I was born and raised in the mid coast region of Maine in the fishing village of Owls Head. I’ve been married to Katalin Vecsey (a native of Budapest, Hungary) since 1991 and in 2002 we had our first child, Kelen, we also have two Mini-Schnauzers, Martha who was rescued from a puppy mill and Isaac who we also adopted. I enjoy being outdoors, fly fishing, hunting, hiking, kayaking, snowboarding, enduro, you name it. I also enjoy experimental videography, you can view my work at Vimeo. I am very interested in the use of mobile technology particularly the iPhone and iPad in education and behavioral health, but also such things as energy recycling and thermoelectrics. Currently I’m working on a Doctor of Arts degree in leadership studies at Franklin Pierce University.
Recent Comments
Building community through the arts
While there are certainly people who might feel that art for art sake is not essential for an open, robust and enduring community, the Art Walk is a great example of community building in an engaging and long term vision.
The Art Walk is an excellent way to show off the wealth of creativity and spirit in the Lewiston Auburn area. It's well understood that the arts play a central role in leveraging human capital and cultural resources and in so doing play a role in revitalizing communities, in Lewiston's case, our downtown. While I'm glad to read there is an immediate economic benefit as commented by Michael Dostie, it's the long term and often very faintly visible benefits the arts have on cultural and economic development by their very nature of being attractive to highly desirable, knowledge-based employees, and instigating new forms of knowledge-intensive production to flourish.
Way to go L/A, keep encouraging art for art sake!
Safety first
As a person who lives on College street (765 College) and who has an active 9 year old who attends Geiger and likes to ride his bike, I would personally like to see several more speed bumps along the road to help keep driver speeds down. I think they are more cost effective than having LPD officers who do fantastic work keeping the community safe doing that work versus having to monitor the speed on the road. College street is very tempting, too tempting the further out you go for a growing number to drive fast. I regularly see and hear all types of vehicles from motorcycles to tractor trailers which are clearly surpassing the posted limit, one of the reasons I am very cautious abut letting my son ride his bike on Colege street. I do not think speed bumps pose a risk to alert and aware drivers, or pose a cause damage to their vehicles as long as they are driving within the posted limit. I think local residents should always have a say in matters effecting their neighborhood and public safety.
I get it's a rhetorical
I get it's a rhetorical question, but it's a good question to think about Gary. I think Lincoln once said a young person is someone who is 10 years younger than youreself, and an old person is someone 10 years older. In this instance rich (and poor) might be looked at in a similar light. I am concerned with the constant march this country is making up the Gini index, for a developed economy and society we have a rather unbalanced income distribution and the trend is showing greater divergence. In terms of median household income, the US census shows Maine at just under$47,000 for a family of about 2.3 people (I know my son would be sour if he heard he only counted as .3) and of course the President has suggested "wealthy" people are people with incomes over $250,0000. One might argue "rich" is a family with more than $57,000 household income.
Let me clarify that, by "very
Let me clarify that, by "very much so" I mean they are caring, I think the vast majority of Maines Legislature is.
Mary, I'm not certain the
Mary, I'm not certain the Legislature is uncaring. I think both Sen. Crave and Rep. Rotundo are very much so. What I am concerned about is whether all citizens have enough information to discuss and debate the challenges confronting us to give helpful feed back to our elected officials.
I think the individuals highlighted in this article have some options, and not certain why no one at DHHS is assisting, though there are certainly people who have more limited options. Theres currently an absence of discussion, outlining of what our states DHHS system really should look like, and what should it do.
There is little doubt in my mind or history books that before the Social Security Act of 1935 and its offspring, the Medicare and Medicaid Amendments of 1965, that life was too frequently miserable for the elderly, or if one was unfortunate enough to be disabled, or an impoverished child how nightmarish life could be. There was no ability to pursue happiness. Congress and FDR did not think Social Security would fix all the nations problems, but they did believe it could help, and from what I see as a helping professional does indeed smooth out the vicissitudes of life.
What I find concerning is the lack of serious discussion of what we want, as a nation or as a state. I also am concerned that there has been so much generational distance from American life before the Great Depression, that the harsh realities of age, illness, and impoverished childhood without Social Security, Medicare and Medicaid has faded from our collective conscious.
