Republicans won't support LePage's cut to elder care facilities

AUGUSTA — The co-chairman of the Legislature's budget committee said his Republican colleagues can't support one of the largest and most controversial cuts in Gov. Paul LePage's Department of Health and Human Services budget proposal.

Rep. Patrick Flood, R-Winthrop, the House chairman of the Legislature's Appropriations Committee, said Tuesday Republicans won't back the governor's plan to cut $60 million from private non-medical institutions. 

The PNMI cut is one of the largest cuts in LePage's proposal to eliminate $220 million from the state's MaineCare program.  

There are about 470 PNMI facilities in Maine housing about 6,000 residents, most of whom would have to find new living arrangements if LePage's plan is approved. The facilities are described by advocates as housing the state's most vulnerable residents.

PNMIs often house elderly individuals who have given up their homes but who are not in nursing homes. According to DHHS, the PNMIs provide personal care and housing to about 4,290 elderly residents. The facilities also house drug rehabilitation patients and veterans. 

All that made the governor's proposed PNMI cut one of the most controversial in the DHHS proposal. During public hearings held before the holidays, hundreds of advocates singled out the PNMI cut as one of the most harmful. 

Flood told the panel Tuesday that the GOP caucus met last week and agreed it couldn't support the PNMI proposal. Flood said the Appropriations Committee would try to find another way to ensure funding remained for PNMIs.

The LePage administration has said the state's PNMI program has come under federal scrutiny and that the program was in jeopardy of losing matching federal funds.

However, advocates for the facilities have said the state need only draft new language to bring the PNMIs closer to compliance.

The governor's office said LePage knew "all along" that an alternative to the proposed cut would be necessary. Adrienne Bennett, LePage's spokeswoman, said that was why the administration's proposal set aside an additional $39 million in the budget stabilization fund.

Bennett said the money was meant to give lawmakers latitude "as they explore alternatives" to the governor's proposal.

That explanation didn't fly with Democrats, who questioned why the governor would include PNMI in his budget proposal if he knew from the outset that it wasn't feasible.

Rep. Peggy Rotundo, D-Lewiston, the ranking Democrat on the Appropriations Committee, called the administration's response "unbelievable."

Rotundo said it didn't make sense that the administration would propose a cut that constituted one-quarter of the DHHS proposal if it knew in advance that it wasn't going to have support from Republicans.

"What I’m thinking about are all the calls and the emails that I have been getting from families who have been living in such fear that as of July 1 that their loved ones are going to be out on the street," Rotundo said. "To think that the governor used them as pawns in this budget is deeply disturbing to me."

She added, "It calls into question the other proposals in this budget. ... What else is he (LePage) withholding from us? Who else is he using as pawns?"

Bennett said the administration anticipated that it would have to work with Legislature and that Rotundo's comments were "out of line." She indicated that the governor's proposal stemmed from the federal government's concerns that Maine was using Medicaid dollars to pay for room and board in the PNMI program. 

During Tuesday's work session with lawmakers, the DHHS commissioner told the Appropriations Committee on two occasions that the federal concerns were a consideration, however, its inclusion in the current proposal was a "budgetary initiative" and not a response to a federal mandate.

Sen. Margaret Craven, D-Lewiston, the ranking Democrat on the Health and Human Services Committee, said the administration's explanations made it hard to determine the "credibility of the document."

"It is very hard to work on a document that seems so untruthful," she said.

smistler@sunjournal.com

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Comments

Andrea Lavertu's picture

LePage

All I can say is, I am glad I did not vote for LePage.

Going Against...

Thank goodness...

Steve Pond's picture

balancing the budget

I am sure that the scare tactics used by Rotundo and Craven, that Governor LePage's proposal to "throw the elderly into the streets" is in part the reason behind the amount of calls and e-mails they are receiving from scared constituents. The Governor by law must present a balanced budget, LePage made his proposal, knowing that it is up to the Legislature to make changes and offer counter proposals as they see fit. Except for making partisan attacks against the administration, where are the solutions offered by either Rotundo or Craven to address the budget shortfall ? It is time to place the politics aside in Augusta and Washington and put a concerted effort to solve our state and national problems.

People that care...

Rotundo and Craven are the best...

 's picture

I will repeat again, there

I will repeat again, there would be no 'shortfall' if lepage and the republicans had NOT given a tax bonanza to their cronies. It is that simple.

 's picture

If republicans legislators

If republicans legislators were smart, they would reject all of lepage's mean-spirited cuts, and rescind the massive tax cuts for the wealthy they enacted last year. However, I won't hold my breath for sensibility and reason to infect the republican party.

Joe Morin's picture

Well...

...If the department of Labor were smart they would take your disability and give you a job in data entry or internet marketing because it is clear that you are more than able to operate a keyboard 14 hrs + a day.

 's picture

only if the Department of

only if the Department of Labor employed stupid people like you who know nothing, and just to conclusions based on personal bias, but with this current administration, it's possible.

Sandra Coulombe's picture

Not that I support either but

Not that I support either but I do have to ask why Dan is being singled out for a knock it off while the guy who attacked him first is not told the same? Double standard much?

Joe Morin's picture

there's a difference...

