It feels like every week I read about the latest amazingly unthinkable thing that Mayhew and LePage have done. Sometimes it’s harming the Women, Infants & Children (WIC) program, other days we’re discussing lowering the eligibility of Maine’s Medicaid program to below what federal levels of poverty were, prior to decentralizing “welfare programs” under Clinton’s administration in 1996.
Here’s a gem of hypocrisy that we can do something about:
Around this time last year, Mayhew and DHHS decimated what’s referred to as “Section 17 Services” under Maine Care. These services are primarily case management and in home services for folks who live with severe mental illness. Prior to spring 2016, those services were widely used by thousands of Mainers to get very basic life needs met (housing, medicine, coordinating complex psychiatric and medical needs).
Mayhew and LePage argued that services for the severe mentally ill (whom they defined as folks who live with Schizophrenia and Schizo Affective Disorder) were not sufficiently available because we were serving folks with less severe forms of mental illness. They argued this was unjust – that folks with those diagnoses were under served.
And this year, despite the massive restrictions they put in place, they now want to reduce funding for services to folks they deemed deserving by over 25%
I know that folks want to believe that we who own and manage social service agencies are top heavy in administration and secretly getting rich, so I’ll provide just a simple fact:
Section 17 services are “fee for service.” No grant funding. No block funding. No admin costs. Agencies that provide that service are paid ONLY an hourly rate for services provided directly to the client. These must be pre-approved (subject to the same kind of scrutiny an HMO insurance company demands).
Example: We must document why I need to have more service hours approved (usually about 8 hours a month) to help an individual who lives with schizophrenia maintain independent living in the community – as though they would be likely to reach a point at which services are no longer needed. (Even a Wikipedia level understanding of Schizophrenia would leave one understanding this is not reality for most).
Maine Care currently only pays for time spent directly with the client. It does not pay for the time or mileage to drive to the community setting where the client lives. It doesn’t pay for countless phone calls, and a lot of the meetings and consultations with other professionals required to coordinate services. It doesn’t pay for documentation, data entry, or work to ensure compliance with host of licensing regulations – all of which they require.
And now they are expecting that we can do all of that for 25% less than what they’ve paid. That’s not feasible. It’s not about belt tightening. It can’t be done at a breakeven level financially. I’d be happy to do the math if you want to see it email me.
We haven’t learned a thing from deinstitutionalization. We moved away from warehousing people in the 70’s and early 80’s and we then marveled that law enforcement, emergency rooms, and community providers were over run by the needs of folks who live with severe mental illness. Now Mayhew and LePage want to further eliminate support for living in the community.
We’re in a day and age in which it hurts to care, but the cost of not advocating is too high. Please contact your local legislators and encourage them to reject the proposed rate cuts to all sections of Maine Care. All of them are harmful to thousands who are amongst Maine’s most vulnerable.