I wonder if as a state, let alone nation, we have the desire to look at the advantages for all of us created by our Social Security system and the desire to sacrifice at all levels to fix what is not working.
Choices
It was unfortunate that the Legislature could not find grounds to make a collaborative change to the state budget as it previously seems to have done. However the changes proposed, appear to me to be both legal (providing the state properly notified CMS of the intent and receives permission), and prudent given the dire predicament MaineCare is in. That might change depending on how the US Supreme Court rules on the legality of the Affordable Care Act.
It is unclear why the press seems to under report the troubles Maine is experiencing with the federal government over our state Medicaid plan. Understanding that may help our citizens and Legislature work together to address the problems we have in a way that has the least harmful impact on all Mainers. Readers can go to materials being posted by DHHS http://www.maine.gov/dhhs/oms/provider/pnmi/citations.shtml
Most immediately concerning is the mature woman who is worried about affording her medications. It is unclear in the article why she does not have Medicare and most importantly Medicare Part D. She would also qualify for QUIMBY that covers co-pays, deductables etc in Medicare, which would cover her medications. The article mentions she experiences depression, if it is major depression she may qualify for full MaineCare with the income indicated.
Regarding the young woman in the story, though in a tough situation, many people are in that boat. I was without insurance for some time when I was that age too. She fits into an age cohort that is the most healthy and capable of self care, childless adults without a disability are not a Medicaid required category and fall under optional coverage, the state can opt not to cover. It's important to note she would not lose MaineCare if she has a qualifying disability. Also she can apply for Dirigo Choice which has a deep sliding scale available.
Depending on how the Supreme Court rules on the Affordable Care Act, many of more could lose MaineCare, or many more could be added. Either way there will be a cost, both human and fiscal, our state much like the nation needs more informed discussion and debate on the matter.
A race to the bottom we do not want
It was clear last December when the story broke, that MSHA was not following federal HUD inspection rules, and was dodging their responsibility. I was surprised to read a MSHA employee state that there was nothing they could do to force landlords to comply with inspection. Indeed MSHA has many options, including working with landlords, terminating landlord agreements, adjudicating serious cases - such as these, and likely many others around the state.
For years MSHA has acted as if it wrote the law, and did not really have to follow the rules the rest if us do. As a human services professional this has been something I've attempted to address for years.
For example.
MSHA also prohibits people who qualify for LIHEAP assistance from receiving it due to receiving certain MaineCare services. Maine has been warned repeatedly by CMS that it can not include room and board in its Medicaid rates, however MSHA has consistently excluded income qualified disabled individuals from LIHEAP (who pay their own room and board, and provide MSHA; rent, utility and food bill receipts) because they receive PNMI services, stating that they are disqualified because the room and board is included in the cost of their services.
Avoiding federal law violations
While I applaud the bipartisan work done to develop our state budget, I also applaud the Governor for doing his job and closely reviewing each line in a very large supplemental budget.
To his credit, Governor LePage made a very reasonable decision that many of us in human services would have made too, preventing our state from further costly violation of federal rules by using Medicaid funds for funding an Institute for Mental Disease (IMD).
Maine is currently under review from the Centers for Medicare and Medicaid Services (CMS) for a large number of serious violations of federal Medicaid rules over many years. In my growing respect for Commissioner Mayhew, she has begun to post online communications with CMS over the past several years of the most serious problems our state must correct in how we administer Medicaid funds, and promulgate state MaineCare rules. A listing of those communications can be found here
http://www.maine.gov/dhhs/oms/provider/pnmi/citations.shtml
Using the line item veto to strike down use of Medicaid funds for our state psychiatric hospitals was a wise act by Governor LePage.
Excellent! Can't wait to
Excellent! Can't wait to stop in.
The Governor is right
The Legislature could overturn GA line veto, but really can't touch the line addressing using federal funds at either of our two state hospitals.
People who are in institutes for mental disease (IMD), such as Riverview (formerly AMHI), Dorothea Dix (formerly BMHI), and a number of others have not been Medicaid reimbursable since the Medicare and Medicaid Act was established in 1965. This is clearly spelled out in the Federal Code
CFR-2010-title42-vol4-sec435-1009.
