Forgotten Communities: How state budget cuts gut public aid infrastructure in Montana’s rural counties

Aug 02, 2018

By Tara Jensen

Montana Free Press and Missoula Independent

By Amanda Eggert, Montana Free Press

When Bill Kaye says the staff and volunteers of the Livingston Food Resource Center saved his life, he isn’t speaking metaphorically. Last year, Kaye, a 61-year-old Livingston resident of 13 years, lost consciousness in the center’s food pantry. “He went down — he was out cold,” Executive Director Michael McCormick recalled. Someone among the organization’s four employees and three dozen volunteers called 9-1-1. An ambulance rushed Kaye to the hospital. His gratitude to the local nonprofit, which works to feed the hungry, promote health and foster economic development, shines through as he recounts what happened that day. The past three years have been tough for Kaye. He used to run a company he started with a longtime friend that had him traveling around the world chasing marlin in sport-fishing tournaments. He got to be quite good at it, too, but his heart started failing and he had to rethink his priorities.   “I knew I couldn’t captain a boat [anymore],” Kaye said. Kaye said he needs surgery on his shoulder, neck and heart, the latter having been weakened by atrial fibrillation (abnormally firing electrical impulses that put him at increased risk for stroke or heart failure) and ventricular hypertrophy (a hardening and thickening of the heart’s main pumping chamber). Now Kaye is waiting for the state to decide if his disability claim has merit. “I’ve paid into [disability] since 1975… and now it takes me two years to get it? And it’s not just me — it’s millions of people that are suffering from the same stuff,” Kaye said. Kaye is frustrated by his situation, but he said he feels lucky to have some assistance. A friend helps him out with rent for his apartment, his family chips in with support while he waits on his disability claim, the Livingston Food Resource Center keeps him from going hungry, and one of its volunteers supplies him with food for Cowboy, his 14-year-old blue heeler. Other Livingston residents living on the economic and social margins don’t have similar safety nets. In the past 13 months, Livingston has lost three public aid offices, and another one, the Livingston Child and Family Services Office, will undergo a sharp service reduction this September. As the effects of funding cuts to the Department of Public Health and Human Services continue to reverberate in rural areas across the state, some Montanans say they worry about what will become of the state’s “forgotten community.” On a hot July day, Livingston Food Resource Center volunteers help Kaye stock up on food to fill his cupboards. He selects from an assortment of vegetables harvested from local greenhouses and farms; meat sourced from nearby ranches; canned goods, pastas, cereals and dairy items donated by the local Albertson’s; and healthy, ready-made meals prepared by volunteers in the center’s own kitchen. Once his bags are full, he puts them on the handlebars of his bike and pedals back to his apartment, Cowboy following closely behind.

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Longtime Livingston Food Resource Center volunteer Miriam Squillace said most of the people who come into the center fall into one of four categories: those with jobs, those with a disability, those waiting on a disability hearing, and retirees living on a fixed income. Between 300 and 340 households use the center’s monthly food box service, which equates to approximately 700 individuals served each month — nearly 10 percent of Livingston’s population. During the past year, the center’s staffers have worked hard to adapt to the office closures that have all but eliminated the Department of Public Health and Human Services’ physical presence in Park County, the Food Resource Center’s McCormick said. The center has banded together with other area nonprofits to introduce stopgap measures — even participating in monthly meetings with other area service providers — to ensure that individuals and families are getting the help they need. But many people in this small community are worried the state’s band-aid approach isn’t sustainable, and that vulnerable populations will eventually fall through the cracks. And maybe sooner than later. Livingston, which is renowned for its blue-ribbon fly fishing and touted on highway billboards as a place “where bull riders and artists meet,” was hit particularly hard when the Montana Legislature and Gov. Steve Bullock cut funding to state agencies by more than $120 million during last November’s special session. The cuts were in response to a $227 million budget shortfall wrought by tax collections that lagged behind projections, coupled with one of Montana’s most expensive wildfire seasons in recent memory. Rural areas such as Park County have disproportionately shouldered the burden of those budget cuts. Other communities that lost their local Office of Public Assistance (OPA) on Jan. 31 are smaller than Livingston and even further isolated from the services those offices provide. Residents in towns such as Sidney, Dillon and Thompson Falls now face a minimum one-hour drive if they need to speak to someone at an OPA office in person. Since the Department of Public Health and Human Services is the largest state agency in terms of its share of funding, it took the brunt of the cuts. It’s also set to receive the greatest share of $45 million in excess revenue in state coffers after the fiscal year ended June 30 with enough revenue to restore some of the budget cuts, according to a recent Helena Independent Record story. According the IR, the governor’s office has already identified health department cuts to be backfilled, and officials have until Sept. 1 to finalize