Maine Care Budget Cuts

At the center of this year's state budget debate was a $141 million deficit expected in Maine's MaineCare budget in fiscal year 2005 (which begins July 1, 2004). It began with the Governor proposing $80 million in MaineCare cuts including the creation of the "MaineCare Basic" program for adults - a redesign of MaineCare with significantly fewer services. The Governor proposed eliminating major services for adults, such as physical therapy, speech and hearing services, occupational therapy, podiatry, services for people with brain injuries, optometric services, adult dental services and others. Also major cuts were proposed in mental health services, services for people with mental retardation and the Drugs for the Elderly Program.

Thanks to the spectacular work of MAIN members, health care providers, health care consumers and advocates many of the worst of these cuts were stopped in their tracks. On the day of the legislative hearing, well over 1,000 people (some estimate 2,000 people!) poured into the Augusta Civic Center for a massive all-day event. Outside a rally and press conference drew an enthusiastic and vocal group, while inside legislators had to split the committees into two hearings to accommodate the crowd. Hundreds stood in line for hours to tell their story of the damage these cuts would cause to people's lives. As a result, the Governor's office was sent back to the drawing board to devise a new - and more humane - plan.

Weeks of painful budget talks ensued, with the Appropriations Committee facing the need to balance a budget and the Governor refusing to raise taxes to help prevent cuts in MaineCare. Under these circumstances, we are pleased to report that although the budget includes serious funding cuts in MaineCare, it restores most of the services that had been slated for elimination in Governor Baldacci's original budget.

Service	Final Budget Action
Ambulatory Care Clinics	Restored. The proposed cut in MaineCare to these city clinics was restored.
Dental	Restored. The proposed elimination of all adult dental services was restored. MaineCare will continue to cover treatment for pain, infection and imminent tooth loss as it does now.
Physical and Occupational Therapy	Restored, with limits. The proposed elimination of these services was rejected. However, to obtain these services, a physician will now have to document that the person has rehabilitation potential. In addition, DHS may limit treatment only to those needing therapy following a hospital stay, a surgery, or when a person has needed extensive assistance in the previous 30 days doing basic activities of daily living (eating, toileting, locomotion, transfer or bed mobility). In addition, for those people who require ongoing therapy in order to maintain function, only one visit per year will be permitted in order to design a plan of care and train patients and caregivers to carry out that plan.
Speech Therapy	Restored, with limits. As with the OT and PT, speech therapy will be limited to those with rehabilitation potential after they have experienced a significant decline in function. Evaluations will be limited to an initial evaluation and a reevaluation every six months.
Audiology	Restored. There will be no cuts in this service.
Social Work	Restored. This cut, which would have affected clients of DHS's adult protective services, has been restored.
Durable Medical Equipment, Prosthetics and Orthotics	Restored, with limits. Durable medical equipment (medical supplies) will continue to be provided to meet standard daily needs. People will be limited to one pair of orthotic shoes and one pair of inserts per year and power wheel chairs will be available only to those who are non-ambulatory. Federal law prohibits states from simply limiting the types of equipment available, as people's needs must be individually determined.
Rehabilitation for Brain Injury	Mostly restored, with redesign of the service. This service was first slated for elimination for a budget savings of $5,690,207 state dollars ($16,337,086 with state and federal dollars combined). Instead, the cut has been reduced to $1,491,129 in state dollars. These savings are to be achieved through a redesign of the program that will assign people, depending on need, to different levels of care.
Adult Day Health	Restored. This service, affecting mainly Alzheimer's patients, was completely restored.
Psychological Services	Partially restored, with limits. This affects psychological services received directly from a psychologist, and not through a mental health clinic. Patients will be limited to 16 hours of group or individual therapy (or a combination of both) per year.
Optometric	Restored. Presently a rule is being proposed that would limit routine eye exams to one per year, unless people have a medical condition (for example diabetes) requiring that they be seen more often.
Podiatric Services	Restored. This service is completely restored.
Chiropractic	Partially Restored. Originally the Governor proposed to limit chiropractic services to 12 visits per year. This flat limit was rejected. Instead, DHS will be allowed to limit this service to those with rehabilitation potential when they have an acute condition or after a surgical procedure.
Cuts to "Noncategorical" Adults	More cuts were proposed for adults without minor children at home ("noncategoricals"). Some legislators sought to cut eligibility for MaineCare for this group, but the majority on the Appropriations Committee rejected that. Services, however, will be somewhat more limited for this group. Here is what happened (next 3 items apply to "non-categoricals only):
Hospital inpatient and outpatient limits	Prior authorization before some services are given. Noncategorical adults will be limited to 2 inpatient and 5 outpatient hospital visits per year, but they can have more visits if DHS authorizes them in advance. The limits will not apply to lab work, X-rays, prenatal care or mental health diagnoses.
Transportation	Restored. The Appropriations Committee rejected the proposal to eliminate coverage for transportation services to medically necessary appointments for noncategorical adults.
3 months retroactive coverage	Eliminated. Generally, people who become eligible for MaineCare can receive coverage for services provided during the three-month period before the date of their MaineCare application if they were otherwise eligible during that time. This three-month retroactive coverage period will be eliminated for noncategoricals, affecting primarily the health care providers who provided services during that period.

In addition to the items above, other major cuts occurred in MaineCare. These include:

As part of the Dirigo Health legislation, last year the legislature increased MaineCare eligibility:

These eligibility expansions were scheduled to go into effect when Dirigo Health begins enrolling people into its health care program this summer. In the budget bill that just passed, those expansions will be delayed until three months after Dirigo Health begins to enroll people.

Originally, the Governor proposed cutting this popular drug program by $3 million by adopting a "strict formulary" for the Drugs for the Elderly program. This means that if your drug was not on the list of covered drugs, you wouldn't be able to get a discount.

The Legislature rejected this cut. Instead of $3 million, it made a cut of $1 million. The Department of Human Services (DHS) will achieve this by requiring prior authorization of more drugs, instead of making them unavailable to everyone.

We can expect major changes in the way people access mental health services that are likely to result in reduction in care. In particular, DHS will be contracting with an organization that specializes in managing mental health care. They will also assess people's eligibility for services and the extent of need for those services based on a standard criteria. This will affect primarily adult care. However, children's care will also be affected with a redesign, and a $1,000,000 cut in state dollars ($3 million with state and federal dollars combined) for home and community support services and behavioral health services.

This program provides MaineCare coverage to children with severe disabilities who would otherwise be over the MaineCare income limits for children (over 200% of the poverty level). It is intended to allow children who would otherwise be institutionalized to remain at home.

Services in this program will be limited to the dollar amount that would have been spent on the child had the child been in an institution.

In addition, DHS is just now preparing to seek approval from the federal government to implement an earlier budget cut allowing premiums to be charged for Katie Beckett coverage. Before any premium can be charged, DHS must obtain a "waiver" from the federal government and must publish rules establishing the premium.

	MAIN UPDATE In Solidarity for Peace, Bread and Justice!
A Joint Project of the Maine Association of Interdependent Neighborhoods and Maine Equal Justice
Volume 8 No. 2		June 2004

MAIN UPDATE In Solidarity for Peace, Bread and Justice!

MAIN
UPDATE

In Solidarity for
Peace, Bread and Justice!