Providers of mental health and adult disability services are scrambling to understand pending changes from the Department of Health and Human Services that could cut or interrupt services for thousands of consumers and change payments for service providers.
According to multiple sources in the mental health service provider sector, the issue came to light in recent weeks when adults with mental illnesses and other disabilities, who receive government-funded Medicaid services in what is known as Section 17 of the MaineCare Benefits Manual, began receiving letters from DHHS notifying them of the upcoming changes.
Section 17 covers community support services, which includes everything from case management to a range of daily living supports.
The new rule, which is set to go into effect in April, is essentially that a person needs to be diagnosed with either schizophrenia or schizoaffective disorder to qualify for Section 17 services, though there are certain conditions under which a person may be eligible for a waiver.
"What does this mean to you? You may or may not continue to get services," reads the March 1 letter from DHHS, which was sent to thousands of Mainers.
Bonnie-Jean Brooks, chief executive officer of OHI Inc., an adult mental health service provider in the Bangor area, said the new eligibility rules have been under consideration for months but that she and others didn't learn that they had been finalized and that implementation was imminent until her organization began hearing from clients about the letters.
"We have not as a service provider community seen those final rules," said Brooks. "One of the problems is that this rule is going to go into effect in April. To try to identify the people who don't have one of those two diagnoses and track down a clinical person and send in a waiver application of some sort, the time is very short to be able to do that."
Samantha Edwards, spokeswoman for DHHS, said the changes are intended to reserve Section 17 for people with "serious, persistent mental illness," and that over the years, people who should not qualify -- those with "mild and moderate" mental illnesses -- have been given the services.
Edwards said less intensive services that are provided in other MaineCare programs are more appropriate for many of the people now receiving Section 17 services.
"This caused a waitlist for services," wrote Edwards in response to questions from the Bangor Daily News. "These changes are being made to ensure that the appropriate services are being provided to those with severe, persistent mental illness. ... Members with mild and moderate mental illness are much more appropriately served through interventions such as counseling and medications, which are available through Section 65 [of the MaineCare Benefits Manual]."
Edwards estimated that about 8,000 Mainers will be redirected to Section 65 and 92 services under the new rule.
Mary Lou Dyer, director of the Maine Association of Community Service Providers, said the announcement of the change and uncertainty about who it will affect has caused many consumers a lot of stress.
"The stated goal has been to get people with illnesses like anxiety and post-traumatic stress disorder off of Section 17," she said. "Could you imagine being told that your services may or may not be discontinued?"
Mark Joyce, managing attorney at the Maine Disability Rights Center, said his organization has been trying to lobby DHHS to implement a plan to accommodate affected consumers' needs. Even if there are programs they can be moved to, there are multiple complicating factors including whether a new service source is even available in a given consumer's geographical area.
"We don't think the rule should be rolled out until there's a concrete plan to deal with the people who are kicked out," said Joyce. "That's why providers across Maine are saying we need more information."
The change is being implemented through routine technical rulemaking, which means it does not require legislative review.
(c)2016 the Bangor Daily News (Bangor, Maine)