those restorations. “As we’ve learned from other states, when services are cut to this level, it is difficult to rebuild them,” wrote Montana Budget and Policy Center co-director Heather O’Loughlin in an email. “It is not as easy as simply restoring the funds and cutting a check, after many service providers have laid off caseworkers and staff, and other nonprofit providers have shut their doors. Regardless of what happens in the coming months, there is no question that we could be feeling these devastating cuts for years.” Squillace said she’s alarmed by the declining trajectory of funding for public aid and services at the national and state level. “[Politicians] just don’t seem to care so much about people they don’t understand,” she said, adding that she’s undergone a perspective shift herself. “I used to be a ‘why don’t they just go out and get a job’ person. Now I’m not,” Squillace said. Squillace said she has volunteered with the Livingston Food Resource Center for 14 years, following it through one name change and two location changes, because she believes so much in the center’s work. Before her shift ended, Squillace sent a stay-at-home mom home with books for her three small children and gave two men some tips that might help them receive job retraining. One is a 56-year-old former logger and truck driver who lost his commercial driver’s license after a blood clot in his leg led to a loss of feeling in his left foot. The other started working construction when he was 14 years old and made good money as a tradesman, but a worksite injury nixed his future in construction. He’s now in his 50s and reluctantly facing the prospect of working for minimum wage. One key retraining resource, Livingston Job Service, closed indefinitely a year ago. In late January, Livingston’s Office of Public Assistance closed as part of a cost-saving restructuring effort that included 18 other OPAs in rural counties. This past April, in yet another blow to Park County, the Livingston Mental Health Center disbanded. Of those three offices, only job services still has some kind of presence in Park County. Two days a week, an employee of Bozeman Job Service drives to Livingston and sets up shop in a space loaned out for that purpose by Community Health Partners, a medical clinic and education resource center. Community Health Partners also opened a makeshift computer lab after the OPA closure so people can fill out online applications for public aid. In many ways, the process of pooling resources and dividing workloads reflects how budget cuts and resulting closures have played out in this tight-knit community with no shortage of socioeconomic challenges. About a year ago, concerned community leaders formed a coalition called the Community Resource Collaboration composed of social workers, nonprofit directors, law enforcement officers and health-care workers. The group meets once a month to discuss the needs of specific families and individuals and develop plans to match them with appropriate resources. Several nonprofits trained their employees and volunteers to assist with online applications for government programs like Medicaid and Supplemental Nutrition Assistance Program (SNAP). Prior to its closure, such services would have been routed through Livingston’s OPA. The Food Resource Center’s McCormick said he’s even started working with other area nonprofits to organize transportation to Bozeman for people who need an in-person meeting with an OPA representative before their public-aid application can be approved. “I started trying to put that together the past week because we have four people [who’ve been told] by the OPA that they need to meet with someone at OPA for their application, and none of [them] have transportation to Bozeman,” McCormick said. Department of Public Health and Human Services spokesman Jon Ebelt said in an email that the agency is committed to working with community partners to ensure that clients are aware of resources available to them. Options for pursuing aid include applying online, calling a helpline, mailing or faxing an application, and receiving in-person assistance at another OPA office in Montana. Ebelt said public-aid applications and program enrollment numbers have continued along normal trend lines since the OPA closures six months ago. In Park County, one woman in particular has been working hard to make sure people are getting the help they need. Dawn Holiday works with Adult Protective Services, a DPHHS unit tasked with protecting vulnerable adults from abuse, neglect and exploitation. Holiday used to share a space with the Park County OPA staff, but after the office’s closure she started working from her home, driving around town to meet folks in need of help. Becky Bird, executive director of the Park County Senior Center, can practically recite Holiday’s phone number from memory. Bird said the center has a fair number of members who need help with applications for programs like Medicare and Social Security. A drive over Bozeman Pass to the nearest OPA or Social Security Office is a challenge for many seniors, and some don’t have the computer skills necessary to navigate an online application. Others call Medicare or Social Security help lines seeking assistance with their benefits and end up having a difficult time hearing or understanding what they’re being asked by the person on the other end of the line. Bird said senior center staff and volunteers do what they can to help, but for more involved troubleshooting she reaches out to Holiday. Contacted by a reporter, Holiday referred calls to her supervisor and provided a Helena telephone number. A recording on that line stated that the number isn’t working. Follow-up calls to Holiday were not returned, but according to sources interviewed for this story, she’s been a very busy woman the past six months.

