Budget proposal: State would stop paying for some counselors

AUGUSTA — If the governor's budget passes as proposed, Mainers who are eligible for both Medicare and Medicaid — typically those 65 and older — would no longer be allowed to see certain kinds of counselors.

The proposal seeks to save $3.3 million a year by no longer paying for people to see licensed clinical professional counselors or licensed marriage and family therapists for mental health counseling. Those dual-eligible for Medicare and Medicaid, which is known as MaineCare in Maine, would instead see licensed clinical social workers instead. 

The change would affect 2,500 Mainers. It would not affect people who receive MaineCare only.

Gov. Paul LePage's administration said the move would save the state money by getting the federal government to pay for most of the cost of services. Medicare reimburses for social workers but not for professional counselors or marriage and family therapists, so when a dual-eligible client sees one of those counselors, it falls to the state to pay.

"The department has found this (proposal) to be the most cost-effective way to address our fiscal challenges while also impacting the least amount of people and preserving as many services as possible," MaineCare Director Stefanie Nadeau wrote in an email.

But counselors and advocates for the mentally ill say there aren't enough mental health professionals in Maine now to meet the need and this proposal would make that situation worse. They believe the change would hurt the people who need help the most and could destroy the livelihoods of hundreds of counselors.

And in the end, they say, the state likely wouldn't save much money because untreated patients would turn to emergency rooms and psychiatric hospitals for crisis care, and that would be expensive. 

"It's really not a cost savings. It's delusional to think that," said Jeri Stevens, a licensed clinical professional counselor and instructor in Husson University's counseling program.

Clinical social workers, clinical professional counselors and marriage and family therapists are similar. All have master's degrees. All take classes in counseling and can provide therapy. All are licensed by the state.

However, the three professions have different philosophies and focus. Social workers are trained to find resources for clients, and to provide counseling. Clinical professional counselors focus solely on counseling. Marriage and family therapists also focus on counseling, but with more attention to working with couples and families.

Experts, including social workers, say the three professions are equal in quality.

Social workers have been around longer and are covered by both federal and state health insurance programs. Professional counselors and marriage and family therapists are not covered by the federal program, but they are covered by other insurance programs, including MaineCare.

They have been fighting for years to be covered by Medicare.

For patients eligible for both Medicare and MaineCare, the state program paid when the federal program wouldn't. Nadeau, with MaineCare, said dropping that coverage would align Maine with Medicare. 

"This proposed change allows us to ensure that dual-eligibles will still be able to receive services they need, while also saving the state money," she said. 

But counselors and social workers say there aren't enough social workers to help the 2,500 Mainers who would suddenly need new therapists for depression, anxiety and post-traumatic stress disorder, among other issues.

"Most of our members have enough clients and couldn't handle the onslaught," said Susan Lamb, executive director of the Maine chapter of the National Association of Social Workers.

Catherine Ryder, executive director of Tri-County Mental Health Services in Lewiston, called the proposed change "catastrophic."

"We're already challenged to fill positions," she said. "When you start eliminating an entire pool (of therapists), we're going to be hard-pressed to come anywhere close to meeting the demand."

If they can't meet the demand, Ryder and others worry patients will go without mental health care. And even if agencies could find enough social workers to cover people, they believe some patients simply wouldn't go to a new therapist.

They worry that, either way, more people will end up in crisis and in the hospital — a situation that would hurt patients and cost more.

"It's shortsighted in terms of what the ultimate outcome is going to be," said Maine House Speaker Mark Eves, D-North Berwick, who recently gave up his practice as a marriage and family therapist to focus on the Legislature.

Counselors are also concerned about their livelihoods. 

Robin Abendroth is a licensed clinical professional counselor who runs a private practice in Saco. Most of his patients are dual-eligibles.

"We could see our businesses decimated," he said. "I could lose 95 percent of my client base overnight."

There are about 1,100 clinical professional counselors in Maine and 79 marriage and family counselors.

The Legislature's Appropriations Committee is expected to hold a public hearing on the proposal at 1 p.m. Monday. Many counselors, social workers and agency leaders say they'll be there.

"We want to fight this thing," said Tom Kubasik, president-elect of the Maine Mental Health Counselors Association.


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FRANK EARLEY's picture

We know how LePage thinks...

