AUGUSTA — There has been a lot of one-sided information in the news lately about recent Maine Department of Health and Human Services changes to mental health services, causing undue panic among many families who rely on those services. As part of its ongoing effort to ensure the right services are going to the right people, the DHHS has undertaken rulemaking to modify MaineCare’s Section 17, which provides intensive community support services to those with the most significant mental health challenges.
Much of what has been publicized about this effort is either incorrect or incomplete. We hope to set the record straight and address some concerns.
Section 17 pays for intensive community services, such as workers visiting members’ homes to ensure they are able to dress, eat, clean and perform the most basic functions of daily life. Historically, these services have been reserved for those diagnosed with schizophrenia, schizoaffective disorder and other severe mental health impairments. However, Section 17’s enrollment has increased 50 percent in just the past five years to include diagnoses such as depression, anxiety and post-traumatic stress disorder.
Of the 17,000 people currently served by Section 17, the department estimates that about 8,000 have these less-severe diagnoses. Meanwhile, there are 350 people on wait lists for these services, many of them requiring the higher level of care that Section 17 was originally intended to provide.
But not all of those 8,000 individuals will lose Section 17 services. Under the DHHS rule, they may still qualify for Section 17 if their clinician attests that they meet any of these conditions:
n Are likely to become homeless, involved with the criminal justice system or require inpatient treatment for over 72 hours.
n Have received treatment in a psychiatric hospital or been discharged from a residential facility in the past 24 months.
n Have had at least two episodes of inpatient treatment for mental illness, for over 72 hours per episode, in the past 24 months.
n Have been committed by a civil court for psychiatric treatment as an adult.
n Until age 21, were eligible as a child with severe emotional disturbance and that in the last 12 months, they are reasonably likely to have future episodes requiring mental health inpatient or residential treatment.
Importantly, for Section 17 recipients among those 8,000 who cannot meet one of the above conditions, they can still receive appropriate therapy and other services through Sections 65 and 92 of MaineCare policy.
Though the rule takes effect April 8, current members will not be assessed for continued eligibility until their next 90-day “continued stay” review.
This routine technical rule isn’t recent news. The DHHS publicly posted it Nov. 6 and held a public hearing Dec. 1. We accepted written comments for 10 days after the hearing and received 62 comments. The department is finalizing the rule and making several changes in response to the received comments and, in accordance with the Administrative Procedures Act, has published written responses to each comment received.
In addition to the rule’s public hearing, the Legislature’s Health and Human Services Committee held an impromptu public hearing earlier last week. Some on the committee are now attempting to hold a third public hearing on what is classified as a routine technical rule – an unprecedented level of legislative micromanagement.
Notably, mental health advocacy groups that are today objecting heavily to this rulemaking did not show the same level of concern over the past several months – some even privately expressed support for the concept. Indeed, they had ample opportunity to introduce legislation between November and the beginning of session in January, as they are now trying in the closing weeks of the legislative session.
The DHHS is committed to continuing to serve those with milder forms of mental illness under sections 65 and 92. It is unnecessary to send a caseworker to the home of somebody with moderate anxiety to walk him through the most basic functions of daily life.
Clinicians agree that this actually fosters a level of dependence that is detrimental to patients’ ability to progress in their treatment and achieve independence. For these patients, outpatient therapy, counseling services and, in some cases, medication assistance are most appropriate, and they will receive those services despite rule changes to Section 17.
The administration will continue to address the concerns of providers and members and ensure that the rule is properly explained to prevent undue alarm.
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