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Spillover from Bozeman’s rapid growth, and the accompanying region-wide spike in housing costs, are two issues that consistently come up in discussions about Park County’s overburdened and understaffed public assistance programs. Just 26 miles west of Livingston, Bozeman is the fastest-growing area of its size in the nation for the second year running, according to the U.S. Census Bureau. Last May, the median sales price of a single-family home in Gallatin County rose to $407,000, a 9.1-percent increase from the prior year. In June, USA Today reported that Gallatin is Montana’s most expensive county in which to buy a home. That means many would-be Bozeman homebuyers and renters look to their neighbors to the east for cheaper housing and adjust to a 30- to 40-minute commute. That puts pressure on rental and real estate prices in Livingston, where wages are significantly lower than in Bozeman. According to the U.S. Census Bureau, the median household income in Park County from 2012 to 2016 was $43,385, which is 10 percent below the state average, and 24 percent lower than Gallatin County’s median income of $57,021. Local nonprofit leaders say the income and housing pressures exerted by Gallatin County are putting longtime Livingston tenants in a tough spot. Some have received notice that their rent is going to increase to an amount they can’t afford, or have learned their landlords intend to turn their long-term rental into a more profitable vacation property listed on Airbnb.com or VRBO.com. As a result, homelessness is on the rise, even if it goes undetected among residents with firm footing in the middle or upper-middle classes.   “There’s a gap in the knowledge base in regard to [Livingston’s] number of homeless,” said Marissa Hackett, the outreach coordinator and service navigator at the Human Resources Development Council. In the course of a recent day, Hackett met with three HRDC clients currently living in their vehicles, and three more facing homelessness in the near future — and that’s typical for what the office has been seeing on a daily basis, she said. “The numbers [of people presenting as homeless or facing homelessness] have increased over even the past six to nine months,” she said. “It feels like it’s rampant.” HRDC is a nonprofit community action agency supported primarily by private donations, with additional operational funding supplied by federal grants and local governments. HRDC is looking into a shelter model in Livingston, Hackett said. Right now, the closest thing to it in the area is HRDC’s Warming Center in northeast Bozeman, which is open November through March. “There’s a huge need [for transitional housing],” said Heidi Barrett, executive director of the Abuse Support Prevention Education Network (ASPEN), which provides shelter, support, referrals and advocacy for victims of domestic and sexual violence. “It would be great if there could be four cooperatively shared apartments [in Livingston].” Such housing could help financially strapped individuals get back on their feet and set ASPEN clients up for a safe transition away from their abusers. Though ASPEN has served Park, Meagher and Sweet Grass counties for 20 years, much of the community is unaware of the pressing need it addresses. “Our safe house has never been empty, not even for one night,” Barrett said, adding that ASPEN provided more than 3,000 nights of shelter in the past fiscal year. “Sometimes people are surprised to hear that, because they don’t want to hear that there’s that much need. But there is.” Barrett said she is also troubled by the April closure of the Livingston Mental Health Center. She said the closure has been especially tough on people living at the margins, who struggle to get their basic needs met. She calls them Livingston’s “forgotten community.” Livingston Mental Health Center’s closure is largely due to Medicaid cuts that financially gutted its parent company, Western Montana Mental Health Center. Specifically, the reimbursement rate for case management has been slashed by almost 48 percent, according to interim CEO Natalie McGillen. McGillen said she hasn’t heard a thorough explanation as to why the rate was reduced so drastically, but she suspects it was targeted as a quick and straightforward way to recover dwindling state revenue. As a result, the company has laid off approximately 118 employees. In addition to Livingston, rural areas including Dillon, Eureka, Libby and Hot Springs have lost their satellite offices as well. Fortunately, former clients of Livingston Mental Health Center have