DHHS chief: MaineCare changes underway

AUBURN — If MaineCare is expanded to add another 70,000 clients to the rolls, “it will break an already fragile system,” Department of Health and Human Services Commissioner Mary Mayhew said Wednesday.

Daryn Slover/Sun Journal

Maine Department of Health and Human Services Commissioner Mary Mayhew addresses a group during a Maine Prosperity Event luncheon hosted by the Maine Heritage Policy Center at the Hilton Garden Inn in Auburn on Wednesday. 

Such an expansion also would continue to drain resources needed for other necessary social services and state programs, including building roads and funding education, Mayhew said at a Maine Prosperity Event luncheon hosted by the Maine Heritage Policy Center. She will appear at a similar event Thursday at DiMillo’s on the Water in Portland.

The Legislature in January is set to reconsider a plan to leverage federal funding available under the Affordable Care Act to expand MaineCare in 2014. The plan failed last year because the Legislature was unable to override a veto by Gov. Paul LePage.

“Our program has grown at a rate we can’t sustain,” Mayhew said, with 25 percent of all Maine residents now enrolled in MaineCare.

In 2000, Maine spent $1.2 billion to fund MaineCare. Last year, spending reached $2.4 billion as services and enrollment expanded. That growth is too fast and too much, Mayhew said. "It is simply impossible to make good and informed decisions and to plan for the future of this program" when so much effort is required to fund and manage growth.

The better path, Mayhew said, is to look at individual members' needs and to help people who are able to get jobs and then fund services for the remaining, truly neediest population.

Before introducing Mayhew to the lunch group, MHPC Chief Executive Officer J. Scott Moody said that, according to MHPC and DHHS predictions, by 2016 there will be “just as many people on our welfare rolls as people working in private-sector jobs.”

“That’s the very definition of unsustainable,” he said, calling on Mainers to work toward “reducing welfare rolls through economic prosperity.” Specifically, Moody said, eliminating the income and sales taxes on a county-by-county basis, starting with more economically stressed areas to the north “where 38 percent of the population is on some sort of welfare.” Moody argued that allowing workers to keep that cash would allow them to invest in their communities, sparking the return of economic health.

Mayhew didn’t address that idea but focused her presentation on what she called Maine’s “insatiable appetite” for federal money to fund a growing number of programs. That appetite, she said, has contributed to an unwieldy and inefficient health and human services system that does not best serve the oldest and sickest in Maine.

"It’s very hard to believe after going through sequestration in the spring, the federal shutdown and the looming shutdown debate that there will be federal dollars down the road” to continue current funding levels, so Maine’s only choice is to streamline programs into a form that can be paid for in state dollars, she said.

Speaking to a group of fewer than 20 lunch guests, Mayhew said her department’s mission under the LePage administration has been to focus on the needs of individuals rather than maintaining previous administrations’ programs intended to “fit all.” That cookie-cutter approach doesn’t effectively address individual health and social issues, Mayhew said, and the best way to get people off welfare is to “move people toward improved health, employment and self-sufficiency” for themselves and their families. “Welfare should not be the finish line,” she said, "for any able-bodied Mainer."

As part of the work to break a welfare-dependant lifestyle, Mayhew said DHHS is aggressively moving away from a strictly cash benefit TANF program and toward funding education and employment training programs to get people the skills they need to get jobs. Every person who qualifies for TANF benefits will be subject to an employment/work experience assessment. DHHS will work with the Maine departments of Labor and Education to individualize training benefits.

“Those ready to work will be on a fast track to a ready job and a chance to get off welfare,” she said. “Thanks to these reforms, TANF will be a pit stop along the way, and not a destination.”

MaineCare members will also get individualized assessments.

Five percent of MaineCare members account for 54 percent of all MaineCare spending, a figure Mayhew said is in excess of $1.3 billion each year, or about $68,562 per high-use member. These individuals, she said, are the truly needy: the elderly, people with intellectual and/or physical disabilities, and people with severe and persistent mental illnesses who live in treatment facilities.

