State budget cuts changes lives of developmentally disabled


Jamee Barman, left, and Barb Sanford, right, stand in their CMMC office as targeted case managers for the developmentally disabled. The two will loose that job title on March 31st, although the hospital hopes to retain them in different positions.

Photo by Jenny Gessaman

There’s change coming to the lives of 3,000 Montanans. They may make up less than half a percent of the state’s population, but those 3,000 residents belong to a group that is vulnerable to change: the developmentally disabled.

Last November’s special legislative session cut the Department of Public Health and Human Services budget by $49 million. On Dec. 21, the department announced it would save roughly $2.5 million of that by changing the way it handled targeted case management for the developmentally disabled.


The what for the who?

Central Montana Medical Center has three targeted case managers contracted with the state, including Jamee Barman and Barb Sanford. All together, they serve 70 clients over eight counties.

The women said what they do centers on the type of clients they serve.

“Our clients are developmentally disabled or cognitively delayed people who are 16 or older,” Barman said. “The onset of that disability happens before 18, and it will continue throughout the person’s life.”

The disability, Barman explained, could be genetic or situational, and has serious continuing impacts. She listed autism, Down syndrome and traumatic brain injuries as examples.

“It’s any significant deficit in their five needs for life: cognitive, behavioral, emotional, social or physical,” she said. “There’s an area, or areas, in their life in which that individual can’t cope.”

That is where targeted case management comes in. Sanford explained case managers don’t necessarily help clients cope. Instead, they connect them with the services that will.

Sometimes, Sanford explained, that means picking up the slack created by a client’s disability, This could be anything from helping them go through a month of mail that has stacked up, to placing calls for clients.

“It’s pretty common they don’t read their mail because they can’t read,” she said.

Barman jumped in.

“Or they don’t know how to make those social phone calls,” Barman continued. “These clients get to know you and get to trust you pretty well. They don’t get frustrated [with you] because they’re understood.”

Both case managers agree a personal connection is key for working with the developmentally disabled. Some of their clients will not talk, or may not tell the truth, during a brief visit with a stranger.

That’s why the coming change has Barman and Sanford feeling nervous.


The change

Montana’s current targeted-case-management model has state and contracted employees serving as case managers. The new model will use only state employees, according to DPHHS’ Medicaid and Health Services Branch Manager Marie Matthews.

“The $49 million budget reduction that came out of the special legislative session means we have to implement cuts to maintain costs at that level,” she said.

The caseload shift is big enough to create change within the state’s system, too: Montana’s 24 case managers currently handle 600 cases. On April 1, they will take on 3,000 additional targeted cases for the developmentally disabled.

“It’s not just a shift, it’s a restructure of how we’re doing things on the state’s side,” she said.

Part of the restructure is doubling the number of case managers in the Developmental Services Division to about 50. Matthews clarified the state would not be adding to the division’s payroll, but instead reclassifying existing positions.

The state’s case managers will also be given authority to deal with more issues directly, although Matthews emphasized they would still have supervisors.

“We’re reducing the layers of redundancy,” she said.

It’s a big change for everyone involved, and it’s happening in a short amount of time. The case manager contracts were set to expire Dec. 31st of last year, but Matthews said the state extended them for three additional months.

“We want to ensure that the transition is as positive as possible, and that couldn’t occur that quickly,” she said.

Now state case managers in nine cities around the state will take over on April 1st. Matthews said they will be held to the same standards as contracted case managers, meaning they will develop personal relationships with clients, and have to meet with them in person.

“Our case managers will have face-to-face contact with the clients,” she said. “They will be expected to have care plans, and plans will contain the planning steps for a crisis situation, if needed.”

The logistics of meeting those state standards have not been finalized, according to Matthews, and are being reviewed by an internal transition team. She hopes to keep open communication during the process.

“My ideal is that, as we are moving between case managers, we are helping the clients and the families understand what differences there are,” she said.

Part of that includes a letter Matthews was sent out this week.

“We are going to be sending out communications to all of the clients, and their friends and family in the community,” she said. “[In those] We are going to share the names and numbers of the regional managers; We’re finding many of these fears can be alleviated by a conversation.”


Lingering doubt

As case managers, Barman and Sanford will lose their jobs at the end of March. They don’t think they will be unemployed, though.

“The hospital is going to try and absorb us if they can,” Barman said. “It’s not an automatic job loss: They’re going to try to see what they can do.”

The two are more worried for the 70 clients that are being transferred to the state.

“Change is scary for you and me,” Barman said. “Can you imagine how scary it is for them?”

The women don’t know yet how they will approach their clients, although it's probable the hospital will help them generate a letter. Part of their hesitancy comes from the large number of unknowns.

“The thing is, this change is kind of out there already, but at the same time, you don’t have the answers,” Sanford said.

She and Barmen are still dubious about how the state will handle the long distances between rural Montana clients.

“It’s not just our area we’re worried about,” Sanford explained. “What abut the Hi-Line?”

The two also fear what would happen if a client had a crisis with no case managers close by.

If you and I have a mental breakdown, we know how to get out of it,” Barman said. “We can self-reason to get out of it. They don’t.”

Sanford finished the thought.

“The case manager, a lot of the time, is one of the first crisis responses, instead of 911 or the ambulance,” she said.

The worst-case scenario would be the loss of independence, which many of Sanford and Barman’s clients treasure.

“Now, in order to get services, they’ll have to go to bigger towns, but that’s not what they want,” Sanford said. “They want to stay on the farm or the ranch.”

It’s an uneasy time for all involved, not just the clients but also the case managers who have developed relationships with them, and the state employees that hope to.

One thing, at least, is certain for the two CMMC case managers:

“We want to let the families and clients how much appreciation and gratitude we had in working with them. It’s been our privilege.” 



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