The news is not good, but not as bad as it could be, according to Brenda M. Harvey, commissioner of Maine’s Department of Health and Human Services (DHHS).
Over the last three fiscal years, the legislature has cut approximately $3.2 million in grant funds from the DHHS budget. “That’s about 13 percent,” Harvey says.
According to Harvey, Maine uses two funding sources for its mental health services: grant/general fund and Medicaid. She notes that when she served as deputy commissioner in 2002 the legislature began to reduce the general fund. “We were able to use the dollars in Medicaid to get two-for-one,” she says. “So we moved services to Medicaid as appropriate and allowed under federal law. There was less need to rely on grant funds.”
Harvey points out that, except for advocacy, some Medicaid-funded family support programs may see reduced staff and slightly decreased, but not eliminated, services. “Training for police is still supported and we have added funds to peer services,” she says, “[although] services for individuals not Medicaid-eligible have fewer dollars to support them.”
Once the healthcare reform law is implemented, Harvey anticipates some positive changes. “This will bring into play adults without children who will be eligible for up to 133 percent of the federal poverty level,” Harvey says. “It will give them more access to services and will expand federally qualified health centers. We will have the opportunity to expand services, to add mental health services, medication management and psychiatry.”
In the meantime, Harvey expresses concern for “gap” individuals, those who are just above the federal poverty level but below eligibility for Social Security Disability Insurance (SSDI). She notes that once they do become eligible for SSDI, it takes two years to get onto the Medicare rolls. “So, they are often ineligible for Medicaid and go without coverage,” she says, adding that Medicare does not cover most Medicaid long-term supports and services for the elderly and people with disabilities, e.g., nursing care, residential care, case management.
Harvey admits that these are “tough economic times…We need to figure out at the community level how to set the services system in motion for the neediest, like the homeless and those in correctional facilities. How do we cut the pie and meet the needs of others while being as efficient as possible? We need to share resources and would like to see the community transform into that. We’ve spent too much energy struggling to keep what we’ve had,” she says.
Carol Carothers, the executive director of the National Alliance on Mental Illness (NAMI)-Maine, says, “The commissioner is right. We need collective collaboration to understand what safety net should be in place. Everybody needs to figure out how they’ll be part of the effort.” She concurs that budget cuts are having an effect, the largest on those who don’t have Medicaid. “There are fewer residential programs, fewer in-home supports and significant shifts in services for younger children.”
Historically, the bulk of the budgetary cuts come from the largest spending areas, i.e., schools and health care, says Carothers. “Because mental health dollars have been disproportionately reduced in the last couple of years, it will also have a disproportionate outcome on people with mental illness. The insurance companies don’t pay for true safety net services,” she says.
However, Carothers applauds the legislature for its “heroic efforts to restore funding” and to help NAMI remain open. “What’s coming will be more difficult. There is a $1 billion impending shortfall,” she says.
Harvey adds, “It’s heartening that the legislature has restored a lot of proposed cuts for mental health in a climate of economic turmoil. The legislature and governor have committed in the last eight years to maintaining support for mental health.”
By Phyllis Hanlon