election bid to serve a second term.
The Gist 📌
New rules limiting greenhouse gas emissions from coal-fired power plants have survived an early challenge from Montana’s attorney general and other Republican AGs.
The U.S. Court of Appeals for the District of Columbia on Friday denied the attorneys general an injunction to stop the Environmental Protection Agency from imposing first-ever limits on greenhouse gas emissions from coal-fired power plants. Montana AG Austin Knudson objected to the new EPA rule in April.
Power plant owners and states will now have to proceed with plans for limiting carbon dioxide emissions as their lawsuit challenging the rules advances.
The states and energy plaintiffs argued that the rules, which require curbing carbon dioxide emissions by 90%, cannot be met and threaten the reliability of the nation’s electricity supply. Winning an injunction in federal court requires proving that your case is likely to succeed, which the state attorneys failed to do.
Planning to cut carbon emissions by 2032 doesn’t pose an imminent threat, the court concluded.
The owners of Montana’s Colstrip power plant have indicated that tighter greenhouse gas emissions could make the plant uneconomical to operate.
—Tom Lutey
On Our Radar 
Amanda — I’ve been loosely following the trajectory of HomeBase Partners’ proposal to construct The Guthrie, a 111-unit building that would (if approved) be the first to take advantage of “deep incentives” in Bozeman’s affordable housing ordinance. The community’s reception to the project has been complicated, the Bozeman Daily Chronicle reports.
Alex — I’m already fed up with the wildfire smoke that’s choked the Missoula Valley this week. So is Mushu, Missoula County’s official “air quali-kitty.”
Mara — When the house is already sweltering, why not turn on the oven and bake something? I’m trying two recipes this week for family birthday celebrations: lemon citrus with fluffy frosting and a classic carrot cake. Hope they’re worth the temporary bump in kitchen temperature.
Brad — You know that feeling when you stumble across a somehow-new-to-you musician with a decades-long discography to explore, as if it were the freshest breath of air you’ve ever inhaled? Yeah, that’s a good feeling.
Jacob — An investigation by Proof News reveals that companies including OpenAI, Apple and Nvidia are using YouTube transcriptions, many of which contain copyrighted material, to train their models. The tool they created to check if your favorite channel is being mined is available for public use here.
Matt — Texas photographer Maxwell Johnston reflects on recovery and community in his cycling life. Plus, the accompanying photos on The Radavist show what cycling should be: fun.
Zeke — As part of my passion for understanding, appreciating and engaging with place, I recently took refuge in the work of Leslie Marmon Silko. Her novel “Ceremony” has helped me find footing in the arid, rugged terrain of the Mountain West.
Tom — The Economist podcast “Boom” is a six-part look at the generation that “blew up American politics.” It’s fascinating to me, having lived through every political turning point the investigator considers critical.
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