MaineCare reimbursement cuts would sever lifeline for mentally ill

Dennis looks like your average middle-aged Portlander with his frayed Red Sox cap, specks of graying hair, stylish frames, and an easy smile, by all appearances one of the “able-bodied” to whom our governor often refers. Few would suspect that he suffers from a public anxiety so debilitating that he is paralyzed by the thought of going to the grocery store alone. Or that he is besieged by severe paranoia that can induce a panic attack just by checking the mailbox.

But with the help of his caseworker, Melissa Parrott, he can do both. “It’s very, very rare that I leave my safe zone,” Dennis said. “But with Melissa I just feel so comfortable, because I know she’s there to support me. She keeps me calm and lets me know it’s okay.”

His affliction is more common than many may realize. According to the National Alliance on Mental Illness, one in 25 adults experiences a “serious mental illness in a given year that substantially interferes with or limits one or more major life activities.” Without help, one can become isolated and slide toward hospitalization, homelessness or incarceration, all of which are disastrous for the individual and more expensive to taxpayers and society in the long run.

Nonprofits such as Parrott’s employer, Shalom House, which are funded in large part by the public through MaineCare reimbursements, provide a lifeline for some of Maine’s most vulnerable.

For Dennis, it’s taken five years of hard-won progress but he has gone from hospitalization to a group home to his own apartment and greater independence.

“There are so many things Shalom House has done for me. It’s phenomenal,” Dennis said. “I can’t say enough good things about it.”

The prospect of losing that lifeline, however, causes him to wince with visible fear.

“I’d go into a deep depression,” he said, shaking his head. “I don’t know what I’d do. I’d feel so lost. I couldn’t get to the grocery store, so I wouldn’t eat.”

A drastic 23-percent cut in the MaineCare reimbursement rate proposed by DHHS, which can be enacted without legislative approval or even proof of financial necessity, would sever him and hundreds of others with severe mental illnesses from the services they depend on to access and maintain care. Left in isolation, many would end up back at square one.

Parrott, who is going on five years with Shalom House, is at the hub of Dennis’s life to make sure he stays connected. Although she is allotted only an hour or two per week to spend with him, including their weekly grocery shopping mission every Friday at 9:00 a.m. sharp, the support she provides behind the scenes is constant. She schedules and follows up on his medical appointments, which she also attends with him; she helps him find, secure and keep his own apartment; she navigates the myriad forms and applications to maintain his housing and food benefits; and she stays atop of an ever-growing stack of required documentation from weekly contact logs to quarterly and yearly assessments of his progress toward the long-term goal of discharge.

And Dennis is far from Parrott’s only client. She has at least 20 more lives to keep track of on any given day.

“In this job, you have to be really good at time management,” she said. “You have to learn how to prioritize or you couldn’t do it all in 40 hours a week.”

Shalom House can only bill the state for the time caseworkers like Parrott spend face-to-face with their clients, with a target of 24 billable hours per week. The other 16 hours are packed with phone calls with clients and doctors, collaborating with community resources and keeping client case files current. Every in-person client contact, totaling 20-30 per week, requires at least a half-page write-up. Additionally, any new client intake requires a 10-page assessment, and each comprehensive yearly assessment takes 40-60 minutes apiece to complete.

Nevertheless, DHHS director Mary Mayhew is convinced that caseworkers such as Parrott are operating at less than peak efficiency and providing “extra” services to their clients, per a 2015 rate study. (Shalom House says it has received no documentation from DHHS regarding these unauthorized services. A Freedom of Access Act requesting any such records for similar providers statewide is pending.) “DHHS expects that the reduced rate will require that services align more closely with MaineCare requirements,” the Jan. 10 executive summary of the rate study states, and elaborates no further.

“The insinuation that we’re not using our time well, that we’re not doing enough or not doing what we’re supposed to be doing, is hurtful, because I feel like we all work really hard on behalf of our clients,” Parrott said. “I don’t think you could do this job if you didn’t sincerely care and wanted to make a difference. When your client thanks you for helping them out, that means more to me than what the state might think.

“The goal is to engage and maintain those relationships. It takes time to earn client’s trust. Many have past trauma and it’s hard for them.”

Program Director Jon Petruschke, who has been with Shalom House for nearly nine years, doesn’t see the alleged waste, either.

“First of all, given how high the needs some of our clients have, we’d be hearing from them pretty quickly. They would call up and say, ‘Hey, I’m not seeing Melissa, I’m not getting the help I need, and I really need it,’” he said. “Second, we wouldn’t be getting enough billable hours to keep the program afloat. There’s a lot that hinges on everyone doing their job exactly how it’s supposed to be done.”

In all the expensive number-crunching done by DHHS to find ways to offset Governor LePage’s proposed tax cuts, slanted in favor of the wealthy, the human cost of stranding our most vulnerable without help appears to have not been worth calculating. The governor’s claim that he is “disrespected more than anyone,” made at a recent town hall appearance, rings hollow when he instructs state agencies to treat a constituent like Dennis as if he is a leech to be scraped off his burgeoning rainy day fund, unworthy of our collective help. The proposed cut would be so devastating to Shalom House, said its executive director in an interview last week, that it would have to cease providing these services entirely, leaving people like Dennis in the lurch.

“If I ever lost Melissa and Shalom House,” Dennis said, “I’m afraid I’ll end up back in the hospital. I really do.”

It’s one fear that he could do without.

Photo via Flickr/Twilight Jones.

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