Further limitations by Congress in the early 80's restricted states from "warehousing" people in the community by setting limits on such facilities as Private Non Medical Institutes (PNMI), group homes, etc which are federally restricted from having more than 16 individuals living there. The Department of Justice has even tighter standards it enforces as a result if the Olmestead Act.
You can read the statute here:
http://www.gpo.gov/fdsys/pkg/CFR-2010-title42-vol4/pdf/CFR-2010-title42-...
April 13 CMS letter to DHHS approving PNMI /IMD determination extension and warning to not bill Medicaid for IMD services
http://www.maine.gov/dhhs/oms/provider/pnmi/documents/IMD-Extension-Lett...
Medicaid fraud and the Maine tax payer
While I continue to have concerns with the Governors communication style, he correctly interprets and vetos line 0105 in LD1903.
This is the line which reads "Adjusts funding to reflect correct reimbursements to Riverview Psychiatric Center and Dorothea Dix Psychiatric Center from MaineCare" which is clearly illegal under federal Social Security law which Medicaid falls under; Sec. 1923. 42 U.S.C. 1396r–4.
It remains unclear to me why the Maine Legislature considers itself above federal law and approved a budget which clearly violates the Social Security Act. This is nothing new, and should be understandable to those Legislators with human services backgrounds.
I appreciate the tremendous work efforts of both houses of our Legislature, and all our local Legislators, I fully appreciate the huge challenges they have before them, none the less I expect these fairly straight forward things like following federal statute. More so, I expect Maine tax payers and those who rely on MaineCare for life sustaining supports that this problem is addressed quickly.
She really is that good!
I can assure everyone reading this that Kati has been working non stop on this lecture and it will be quite excellent! I think there will be some great insight into the use of ones voice to create not just characters on stage, but the role of controlling your voice in shaping other peoples perceptions of you. This is not only critical for actors, but anyone who relies on their voice... that would me virtually all of us.
While I agree sith senator
While I agree sith senator Craven there isn't a cost savings in this move, I also think it happening so late in the Legislative session is questionable. However there could be future savings or avoidance of issues with CMS if it's determined ICMs have ever billed MaineCare for people in jails, IMDs, or otherwise under the care of the Commisioner e.g, people released from Dorothea Dix or Riverview Psychiatric Hospital's forensics programs, but are still court ordered to receive services.
Maine currently has private non profits which provide Assertive Community Treatment (ACT) services which is an effective evidenced based psychosocal rehabilitation model that was developed specifically to reach out to people who are resistant to mental health services. Sadly over the years ACT service funding has been cut, and state rules which could have helped them attain full staffing for 24/7 services were allowed to fizzle out. While I am not involved with ACT services, I know people who are and they are all very capable. I also know ICMs who are losing their jobs, and while it's a loss for them personally, it's a loss for the service system since they do indeed have exceptional people skills. If the state fully funded ACT service I see no reason why they couldn't easily get hired into ACT teams.
It's not clear why the Commissioner would contract services out to private ICM versus fully funding existing ACT services, however shifting the service from the state to contracted organizations fits with the Administrations mantra about reducing the size of government. I agree with Director Cousins that this is a way to streamline without eliminating a helpful service.
It is unfortunate for all
It is unfortunate for all Mainers that there is such political rancor related to MaineCare, we have very real challenges looming none the least of which are clear time sensitive mandates from the Centers for Medicare and Medicaid (CMS) of what Maine must do to address a number of serious problems we have or face federal intervention which could include more in-depth audit of our system (usually at the states expense), withholding of payments, clawback of payments for services not allowed, etc.
While Maine clearly needs to address a potential error of paying for some 19,000 MaineCare beneficiaries who lost eligibility. Our system needs to strive for no errors, the issue as the Commissioner points out, is complicated because over the decades Maine never merged or created a clear process for eligibility and payment systems or personnel to communicate. Along with that, an error rate of around 6% in Medicaid programs is within the 3 year rolling rate PERM (payment error rate measure) which CMS evaluates states with. In other words, while 19,000 eligibility errors is not good, it is within the average of errors which happen in all states Mediciad programs.
If the Legislature is not aware of these historical issues with our MaineCare system, that would certainly be a problem. I don't think that is the case, how the issues as characterized by Senator Schneider comes across, is just plain unhelpful politicking.
