The Maine Department of Health and Human Services has revised who can receive wrap-around community support services under its Medicaid program, focusing mostly on those “with severe and persistent mental illness.”
What was previously available to individuals dealing with mental illnesses like posttraumatic stress disorder, depression, and anxiety, will now focus on those dealing with a primary diagnosis of schizophrenia or schizoaffective disorder in accordance with the DSM 5, said Mary Mayhew, commissioner of the Department of Health and Human Services.
“This is a policy designed to support people with severe and persistent mental illness – especially schizophrenia or schizoaffective disorder where it is supported by research that they are in greater need of wrap-around services,” Mayhew said. “That was the priority.”
Community integration services provided under Section 17 include in-home support, comprehensive case management and assistance with daily living.
When the department looked at who was receiving services, top recipients included those dealing with diagnoses of PTSD, depression, and anxiety, Mayhew said. “The diagnoses and national recommendations and research did not support the level of comprehensive services being provided,” she said.
The department has been evaluating “how well our payments and policies are effectively supporting and incentivizing the right services based on the diagnosis to provide the best possible outcomes for those receiving mental health services,” Mayhew said. “It is equally concerning when we have individuals, particularly people with severe and persistence mental illnesses, who are on wait lists for services, who are unable to get timely access to these services.”
However, Sweetser, the largest behavioral health organization in Maine offering a range of community-based services to adults, youths and families, is concerned about what the changes will mean for those who have been receiving wrap-around community support services.
“I don’t believe any of us in this field are mature enough to be able to look at information and say this hasn’t been successful for a particular diagnosis,” said Cynthia Fagan, vice president of programs at Sweetser.
“It’s our feeling that many folks who have the diagnosis of PSTD do benefit from someone who is assisting them to integrate back into the community – helping them find appropriate therapy they need and/or they might be helping them find some social, educational or other types of services that help them become a functional member of the community they choose to live in.”
She said community integration services, case management in particular, are comparatively inexpensive and help individuals dealing with mental illnesses function in their communities. Without those services, an individual could end up in a hospital or require more expensive care from the state. “Without those services, we are concerned folks will fall into the proverbial crack as well as end up in higher levels of care that won’t be necessary if this hands-on, fairly inexpensive service was allowed to continue as it had been,” Fagan said.
Changes went into effect in April, but there is a 120-day transition period allowing those who are no longer eligible for Section 17 services to find other programs and services under Maine’s Medicaid program.
The department is also allowing some individuals outside the primary diagnosis for these services to continue receiving services if a clinician provides a letter indicating these services should continue for the individual.
“It really is for some folks the first step to assist them to begin to plan their own recovery,” Fagan said.
By Rivkela Brodsky