The purpose of individualized assessments will be to reduce the health-care costs of the remaining 95 percent of members, people who do not — for a variety of reasons — access physical and mental health care services at the primary care level, but wait until a medical crisis and then seek care at high-cost emergency departments.

“We pay for the crisis,” Mayhew said, for the acute demand on the health care system. With some coordination of services, MaineCare members can be taught and “incentivized” to access lower-cost preventive care. And when they do, the annual cost to care for these patients is closer to $937 than the $21,011 spent annually for thousands of crisis patients.

If some of the services required by these members could be reduced through home care, particularly providing light housekeeping and meal preparation for elderly members, Mayhew said the system could become even more efficient.

Lewiston and Auburn are sites for a DHHS pilot program to monitor families with two or more members who each access more than $10,000 in medical services every year. Mayhew said these families will be evaluated by a primary care physician and helped to find the best health-care deals for the lowest possible price.

“The days of paying for quantity instead of quality are over,” Mayhew said, as DHHS focuses on improving health instead of simply paying bills for services. And, she said, the department will eventually get to the point of paying medical care providers based on patient results.

Asked whether DHHS is making any move toward requiring MaineCare members to comparison shop for routine medical services, such as colonoscopies, Mayhew said that education outreach is beginning.

And, asked whether DHHS would re-evaluate the fees it sets for MaineCare services provided to public school students, Mayhew said that evaluation is underway.

According to lunch-goer Bill Webster, superintendent of the Lewiston School Department, the Lewiston district is forced to pay the DHHS-set fee of $58.68 for a behavior specialist visit rather than that specialist’s $25 private-patient fee. “That doubles the school’s cost,” he said, “and it ultimately comes right out of Maine taxpayers’ pockets.”

Mayhew agreed that was a problem, and said, as a way to trim costs in the future, the department is looking at prior authorization for in-school services to ensure the services match a student’s individualized education program.

jmeyer@sunjournal.com

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Comments

David Lingard Jr's picture

YAYAYA....

Point he fingers every where else then who the real problem is Ms. Mayhew. The problems have been right there in the governors hands. I do not care what anyone else thinks. I am just giving my own opinion as a looker oner. I saw Mary Mayhew at the yearly seminar I go to and all she does is let out hot air anything that Lepage wants. Oh well as soon as we are rid of him hopefully we will someone in the spot of Mary Mayhew who knows nothing of the position she is in. When he put in there all she knew before she got in there was to be his medical adviser. They fired and layed off all of those people who obviously needed there jobs as much as the next person. In that bunch of people were people new how to do there jobs and did them well. It is not all DHHS's fault they are just pointing fingers at other so they will not look bad. Oh well I am just spouting have good holidays everyone.

FRANK EARLEY's picture

I think I have an answer to this.........

In her address, she mentioned that such things as the sequester, the Government shut down, among the reasons she can't believe that federal funding will be available down the line. Well how about we just quit letting Republicans make any decisions. All I hear is that the ACA is going great everywhere accept States with Republican Governors. Other states are able to successfully expand and run their Medicaid program, why can't we? I think that as long as these Republican governors are going to keep fighting to abolish the ACA, then Medicaide can't function properly. You can have people making speeches left and right, it doesn't matter. If the Governor wants this program to fail, we, the people, have little hope. If we want it to succeed, we need to get rid of LePage now..................

PAUL ST JEAN's picture

"Well how about we just quit

"Well how about we just quit letting Republicans make any decisions."
You preach freedom of choice and tolerance and all that other liberal bs, but you don't practice any of it. News Flash!!! It's a two party system. Get used to it, Frank.

FRANK EARLEY's picture

Sorry Paul, you have it wrong this time..........