What continues to remain unaddressed by either the Administration or Legislature is the Damocles Sword of the directive by the Centers for Medicare and Medicaid (one directive from 2008, and another from this past December 23) to correct our states billing practices regarding bundled rates, billing which did not get submitted before the end of the year which qualified for ARA "enhanced FMAP" (Maine will not be able to draw down that enhanced rate) and the issue of paying back Medicaid at the "enhanced FMAP" for errors submitted over the past several years.
These are not partisan problems, these are Maine problems, we need our elected officials to understand with guidance from DHHS, and thoughtfully and timely address to help assure future (hopefully effective and efficient) functioning of our states social service systems, there are too many frail elderly ads seriously disabled citizens to let these issues to become political fodder and go unaddressed.
There is clearly a conflict
There is clearly a conflict of interest, I certainly hope the Maine Ethics Commission http://www.maine.gov/ethics/legislators/index.htm has a very close look at this dynamic.
Again, an excellent outline
Again, an excellent outline for moving the L/A area "out of the shadows" and into a central role in our state, maybe one day the region. I especially agree with working on improving our educational system, we want people of all ages understanding the value of being a life long learner for them personally, but also as a community. Though unable to attend the meeting in person I appreciated the virtual component from the SJ as well, and hope to see more down the road, maybe opening things up like WCSH 6 has started to do on Friday morning broadcast with their Google+ video community. Nice work folks!
From a pragmatic standpoint,
From a pragmatic standpoint, merging substance abuse and mental health departments makes sense (elder care and developmental disabilities makes some sense too, due to long term care needs, though this is not my area of specialization) since there is very clear research on the co-occurring relationship. Approximately 47% of people with a severe and persistent mental illness have some form of substance abuse challenges, it makes sense to have a pooling of resources, both fiscal and human. Indeed best practices research also suggests better outcomes when services are integrated.
The real development is one which has its roots in the Affordable Care Act (ACA) euphemistically referred to as Obama Care. That development is an integration of all health care, referred to as Patient Centered Medical Home, which is in reference to the recognition that effective and efficient quality care emerges from a primary care relationship, ones relaionship with their primary care provider is central to health maintenance, and improvement when one is not well, it also seeks to move away from fee for service payment models and towards wellness outcomes. This later part was the direct result of efforts in the Bush Administration to improve healthcare communication and coordination and in doing this drive down the cost of healthcare, which lead to the creation of HIPAA.
I think it is important to bolster frontline staff in all DHHS services, since they are the gatekeepers and reviewers of the fuctioning of the system, developing a long term strategy to address Maines unique needs as a rural and rapidly aging state with a number of serious health issues is critical at this point in time.
I really like the concept and
I really like the concept and modern feel, and agree its not something that would be built here, but the vision is fresh while still working off of existing structure of the community. More power to the Museum to fully develop the concept and move towards an actual plan!
If a service provider
If a service provider (physician, mental health practitioner, pharmacist, hospital, etc) intentionally overcharges MaineCare, up-codes, does not actually deliver the service or good, would clearly indicate Medicaid fraud, waste or abuse. If convicted there are usually a series of remedies including restitution of overpayments and loss of ability to participate in the Medicare and Medicaid programs, and possibly civil penalties as well.
Being elected Speaker of the House of Representatives is an entirely different process, that is not to say that the Legislature should not carefully consider electing a Speaker with high integrity best representing the Party and State.
I'm not interested in the politics, though I do believe that Maine like the nation struggles with governance by consensus. We live in a civil society and should be willing and able to have polite but assertive discourse on the running of our State.
Unfortunately this error
Unfortunately this error plays well in both Parties politics.
While I tend to agree that the Commissioner should have notified the Legislature of the problems as she knew them with MaineCare while she was meeting with the Legislature, the fact that some 19,000 written notices went out to people informing them that they were no longer eligible for MaineCare only adds creedence to the Governors cries of widespread fraud.
It remains unclear at this time whether any of those individuals might have reported their MaineCare not being shut off, and what if any response they received from MaineCare. It is unquestionably Medicaid fraud on the individual level to use the benefit once one becomes ineligible, even if MaineCare continues to pay. Whether one read their mail and didn't believe it, threw it away or ignored it none the less indicates misuse of an entitlement.
