The various MaineCare cuts and limitations proposed by the Department of Health and Human Services, one of which brought a few hundred protesters to the State House Friday, are the perfect distillation of the LePage administration’s philosophy on the social safety net.
Taken together, the changes prioritize upfront financial savings, often ignoring long-term costs, and they set a high bar for the state’s “most vulnerable” residents, favoring some populations while underestimating what cutbacks would do to others.
Those actions are based on the administration’s belief that too many people are receiving expensive services they don’t need and often would be better off without.
That may be true in some circumstances – it is a massive system serving thousands of people with complex needs and histories.
But the administration’s approach in the past has left many people worse off than before, and the MaineCare changes threaten to do the same.
RATES AND REQUIREMENTS
The suite of changes proposed by the department would cut MaineCare reimbursement rates or raise eligibility requirements for a variety of services, including home- and community-based treatment, medication management, and case management. Thousands of adults and children would be affected.
One rule change, for example, would require a diagnosis of schizophrenia or schizoaffective disorder to receive intensive case management services.
The DHHS says the change would reserve intensive services for those with “severe, persistent mental illness,” but that discounts the struggles of people with one or more other illnesses such as bipolar disorder or post-traumatic stress.
They would be eligible for lesser services, but in many cases those would be insufficient; and in any case, many patients would struggle with the transition. As a result, they may lose housing, miss doctor appointments or stop taking medication.
Reimbursement cuts would further impede the delivery of services by cutting down on the already low number of mental health providers.
Together, the changes would lead to a disruption of the fragile social service ecosystem. As DHHS has noted, some of the patients would be able to stand on their own. Others, however, would fall, and the department hasn’t adequately answered how it will make sure they don’t go through the cracks, and end up in the hospital or the criminal justice system.
THROUGH THE CRACKS
In other, similar situations, there is no doubt that changes designed to “right-size” public benefits programs have instead left people without much-needed support. Initiatives nominally designed to keep Maine residents from abusing the system likely have done that, but they’ve also caused collateral damage. Collectively, these reforms have certainly lowered spending, but they’ve also decimated the social safety net.
Many of the people dropped off of public benefits as part of the department’s fight against the “culture of dependency” continue to struggle. It should be of no surprise that the absence of aid for food, housing and health care has only left many Mainers hungrier, sicker and in unstable living situations.
Cuts in food stamp spending, for example, have drawn applause from conservatives nationwide. But they’ve also coincided with an incredible increase in demand for food banks and soup kitchens, and a rise in childhood hunger and food insecurity.
Restrictions placed on the Temporary Aid for Needy Families program have unnecessarily kicked people off that program, too. In 2010, more than 60 percent of the people who needed benefits received them, but by 2014 that number was cut in half.
In that time, the number of children living in extreme poverty increased by 50 percent, and Maine was the only state with a significant increase in the number of children without health insurance. (DHHS has said that tens of millions in unspent TANF funds will be used to counteract these trends, but it isn’t clear that the department’s plans will help those most hurt by recent cutbacks.)
The LePage administration wastes no opportunity to tout how its reforms have dropped spending on social services.
But the reforms have also harmed many residents, and before significant changes are made to mental health services, the administration has to answer for that, too.
Send questions/comments to the editors.
