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Shalom House's Community Integration Services Shut Down Due To Stagnant Medicaid Reimbursement Rates

Shalom House

A program in Portland that helped 170 people with serious mental illness live in the community has been shut down.

The executive director of Shalom House says the organization was forced to end its Community Integration Services because Medicaid reimbursement rates have been stagnant for more than a decade. The Mills administration announced this week that it's launching a review of its rate-setting system, but officials at Shalom House say it comes too late.

Back in 2016, Shalom House Executive Director Mary Haynes-Rodgers predicted that the nonprofit would have to close its community integration program if the state didn't boost reimbursement rates. Unfortunately, she says, that prediction has come true.

"We've already been begging for help for years. The time ran out."

As of January 10, Shalom House ended its program that helped people with mental illness live in the community. Haynes-Rodgers says under the community integration model, caseworkers connect clients to other providers. They also help clients find housing and assist with daily living tasks, like navigating the grocery store and paying rent.

Credit Patty Wight / Maine Public
Maine Public
Mary Haynes-Rodgers, Executive Director of Shalom House.

"It's humane. It also saves money,” Haynes-Rodgers says. “If you spend money on community-based health services, you don't spend money on jails and hospitals."

But the state isn't investing in community integration services, says Haynes-Rodgers, because Medicaid reimbursement rates have only increased by four cents in the past decade. She says that has caused Shalom House to sustain losses upwards of $100,000 annually for the past few years. She says the combination of stagnant rates, onerous certification requirements that make it difficult to hire case workers, and administrative burdens around eligibility have ultimately forced the nonprofit to end a service it has provided for 28 years.

"Community mental health has been decimated in the last decade,” she says. “And it's no better today than it was a year ago. And there are things that could be done immediately that would have made a difference and saved the program."

Maine's Department of Health and Human Services acknowledged this week that the system for setting reimbursements for MaineCare — the state version of Medicaid — is problematic. Speaking to the legislature's Health and Human Services Committee, MaineCare Director Michelle Probert said there actually isn't much of a system.

"They're changed, and then they're not changed again until somebody gets around to saying, 'maybe we should change those.' And whether that's a year or quite a few years, it varies."

Probert says that DHHS is undertaking a comprehensive evaluation to improve how it sets rates. But the review is expected to last through November, and that's time that Haynes-Rodgers says Shalom House just doesn't have. Though the nonprofit will continue providing other services, it is now working to find placements for the 170 clients served under community integration.

Catholic Charities has taken nearly two dozen of those clients. Spokesperson Judy Katzel says they'll receive services under a different model, called a Behavioral Health Home, which she says is more streamlined.

"In some respects it may well be easier for them because they may have had other providers providing some of the services. And they may have had to look at a couple of different places, and all of their records may have been in different places."

Katzel says the funding model is also more flexible and sustainable because it's a monthly payment, versus fee for service. She says while it's hard to watch other providers like Shalom House have to end a program: "the Behavioral Health Home is, I believe, where the industry is moving in general."

Statistics in Maine back that up. Recently, the number of people receiving services through Community Integration Services versus Behavioral Health Homes has essentially flipped. In the past four years, the number of people served through Community Integration Services has dropped by more than half and the number served through Behavioral Health Homes has more than doubled, to about 7,500 people.

But Haynes-Rodgers says that while Behavioral Health Homes are important, both models are needed to help people with mental illness live in their communities.

A spokesperson for DHHS says in addition to evaluating reimbursement rates, it also plans to evaluate the effectiveness of both models.

Originally published Jan. 23, 2020 at 5:38 p.m. ET.

Updated Jan. 24, 2020 at 6:22 a.m. ET.