One of the lessons hopefully both Parties will walk away, aside from fixing this problem, is helping beneficiaries better understand their rights and responsibilities.
I think Odelle's budget is
I think Odelle's budget is ambitious and what Lewiston Auburn need all businesses, public, private engaging in. Making sure Lewiston Auburn isn't thought of as just two exits on the interstate. The more vibrant our communities are, the more our students graduate from high school and go to college or trade schools, the more our downtowns are energized, and of equal importance the easier it is to establish a business in L/A the better our prospects will be.
I think City Council representation on L/A Arts is realistic - with their Boards agreement, and IF, the Council representative actually attends all their Board meetings and has the same duties as any other Board member. In other words, if they have a role of improving coordination between the cities and L/A Arts.
This type of problem within
This type of problem within MaineCare is not new, and not caused by any one Party, rather it is a systems problem caused by regular changes in leadership and people with institutional knowledge of how to manage large systems.
Unfortunately this is coming to broad public light at a very inopportune time. Maine is currently under tight deadline from the Center for Medicare and Medicaid Services (CMS) 90 days starting 12/23/11, of providing to them an approved plan of correction for it's PNMI bundled rates. The correction must entail provider agencies documenting and maintaining on site certain staff credentials, specific hours of work, etc to assure services are being provided by properly credentialed staff. Which to date it has not. No agency I have heard of has been informed of changes in its budget development, staffing patterns, personnel records, etc which would be required to establish compliance with an approved plan.
The letter from December 23 of last year http://www.maine.gov/dhhs/oms/provider/pnmi/documents/CMS-12-23-2011-Let...
by Richard McGreal regional chief for CMS, gave the state 90 days to get it's rules amended or rewritten - and approved by CMS for how the Department will address it's PNMI (and other services) bundled rate issue, or face a "formal compliance process".
A formal compliance process would indicate a very specific plan of correction and likely suspension of all federal payments.
I do not believe this is a time to point fingers, rather it is a serious juncture for the states MaineCare program and as many who can help Maine overcome this challenge should for the sake of keeping the most vulnerable in our society safe.
Excellent, another small
Excellent, another small business! I'll have to check out if they have any byrek on the menu!
Sen. Snowe has served Maine
Sen. Snowe has served Maine well, I agree on both areas that Congress (both sides of the isle) must find new ways to work together in a collaborative process for the betterment of our nation, I also agree it is time for her to move on. Thank you Sen. Snowe for your service to Maine and the nation, I wish you the best in your new endeavors.
My wife, son and I went to
My wife, son and I went to Sea 40 tonight. My son is 9 and he loved the Chefs and the food, he now wants to go back for his birthday, We ate hibachi (my wife and i will go out for sushi alone sometime) and I had the chicken, my wife had the salmon and my son had the kids steak hibachi and everything cost $47.10 not including the tip, we had a great time! I don't think this was expensive and way more fun than the run of the mill Applebies or TGI's. I don't know if little kids would like it, there are flames shooting up, smoke Chefs chopping fresh food and tossing bits of food to customers across the grill, it's hibiachi as I remembered it. Like I said, this helps make Lewiston more vibrant and a place to go. Yes it's in he old Ames store, but until you go inside you really can't imagine what they've done.
Welcome to town Sea 40! This
Welcome to town Sea 40! This is exactly the type of thing which attracts and keeps young people in Lewiston, and Maine. We need more variety around here. Hibachi style eating is not about gulping down deep fried calories. It's been awhile since I've ate hibachi style, but the prices listed are anything but expensive - good hibachi is both entertaining and healthy. Can't wait to get over there.
Now is precisely the time to
Now is precisely the time to begin 'laying the tracks' for the return of passenger rail service to L/A. Maine once had a very extensive and affordable light rail system (as did many parts of the country) which was systematically dismantled by the petrolium and auto industries. Having lived and worked in Europe, it is very clear to me rail saves money for individuals and economies by moving more people safely and quickly for less. I think cars are essential in the American economy especially as one gets into rural areas like Maine, but freight and passenger rail is an essential part of the equation for our economic recovery as oil prices continue to climb. The billions of tax dollars which subsidize our national interstate system and petrolium companies could and should be moved towards rail.