been left with treatment options, even if they’re farther away or less comprehensive. McGillen said that before the office closed, case workers coordinated with other organizations to develop a plan for each of its clients, who suffer from a range of ailments including anxiety, depression, schizophrenia and bipolar disorder. Gallatin Mental Health Center in Bozeman took on treatment for some of those people. Livingston Healthcare and Community Health Partners, which serves individuals regardless of their ability to pay, split case management for about 60 clients who are continuing their treatment in Livingston. Livingston Healthcare’s interim CEO, Deb Anczak, said her organization has gotten creative with funding solutions in order to meet increasing demand for mental-health treatment. Livingston Healthcare paid for two new social worker positions with support from a pair of two-year grants. Anczak said she’s hopeful the hospital will get enough reimbursement through Medicare and Medicaid to make the positions financially self-sustaining. Despite many residents’ concerted efforts to shore-up Park County’s safety nets, ASPEN’s Barrett and others are worried that vulnerable individuals aren’t receiving the help they need. “[We have an] intersection of drug addiction, and/or poverty, and/or mental illness,” Barrett said. “It’s really a humbling feeling to be like, ‘We don’t even have the resources to help you.’”

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It would be hard to argue that there isn’t an urgent need for both immediate, crisis-style intervention and long-term, proactive case management, which addresses multiple aspects of client well-being. Park County has the third-highest suicide rate of any county in the state, according to the 2016 Suicide Mortality Review Team Report. “[It’s] demographically inconsistent with the rest of the state, which is demographically inconsistent with the rest of the nation,” said Livingston Police Department Detective Joseph Harris, referring to the fact that Montana regularly leads the nation in suicides per capita. “The way you die in this county — and I can speak with some authority on this — is: No. 1 [from] old age, thank goodness. No. 2 is [in] car crashes, and No. 3 is by your own hand.” Harris said the Livingston Police Department’s workload has felt the impact of untreated mental illness that escalates into crisis. If police are called to respond to a situation in which a mentally ill person has been deemed a danger to himself or others, an officer has to stay with that person until another form of intervention — a crisis response team, for example — arrives. That can tie up law enforcement resources. “That’s an officer who’s not responding to your house in the middle of the night to get the drunk guy off your couch. That’s an officer who’s not responding to your house to stop your spouse from beating you. That is also an officer who’s not responding to your house to see that your house is filthy and that your child has been beaten,” Harris said. Harris, who’s approaching 17 years with the Livingston Police Department, estimated that one-third to one-quarter of his investigations involve children who’ve endured some form of physical abuse, sexual abuse or neglect. Harris said he’s seen drug injection needles hidden in a diaper bag, rats and their droppings in a baby’s crib, a 12-year-old child incapable of writing or speaking, and a victim of years-long sexual abuse. The list goes on. In those cases, Harris said, he works closely with the Department of Child and Family Services, an agency he knows well because his wife, Jacqui Poe, is one of Livingston’s three child-protection specialists. After 17 years with the agency, Poe learned that Livingston’s office, which also serves Sweet Grass County to the east, was slated to close Aug. 6 as part of a reorganization effort designed to meet growing demand for caseworkers in Yellowstone County. She was told that she and her two colleagues could take case manager positions in Billings, transfer to other open positions elsewhere in the state or leave the agency altogether. The reorganization called to shift Park and Sweet Grass counties to the jurisdiction of Bozeman’s DCFS office, which also oversees Madison County. Harris expressed concern that coordinating forensic interviews with an already overburdened office 26 miles away would delay investigations and compromise the safety of vulnerable children. When an adult is suspected of abusing or neglecting a child, it’s important to have ready access to a professionally trained social worker and an appropriate place