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.