What this study showed was
What this study showed was the child was able to perform the math calculation in her head and choose the correct answer on the iPad. Paper and pencil not required.
That computers (iPads are just very portable ones), can improve children's mathematics learning is nothing new http://www.nytimes.com/1998/09/30/us/computers-help-math-learning-study-... The real issue is how well the iPad might be able to help children move beyond basic mathematics to more complex math and logic concepts essential in a STEM education system, for example expanding the "classroom" into age appropriate places where those STEM skills are used, my 9 year old is certainly interested in how his iPod Touch actually works - he might benefit from a school experience where some of his day is paired with a technician at National Semi Conductor using the math he is learning in semiconductor design. Then again there are days when he just likes to climb trees, it's all good.
This is a good illustration
This is a good illustration of what the iPad can help teachers and parents with, making the necessary rote memorization of things like core mathematics a more self-directed and dynamic learning process for children. Hopefully the schools do not stop there and encourage the students, for example to become involved in activities like MIT's great SCRATCH project http://scratch.mit.edu/ to encourage the creativity, collaboration, and logic important for future success in STEM education. There are some very young children using SCRATCH who have created some impressive software programs, this goes a long way in encouraging future engineers, researchers, etc.
This is a good illustration
This is a good illustration of what the iPad can help teachers and parents with, making the necessary rote memorization of things like core mathematics a more self-directed and dynamic learning process for children. Hopefully the schools do not stop there and encourage the students, for example to become involved in activities like MIT's great SCRATCH project http://scratch.mit.edu/ to encourage the creativity, collaboration, and logic important for future success in STEM education. There are some very young children using SCRATCH who have created some impressive software programs, this goes a long way in encouraging future engineers, researchers, etc.
Yes adult ed is a different
Yes adult ed is a different story, adults learn differently than children. Though even children have significant differences in learning style and intelligences, which our current education system in the US and Maine is rather poor at exploiting the full potential of - this has been my concern for many years as a hinderence to our educational system, Harvard's Howard Gartner has done considerable research into multiple intelligences http://pzweb.harvard.edu/index.cfm an area which is still largely ignored in how we evaluate students, teachers and schools effectiveness. I'm not certain, with the cost of bricks and mortar schools we can afford to only recognize education which happens there. The pre reading ability you describe (navigating the iPad/Internet symbols) is actually a part of developing literacy, this is related to the theory behind helping children learn language first through sign language.
And I agree, if my son (9 years) goes on about Angry Birds much longer, Angry Bird this and that, their not going to be the only ones who get angry.
Yes Bob you can actually turn
Yes Bob you can actually turn off Safari (the web browser), and lock that app away from kids and replace it with an app such as Mobicip which is a secure child safe browser. Alternatively, it's also very easy to limit the iPad, at least at school and home to a MiFi system wich is a wireless intranet one can completely control the content on -this is not internet but certainly could help a child learn how to use the internet.
I agree communication is key
I agree communication is key Jason. Though I have more concerns with contemporary "face to face" encounters, I know in Lewiston my son attends Geiger where i have nothing but high praise for his teachers, much of the face to face (in classroom of 25 kids) is dealing with behavior, and as a classroom size expands I don't know that our current assumptions of face to face are particularly effective. My observation of the use of iPads and my own use in teaching in Adult Ed actually expands face to face time by boiling down/through all the other distractions (pulling out different books, finding that elusive #2 pencil, etc, etc) so in class I'm more focused on teaching. It also gives me more opportunity as students grapple with a task outside of the classroom to help them in that moment without eating into time - in other words I find it allows me to indeed teach outside of the classroom as an individual learner grapples with, say how to set up their mailbox, or shut off apps running in the background of their iPad e.g. http://laeipad.blogspot.com/
Good questions. The iPads are
Good questions.
The iPads are already bought and paid for. The real question, will be, is this device something that could begin to replace books and various supplies down greatly reducing the cost of acquiring and maintaining that inventory? Auburn is too small of a study to answer that, but it's one of the things to evaluate. The other significant question is one raised by Education Commissioner Bowen, that of meeting his challenge for creating an education anywhere/everywhere system. While there are certain academic activities which may be best delivered in the traditional four walls of a classroom, there is a tremendous amount of potential for education outside of a classroom environment which we do not captitalize on. While I would not suggest we might not need the expense of building and maintaining traditional school buildings down the road, whether we need the size and costs associated with building and maintaining those physical plants, that's another consideration.
