Advocates Decry Proposed MaineCare Rate, Eligibility Changes

Mar 22, 2016

Maine’s Department of Health and Human Services wants to change eligibility and rates for certain MaineCare services. The Department contends that their proposals will ensure appropriate care at an appropriate cost.

But advocates for individuals with intellectual disabilities and mental illness say the changes jeopardize the future of critical services and those who need them.

The proposed MaineCare rate changes come out of a report by Arizona consulting firm Burns and Associates. DHHS commissioned the firm to examine rates for services that range from supports for kids with cognitive impairments to adults with severe mental illness.

When the Department’s Nick Adolphsen presented the report to the Legislature’s Health and Human Services Committee on Tuesday, he emphasized one point in particular.

“The Department and Burns and Associates presented a draft — and I want to bold that word if I can — a draft rate model to the providers,” he says.

Adolphsen didn’t go into the details of the report, but Pete Plummer of Woodfords Family Services says it amounts to sweeping cuts. It’s a far cry from what he was expecting.

“We were hoping that the rates would go up,” he says.

Plummer says MaineCare rates for some of their services haven’t increased for at least half a dozen years. For the past two fiscal years, he says, Woodfords has lost money.

He says the proposed cuts, which range from about 10 to 50 percent, are an even bigger hit than they appear because MaineCare is funded through both the state and the federal government.

“State of Maine funds one-third of that, and two-thirds come from the federal government,” Plummer says. “So when you cut $100 from the state budget, you’re cutting $300 from a social service agency.”

If the cuts go through, he says, Woodfords will have to close some programs.

Drew Gattine, the Democratic co-chair for the Health and Human Services Committee, says some MaineCare services already have wait lists. He asked Nick Adolphsen of DHHS how the proposed rate changes may affect future availability.

“What does the department do to make sure there will be sufficient services in place?” Gattine says.

“We don’t have a final rate model yet, so we don’t know what those rates are ultimately going to look like,” Adolphsen says.

“So the answer is you don’t know,” Gattine says.

“Certainly we haven’t made a plan to deal with something we don’t know,” Adolphsen says. “I mean, we don’t know what it’s going to look like at the end of the day.”

Along with the proposed rate changes, DHHS, effective Tuesday, also changed eligibility requirements for services for adults with severe mental illness. The new requirements will shift about 8,000 people to less-intensive services.

Dale Hamilton of Community Health and Counseling Services says the change in eligibility raises a red flag.

“You then, immediately after that, tack on the fact that a lot of those services they’re talking about people being transitioned to are now going to experience significant rate cuts,” he says. “Twenty, 30 percent cuts. It raises a question about whether or not the system is going to be in place and intact to be able to support people.”

Jack Comart of Maine Equal Justice Partners shares that doubt. He says DHHS is not working with providers or those who receive services to ensure a smooth transition to less-intensive services.

“Our concern is that they sent out a notice two weeks ago that said to people your services end April 8,” he says. “They told people to call this number if they needed help. When you call that number, it tells you to call your providers.”

Come April, Comart says, he’s worried people will effectively be dropped from the services they need. Simone Maline of the Consumer Council System of Maine told committee members that when she looks at the big picture, it’s bleak.

“The whole safety net of the entire mental health system is being pulled from one direction and another, and I don’t know what’s going to be left,” she says. “I honestly don’t know what’s going to be left.”

DHHS is accepting public comment on the proposed rate changes until April 8. Adolphsen told the committee that the final rate report will be completed by the end of the fiscal year, and DHHS can implement changes if it so chooses.

But that time frame, says Rep. Drew Gattine, extends after the current legislative session is over, and so the committee won’t have an opportunity to respond till next year.