You are almost right, this is supposed to be a two party system. Since the irresponsible actions of the Tea Party, since the start of the obstruction in Congress, the two party system ceased to exist. I don't consider a political party, supposedly a part of a Democracy, who declares war on the opposing party, for absolutely nothing more than spite. I don't consider that party a fair participant in any way shape or form, of a proper two party system. I call it bullying, attempting to circumvent the fact that they lost the Presidential election.
They have instead, decided to force their agenda on this country anyway. whether anyone wants it or not. They are wasting millions of taxpayer dollars by not allowing the normal activities of the House and Senate. They lost the vote, so their going to do things their way anyhow. What does that say for Democracy? I say it's all a joke, and it's the ,Republicans who made it that way. This is nothing more than a tug of war, between the Tea Baggers and the rest of the nation. Nothing substantial will be allowed to happen as long as the Tea Party mentality is allowed to continue................

PAUL ST JEAN's picture

And continue it will. The

And continue it will. The drums of change are beating.

FRANK EARLEY's picture

Actually...........

Actually, it's more like beating a dead horse.................

PAUL ST JEAN's picture

What would you have the

What would you have the republicans do, lay on their backs and say to the dems, "Here we are take what you want"? There is no longer any opportunity for compromise between repubs and dems. It's "to the victor goes the spoils". Whoever is in power takes and does whatever they want with total impunity. The politicians take the elevator and the American people get the shaft. The survival of this country was at no greater risk during WWII than it is today, except that today's enemy is domestic; our present government.

FRANK EARLEY's picture

What is happening this year is unprecedented...........

Whats happening this year is unprecedented. It's stupid, it's the result of a totally frustrated group of angry old men who refuse to admit defeat.
Used to be, when a candidate, or should I say majority of voters, has made their choice. As a rule, that dictated what the people wanted. President Obama, ran his campaign on the ACA platform. He promised, and a majority of the voters wanted, a change in how Americans receive health care. No one ever assumed for a minute that it would be a smooth transition, or without it's problems. People who for whatever reason haven't been able to acquire affordable health care insurance, spoke up, and wanted change. Some of those people have experienced the nightmare of having a serious illness, with out insurance. Many others couldn't bear the thought of that happening to them.
President Obama has an idea, he has a plan. He has said he expected to encounter problems rolling it out. Fact of the matter is, it needed to be rolled out in order to realize the problem areas that needed fixing. It may very well take a while to get running smooth, but what are the alternatives? We've been fighting a dysfunctional system for years. Every year, people are dying because they have no insurance or the insurance they have doesn't cover what they need. This is unacceptable.
Now we have the Republican Party, who lost the election, yet they feel the country wants their policies anyway. They are trying to force them down our throats. Whether or not we want these policies is one thing, the overall attempt to stop the president from doing his job is totally unprecedented. At no other time in history has any one group attempted to highjack the American government, such as is happening now. Preventing the elected party from performing their assigned duties, is directly affecting the people of this country, in a very negative way. It is unfair, and in my opinion, unethical for the Republican Party to ignore the will of the people and continue this travesty of obstruction in Washington. If you feel that the Republican party is being unfairly treated, just keep in mind, they bought it on themselves. If they want to implement their own policies, they need to win their own election. Until then play by the rules..............................

PAUL ST JEAN's picture

Great post. Except you have

Great post. Except you have it all backwards. oBAMa ran his campaign with the core of his platform being the ACA, most of wich was based on lies, lies and more lies. And his only response to these lies is he didn't know, he wasn't told, and he was misinformed.
Bush was misinformed about WMD's in Iraq and he was a liar. Why, then, is oBAMa not a liar? And, don't give me the Bush lied; people died crap. People are dying right now because of oBAMa's lies.

FRANK EARLEY's picture

Were they really lies?????????????