This is certainly encouraging
This is certainly encouraging information;
“In every measure we examined, the iPad students were outperforming the comparison students. When looking at short-term literacy gains, we're definitely seeing the data trending toward favoring the iPad students.”
though, I would caution, just beginning of evaluating the role of iPads and similar devices in education.
Having worked with iPhones (repairs, training, writing for iPhone Life magazine) since they came out and now iPads (teaching a Lewiston Adult Ed class on them) it's fairly clear to me that the nature of the touchscreen interface and interplay with audio and accelerometer in the devices makes them much more dynamic than a typical laptop, or cell phone, etc. An example of how I've observed the devices help improve literacy is with dynamic books like Ocean House Media's Jack in the Bean Stalk which allows a child to read or will read to them, and help pronounce words. In short, while I believe it is best for a parent (or other involved adult) to read to a child, in those instances when it's not possible, the iPad (and iPhone, iPod Touch) can take over the role, thus extending the reading experience critical to gaining literacy skills.
I think the L/A area children, and Maine can prosper by leveraging the additional time and attention to education the iPad can offer. I think the real potential however lays further down the road in secondary and post secondary education. I can personally vouch for the exceptional ability of the Biostatistics app which clearly outdoes SPSS (for anyone concerned with statistics) in both its portability and ease of use.
I agree with rescinding the
I agree with rescinding the tax break in this instance, however it will not be enough because our problems with the Centers for Medicare and Medicaid (CMS) is over how our state Medicaid Plan is written and how we have been running our Medicaid program (MaineCare) since the last renewal. To clear a path out of the MaineCare woods will require DHHS rewriting our state plan, and apprising the Legislature so that its fully aware of what our plan allows us to do. We have not really fixed the PNMI issue, there are still PNMI's with over 15 people (theres one with 40 + people in the County) around the state which is a clear violation of both federal and state law, Maine also "bundles" rates for a number of it's MaineCare services, something CMS has expressly warned us about not doing - at least without very detailed descriptions maintained by provider agencies what service and who is providing it in the bundled rates, and several other issues.
Furthermore, by 2014 when the Affordable Care Act (ACA) kicks in, a provision in the ACA expands the income limit to 133% of the federal poverty level. That means 10's of thousands more Mainers will qualify for regular MaineCare - I do not see anyone trying to develop the system now to manage that.
There are ways to manage the mess we have with MaineCare, both major parties cooperating is a good start, but it will take more - the Executive branch, I think, will need move beyond saying "No" to "How shall we".
Maine's race to the bottom
Then the Social Security Act Amendment of 1965 was passed it was done so after Congress recognized the rapid aging of the US population, between 1950 and 1963 growing from 12 million to 17.5 million senior citizens and the rapidly rising cost of hospital care at around 6.7% annually.
I would suggest that Maine has a similar dynamic and that current planned cuts to MaineCare by both the Legislature and Executive branch of Maine's government will only exacerbate our states race to the bottom - a return to the pre-Social Security Act of 1935 (the Act under which Medicare and Medicaid exist) life. Which was ok if you were young and able, but, contrary to much of the romanticism of the past, for many if not most Americans who were old and or disabled, uterly horrible.
The system we have developed in Maine is not sustainable, it does not mean however there should not be a safety net system; the aged, children and the disabled.
Maine should focus on preserving the social safety net for those individuals who are vulnerable, frail and unable to care for themselves. While I personally think as a nation we should move towards a basic form of universal health care, Maine simply does not have the economy of scale to do so. Continuing on our current watered down services only fosters a true race to the bottom, equivalent to a $10 tax break spread out over the course of the year.
A new beginning
I think an expansion of the arts downtown, if Odelle can find a suitable new location for Gallery 5, would likely attract people do the downtown. Over and over we hear from young people that part of the mix to retaining them locally is fostering vibrant social opportunities. That often includes a variety of eateries, arts and entertainment, retail and the like. We have a new Mayor and a new City Council, this would be an excellent opportunity for them to show some vision and leadership and help create a new beginning for the downtown.