to conduct forensic interviews, Harris said. Time is of the essence when collecting information for an investigation. Black eyes eventually fade, and a child who’s hungry on Sunday might not be on Wednesday, halfway through the school week. The sooner an endangered child has a safe and stable domestic situation, the better. For some Montana children, the consequence of delayed action can be fatal. Fourteen children died in Montana last year after having been the subject of child abuse or neglect complaints, according to a recent Department of Justice report. None of the public officials, law enforcement officials or aid providers interviewed for this story disputed that the need for child protective services is great in Billings. According to DPHHS spokesman Ebelt, Yellowstone County had 880 children in foster care at last count, compared to Park and Sweet Grass counties, where approximately two dozen children are in foster care. Social workers in Billings are overburdened with remarkably high caseloads — as many as 60 children per caseworker, according to Ebelt. By comparison, the average caseload for social workers in Gallatin, Sweet Grass and Park counties is 11 children, he said. Many officials point to an increase in drug use, methamphetamine in particular, to explain the grim situation in eastern Montana. Still, many Livingston residents called the reorganization plan shortsighted and said it would leave a community that’s still reeling from a series of public-aid closures in even worse shape. A July 4 statement from Court Appointed Special Advocates of Park and Sweet Grass counties (CASA) plainly stated the organization’s concern: If implemented, the plan would result in an increase in the number of abused and neglected children. The statement also criticized the state for its move to consolidate services in more populous areas. “Over the years we have watched the state move toward ‘regional hubs’ for services during budget shortfalls. It is safe to say that rural Montana is being further isolated with these cuts, as social services fail to extend to communities that need it most,” the statement read, in part. CASA’s statement was just one part of Livingston’s response. In the weeks following the announcement by DPHHS, local stakeholders met to learn how they could urge the agency to reconsider. Park County Sheriff Scott Hamilton posted a Facebook statement in opposition to the plan that was shared 72 times, and Livingston Rep. Laurie Bishop, a Democrat, organized a meeting with top DPHHS policymakers. The coordinated effort seems to have resonated with department officials, who released a revised plan on July 20. Under the new plan, Livingston’s office will close at a later date, Aug. 31, and DPHHS will create two new case manager positions under the jurisdiction of Bozeman’s CFS office. One of those case managers will be based in Bozeman but focus on Livingston cases, which will likely involve significant commuting time, and the other will work remotely from Livingston in a space that’s been offered by the Livingston Civic Center at no charge to DCFS. Livingston’s three child-protection specialists have until Aug. 3 to decide if they want to apply for the Bozeman positions. Ebelt said Billings will still get the additional employees called for by the original plan. Bishop said timelines are still being ironed out, and there will be lag time while the city of Livingston remodels the space for its new use, but she’s heartened by the response. She said she’s been impressed by the cooperation that enables Livingston residents to overcome service reductions, but she wonders how other communities without Livingston’s cohesive nonprofit infrastructure have adapted. “We have this incredible capacity to come together and weave that net as tightly as possible … we have a lot of chemistry in place,” Bishop said. “I just don’t know that other communities have that same thing happening.” Detective Harris expressed concern that it takes a threat so drastic to unite people around a service like protecting vulnerable children. “I don’t know how [Livingston’s situation] is going to get addressed in the long run, but the global issue — and by that, I mean the statewide problem — is still there,” he said. That issue is rooted in values, priorities and fiscal management at the state level, Harris said. “Until you beat the apathetic response that most of us as Americans have, you’re not going to get [to a better solution],” Harris said. “If [DCFS’s mission] is important to Montanans, the money’s going to be there. If it’s not important to Montanans, the money won’t be there.”