Obama ran with an idea, as it turns out he wasn't the first to have this idea, therefore he had a model to run it with. Unfortunately the model he had, wasn't full scale, it was very close to what he had in mind, but on a much smaller scale. Thus he had a lot of what-if's to deal with. When your treading on new ground, you can't know what's around every corner. I will concede, he never should have made promises based on uncharted territory. I think he has learned that lesson the hard way. I also believe the citizens who were affected by this oversight, maybe should have been a little more cautious. I never, take anything a politician says at full face value. It's not that I'm assuming their out to lie to me, it's that they are just human beings. Human beings make mistakes. Some you can see coming, others you get a feeling somethings not right, and then there's just out and out screw-ups.
I honestly don't think Obama actually set out to lie to anyone. As I've stated before, I feel he was a little naive on insurance company policies. Maybe that's because I've had intimate knowledge of how insurance companies operate. For the past ten years my life has pretty much been run by health insurance. I never thought the original claims made by Obama would fan out. I new there were millions of trash policies out there. It's something I learned about through other peoples disastrous hospital experiences. About the only thing I could compare it to would be the recent "Housing Market Collapse", which happened because motgage companies were selling what the people wanted, affordable mortgages. Unfortunately, they got what they paid for. and in no time at all, the do-do hits the fan.
These insurance policies were like buying a new operating system for your computer. If your computer doesn't meet the minimum requirements, it's not going to function in you computer. Trash policies, didn't meet the ACA's minimum requirements. I feel this should have been identified way before it was, it would have prevented a million headaches. After seeing the roll out of the web site, nothing surprises me. I mean a company like "Ticket-tron" deals with probably more potential customers a day than the ACA would generate. Their system works like clock work.
I think it's going to take time, some real expertise, and a bit of luck, but I think it's going to work. I hope so because I know a lot of people it might help.
My 29 year old daughter, a college student living in N Carolina called me the other day telling me she and her fiance have purchased health insurance, and they can actually afford it. I can't remember if N Carolina expanded medicaid or not, but she said it took a total of fifty minutes on line. So I guess the only thing left to do now is just sit here and keep my fingers crossed for the rest of the country.........................................

Eric  LeBlanc's picture

The republicans who have fought to stop Obamacare are heroes

Any traitor who supported that piece of garbage legislation will go down on the wrong side of history and should be put on trial and hanged.

FRANK EARLEY's picture

Oh, that's a good one..................

The Republicans who fought to stop Obama Care are not really heroes, I mean it is, after all, the law of the land. How can they be heroes? Maybe if they managed to actually defeat the bill before it became law, I guess I'd give them a little credit then. Maybe we could refer to them as martyrs, that sounds a little more dramatic than what they really are, "Failures".
As for being on the wrong side of history, I've been there before. I always seem to be on the wrong side of something. I've actually grown quite accustomed to it. I don't really think hanging someone for wanting health insurance really makes any sense really. The "trial" thing is simple, put Paul LePage on trial for impersonating an intelligent person. Now there's a slam dunk if I ever heard one.............................

JOHN PAINTER's picture

I agree with the

I agree with the Commissioners data, it's fairly well known at least amongst healthcare provider community, that a very small percentage of MaineCare beneficiaries disproportionately drive the cost. However she did not go quite far enough in describing that the 5% who are driving over half the cost have complex co-occurring conditions e.g. mental illness, COPD, type 1 diabetes, substance abuse, etc. Many of these individuals, if earlier in their lives had easy access to services, would have been much easier to reduce or prevent those conditions. Though to some, that may sound too much like "welfare" to act upon.

I also agree that Maine is addicted to Federal Medicaid funds and does not utilize the funds well, primarily targeting the money towards expensive hospital based care to the virtual exclusion of evidenced based primary and preventative wellness services. Maine has on payroll very capable statisticians and actuaries under the governments direction, it's to entirely clear why we have tens of thousands of tax payer dollars to hire consultants to do the same work.

I also think the Commissioner is correct that a cookie cutter approach (single model trap) is expensive and unhelpful in our states health and human service system. Though, for example, Maine still requires people who can live in the community in their own homes which they pay for, but need rehabilitative services such as PNMI mental health rehabilitation to give up their homes and move into a state controlled residence, which they must move out of once they are better and try to find a new home. In this case the Legislature and Administration could immediately pass LD 87 and move to eliminate such costly and disruptive practices.