I made an assumption based on information that Dan has freely divulged in previous posts as well as my observations of his computer abilities as exhibited through his incessant postings. Dan is in violation because he calls people stupid. For example, if Dan would have said that I should be taxed more because I obviously work a lot based on the fact that I have divulged that I work in the private sector and the frequent long gaps between streams of posts by me. He may assume that I don't have the time to post because I'm busy making a living. That is the recipricol. If he were to assume such would that break the rules???
Lastly I apologize to you Pattie for giving you a hard time. The person who you are in response to obviously doesn't realize how much time you spend monitoring Dan Breton and his insults.

Jason Theriault's picture

Definition aside

Definition aside, cuts have to come from somewhere. Yes, I would love to fund everything, but we can't.

Mark Elliott's picture

Jason, I can honestly agree

Jason, I can honestly agree with you on this one......

JOHN PAINTER's picture

One of the reasons we have

One of the reasons we have some of the problems with Private Non Medical Institute (PNMI) services we currently do involves a mix of understanding what Medicaid pays for, what the state and other federal programs pay for (Section 8, EBT), and what the individual pays for.

Maine has used the notion of PNMI as both a type of rehabilitation service, clearly articulated in Section 97 of the MaineCare Benefits Manual, as well as a "funding mechanism" for other services most notably Assisted Living Facilities. Maine has for years has maintained a cumbersome ands costly dual licensing system, where some agencies are licensed as both Assisted Living facilities and PNMIs and this is where the trouble begins.

This past November Maine closed 5 PNMI programs, which it found after review urged by CMS, were actually Institutes for Mental Diseases (IMD) since they were over the federally allowed 15 beds serving people with mental illness and substance abuse issues, and as such were the responsibility of the state, not Medicaid.

Our current PNMI and Assisted Living Service system is poorly designed.

Maine would have no problems with CMS if our PNMI or or Assisted Living facilities billing as PNMI if it had 15 beds or less. An obvious fix to this problem is to assure agencies licensed and/or billing as PNMI have no more than 15 beds at least in any one cavity, this would mean some people need to move to PNMI's which are under the limit. This is a short term fix, since even 15 bed PNMI's or Assisted Living Facilities or what ever we decide to call them, may violate the Olmsted Act which is under the jurisdiction of the Department of Justice, not CMS.

A better, and longer term fix includes moving away from the congregate PNMI/Assisted Living model and towards home based services whenever possible.

In 2009 Maine unwisely eliminated from our state rules one of the only sensible things which existed in the PNMI service system - so called "scattered site" PNMIs. These were PNMI' services offered in a persons home, 24/7 as long as there was medical necessity as evidenced by assessment, and annually reviewed and approved through a doctors orders.

Maine's DHHS could at any time reinstitute the scattered site PNMI rules since they were already approved by CMS. This would immediately allow services to be provided in people's homes, and in the medium and longer term decrease the flow of people to group settings as the only way to access service.

Maine might also do well to move towards a more flexible and beneficiary focused Medicaid waiver, the 1915(i) similar to that used in Wisconsin in their mental health system. Maine could target it in the way which best fits our states needs, whether for seniors and or those with disabilities.

CLAIRE GAMACHE's picture

Confusing

I am wondering what is the rationale behind a 15 bed limit. You seem to understand this program perhaps you can explain to me why scattering these patients wouldn't be way more expensive since most of them can't work, can't drive, oftentimes can't feed or dress themselves. Is the plan to eliminate these services and just stick them in a boarding home ? How does this work in Wisconsin.

JOHN PAINTER's picture

Hi Claire. The 15 bed limit

Hi Claire. The 15 bed limit was set by Congress in the 1980's as a way to halt what it (in my opinion rightly) saw as many states reverting back to the institutionalization mentality/approach, we were trying to work our way out of as the result of the Community Mental Health Act set in motion by President Kennedy just before his death. It was that Act which led to many large institutions which essentially warehoused people, often with very sketchy medical or civil rationale, being shut down across the country. Congress became aware that even as states shut down state hospitals/asylums people were not really being integrated back to their communities, and were instead being reinstitutionalized in smaller facilities. This basic belief, that people should and really must be provided services in the least restrictive environment was reaffirmed in 1999 after the Olmstead Decision http://www.ada.gov/olmstead/olmstead_about.htm

Aside from the civil rights issues, most research on rehabilitation does show people tend to improve the quickest and remain the healthiest when given the option of home based care. True, not for everyone, and there are options for skilled nursing homes - however many of the people who are in the PNMIs or Assisted Living facilities are not medically at a nursing home level. If anyone is, I would certainly think in this states current dynamic that option should be utilized.

For a number of people however, having a 24/7 wrap of in home services is a realistic option and even for surprisingly disabled people (can't drive, poor ADL's, etc) they flourish, I observe this regularly at work.

Wisconsin actually has a much higher degree of beneficiary choice and direction than Maine does, yet provides a very clinically effective rehabilitation service system. My particular work (psychiatric rehabilitation) and professional interests somewhat necessitate me keeping an eye on what's going on out there in the rehab world. Did I answer your questions?

CLAIRE GAMACHE's picture

Thank you

That was very informative.

JOHN PAINTER's picture

Sorry for the mistype, i

Sorry for the mistype, i meant to say "in any one location" I'm typing on my iPad which inserted "cavity".

Norman Rust's picture

Governor's proposal regarding elderly, etc.

Thanks John for the great explanation. Having been in the medical field you certainly have a good handle on what has not worked and what could work.

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