Over a period of time, a person makes a lot of decisions. When you can follow these decisions, you can sometimes see a pattern start to form.
Being disabled and on a fixed income, I pay very close attention to what Paul LePage does on a day to day basis. With good reason, since he's been in office, he has shown a very distinct pattern of denying many benefits to anyone he deems as unproductive enough. He seems to think he has the right to deny medication to elderly, or medical treatment to disabled or unemployed citizens. Anyone who has the misfortune to become elderly, sick, unemployed, or just poor, is fair game for LePage. Now, he's decided that certain types of therapy is too expensive. Again, his favorite method of cutting spending is to shift it to someone else, in this case Medicare. That looks good in LePage's books, but anyone who has ever dealt with switching or changing anything with Medicare or Medicaid, knows that it's just slightly more painful than a "root canal", without anesthesia.
I'm glad to see LePage is starting to branch out, he's decided to inflict his pain on everyone. It seems that every town and city now, is talking property tax increases. So instead of being able to enjoy the fruits of our labor, we are being forced to pay more. We all know that when a town stars scratching for more money, the pain trickles down, those least able to afford the increase and least able to defend their rights, are hit the hardest. That's OK though, because under Paul LePage, the sick and elderly are already used to being denied the help and respect they deserve. After all, do we really need to be wasting good money on someone who is no longer able to give back?????????


Typically those 65 and older

Typically those 65 and older.......I understand that the Governor is trying to straighten out the State's money situation. Social Security recipients recieved a raise this year. Those in the low income bracket also recieved cutbacks in their other benefits and raises in their co-pays. Add that to the recent cutbacks in the things their insurances will cover, and they end up with quite a bit less money and benes that they had last year. So much for the cost of living raise. I understand that these things needed to be done because the State and the Country are in a mess moneywise.
There are a lot of mental health issues that social workers are not qualified to handle. Why not cut the length of time of the sessions across the board to save money. There must be something that could be done other than targeting the elderly.
I have backed the Governor in a lot of things, and I believe he wants to help the State get back on it's feet. But I find this particular proposal just WRONG, WRONG, WRONG!!!!!


For some, this is going to be

For some, this is going to be a dangerous course of action. Therapy doesn't just last a few weeks or months. It lasts years and years. In order for therapy to work the client needs to build a relationship with his/her therapist. Making someone change therapists is detrimental to their mental health. Most will not take the time to go to a new therapist because they have such extensive histories and do not want to have to start all over again. This will cause their issues to get worse and could end up in more crisis situations where the person will have no choice but to go to the hospitals which will end up costing more in the long run.

As someone who has seen a LMFT for many years, I would not go to another therapist because I have one who I actually trust, who knows me, knows how to handle my issues, and knows when I can and when I cannot be pushed. I would not be comfortable in dealing with anyone else. Over the years she has been able to identify when I am in the "crash and burn" mode and has been able to intercept it and prevent it from happening therefore preventing hospitalizations which would just cost more money.

It is time the governor and his staff start looking elsewhere to balance the budget. They created this problem by having a budget that relied on waivers they were not granted. They have taken from the elderly, disabled, children, and poor long enough. You cannot get blood from a turnip and you have tapped this well one too many times and now it is dry. There is no more money left to take from the programs for this demographic. The services are already at the bare minimum. The wait list for services is growing on a daily basis because the services have already been stretched to their limit.

This is pure discrimination...

The governor has decided in his "infinite wisdom" that old people and people on disability (it effects them too) are so healthy that they couldn't possibly need the same level of care as young healthy folks. He is restricting mental health care based on a demographic. Mr. Lepage, it is sounding more and more like you need some therapy there yourself "buddy".

Betty Davies's picture

How did LePage decide...

That what elderly people and disabled people who have Medicare MOST need is an emphasis on "resources" (as in social work) rather than on psychotherapy?

I see no mention of research that was reviewed in order to reach this conclusion. The only factor mentioned is money to be saved by changing the source of funding.

I wonder how expert someone who focuses on community resources is at providing DSM-IV diagnoses for complex psychiatric illnesses. Diagnosis guides treatment, after all.

FYI, I'm NOT a therapist, neither LCPC nor LCSW.

JOHN PAINTER's picture

Penny wise but pound foolish

I was disappointed, especially after Newtown CT, to read in the Governors proposed budget such a penny wise but pound foolish approach to both balance our budget, and assure the health and safety of all Mainers.

Maine over the years has had a practice of restricting the types of practitioners allowed to work within the state, this has neither made our state more efficient or effective in mental health services. It has not made our state any safer than states with a broader range of recognized professions. Indeed, Maine has artificially inflated the cost of our states mental health system, as in any supply and demand system, by limitation of qualified mental health professionals available. While not the only reason Maine is consistently at or near the top of East Coast states in per capita cost for mental health services, it is a factor which could be leveraged to bring costs down. Not at some distant time in the future, but now. Maine has not kept up with advancements in professional development in behavioral health sciences which can reduce cost while improving patient outcomes, and instead tends to rely on administrative gimmicks, or outright defunding of services and discouraging innovation - innovation usually entails change and Maine struggles with that.

I would encourage the Governor to expand the range of qualified mental health professionals in Maine, and rapidly proceed with his plans to introduce Value Based Purchasing within our behavioral health system (not only MaineCare) to evaluate the cost and effectiveness of services delivered by a broad range of professionals and then determine how to target general fund resources.


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