Unfortunately to date, we have largely the same system we had a decade ago, or for that matter somewhat digressed to several decades ago in the 1970's when Maine had a Department of Mental Health and Corrections. Though it seems ironically fitting as the Commission and Governor plan to move people from our states flagship mental health hospital into the prison system and effectively give up on patients healthcare providers in the hospital have a hard time understanding.

I hope that the Commissioner and LePage Administration now that they are looking at the data and articulating some of symptomatic problems of our Health and Human Services System, have the fire in their bellies necessary to look at what is really going on in actual peoples, lives and develop public policy to rebuild a system that focuses on the hope and wellness of our people, and not the demagoguery which has crept in to Maine.

GEORGE MCLEAN's picture

waste

Question why Maine-Care pays LCSW, LCPC, LADC's at a higher rate then most insurances.

Why does Maine-Care pays for drunk driver counseling? If these folks had enough money to buy booze why should tax payers foot the bill for them to get licenses reinstated?

JOHN PAINTER's picture

I'm not certain where

I'm not certain where Superintendent Webster got that figure from, that's likely a quarter hour cost. Most private practice clinicians I know charge around $60/hr. However he and the Commissioner are correct that Maine's DHHS completely controls the cost of MaineCare rates, similar to how Congress controls Medicare rates - it has nothing to do with the free market.

Maine also discourages competition in healthcare emerging professions, since we do not let some of the newer professions which have developed over the past quarter century to practice in the state as they do in other states, e.g. in New Jersey, Pennsylvania, etc I'm recognized as a fully qualified mental health professional (QMHP), in Maine my (national) credential CPRP is only recognized as a para profession. I would argue, allowing some of the newer credentialed professions with solid evidence base to practice in Maine, likely would help drive down costs through market competition.

Regarding the drunk driving, because addiction is considered a form of mental illness, services meant to address the addition are considered a covered health service. I'm not certain that helps your feeling on the matter, but that's the reason it works the way it does. Personally I'd rather see the person in effective treatment than plowing into my wife or kid in a head on.

DONALD FERLAND's picture

This is a joke. If they want

This is a joke. If they want to save money on welfare then maybe they should talk to past and present recipients to find out what worked and what didn't, what was needed and what was not needed. There need to be jobs out there for people to go to work. These jobs need to pay enough so a recipient can get off state aid completely and not just partially. Barriers to work need to be addressed, for example, day cares are expensive and do not always meet the needs of the family in regards to times they are needs. People work nights and weekends not just during the day. They need to look at the medical costs that are charged by doctors and hospitals. Bring those costs in line and they might just see a major savings. Stop giving contracts to out of state agencies to deliver a service here in Maine that is not working ..i.e. transportation to appointments. Stop making changes that make things worse not better....calling DHHS in Lewiston can lead up to a 30 minute wait for someone to answer, going in to DHHS in Lewiston can lead up to a 1 -5 hour wait to see someone (that is time that could be spent training or job searching). They are not just reviewing the Mainecare program but DHHS services in general. And again this contract went to an out of state agency. What happened to keeping money in Maine?

Claudette Therriault's picture

I believe that Mayhew is Lepage's puppet.

She, like her puppet master, are declaring war on Maine's poor. And, not all poor people are unemployed.

Expanded MaineCare is a must, especially for the working poor and the struggling small business owners. Because Maine has not yet accepted the expanded program, single people, under a certain income, are denied ObamaCare subsidies because of our state's choice. So, once again, the working poor must get free hospital care, thus launching a whole new set of problems for Maine.

And while, I'm at this, the governor has hired an anti Medicaid firm to review our MaineCare program? Really? That is so wrong in so many ways and probably illegal. But then, he does not know the meaning of fairness.

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