I'd be happy if we actually
I'd be happy if we actually had a winter. Ahhh what do rodents know.
Personally I think Maine has
Personally I think Maine has a lot of potential, that's why I moved back, though my wife (who is a naturalized citizen) found it very hard at first to give up the more robust economic and cultural life in other urban areas. Having grown up lobstering, I was prepared, though having lived outside of the state and country for several years I had to readjust too.
Maine has for many decades thought of itself primarily as "vacation land" for others, and not enough as gateway to Canada, Europe and the information age. Unfortunately when we have attempted interesting things; Dirigo Choice it has been far beyond our economy of scale; or the laptop initiative - too focused on the particular machines and not STEM education to make them do helpful things, to be viable in the short, let alone long run, though we have the core necessities to develop into a more economically and culturally robust state. For that I am hopeful, I've always felt Mainers know how to get things done - maybe not so pretty but we make it happen.
Our infrastructure like roads and bridges are in rough shape, like most of the other country, I agree with you that's a drag on people and our economy.
If we don't get an exemption
If we don't get an exemption from the MOE, it will cost us $200 million or so, the projected deficit for DHHS, as we are evidently using 4th quarter funds to cover into April.
The exemption from MOE is not the only way to go, we could cut other state agencies, like education and any of the other state agencies - though there could be unanticipated problems and costs down the road for cutting them. We could raise taxes. There are options, though all of them have consequences and don't necessarily address the real issue. I do not envy anyone in the Legislature right now.
I don't think the real issue is about waivers or extensions, or money, specifically. I think the real issue is there isn't a real vision, direction or organization of DHHS, other than to cut costs. The risk right now, is that we have a fairly new administration which is playing catch up and doesn't quite comprehend the problems it has inhereted, and when it does figure something out is so callous in presentation of the problem that no one can see the forest for the trees.
Tina, We are already having
Tina,
We are already having "trouble with Washington" / Ceneters for Medicare and Medicaid Services (CMS) for a number of issues including the PNMI issue which is not resolved, bundled rate services, credentials of providers Maine has approved and not approved in its state plan, and several other serious things. Maine currently has 60 days to provide a written correction plan to CMS to correct these and other issues, failure to do so would, according to CMS regional head Richard McGreal result in stiff sanctions e.g. closer scrutiny, claw back of funds, etc. This would not go well for Maine, we tend to have very sloppy Medicaid program, I doubt the Feds want to look unless they are forced too such as ongoing rule violations.
I believe currently the LePage Administration and Legislature are misunderstanding Title XIX rules mixing Federal statute up with the Affordable Care Act (ACA), which is cerainly a bear to read but which is fairly clear that it can with state certification of hardship, exempt the Maintenance Of Effort (MOE) requirement under the ACA.
This is the full link to the memo from CMS to state Medicaid Directors which includes the circumstances states must face, and process and extent of exemption from MOE read at this
link http://www.cms.gov/smdl/downloads/SMD11001.pdf so that you can get a sense of the context.
I'm hopeful that our elected officials will pull things together, since not doing so risks much more that $200 million.
The tyranny of the status quo versus care of the most vulnerable
While it should be clear to anyone familiar with Medicaid CMS never issues "waivers" to reduce eligibility - that's contrary to the Social Security Act, it is evidently not clear to many in our Legislature or DHHS that CMS can in certain circumstances approve exemptions from the MOE requirements of the ACA. This was made very clear last year.
The direction to each of the states Medicaid Directors was:
"Yes. Under section 1902(gg)(3) of the Act, as added by the Affordable Care Act, during the period January 1, 2011 through December 31, 2013, if the State submits a certification to the Secretary that it has or projects a budget deficit for the current or following State fiscal year, the Medicaid MOE provision does not apply for certain adults during that year. (See Q4 about the interaction with the Recovery Act MOE provision.) Specifically, this exception to the MOE provision may be applied to adults who are not eligible for coverage on the basis of pregnancy or disability and whose incomes are above 133 percent of the Federal poverty level (FPL). (See Q5 for more details on the specific options available to States.)
It is important to note that, while the MOE would not apply, the State would need to submit a Medicaid State plan amendment (or amendment to a waiver/demonstration under section 1115 of the Social Security Act, as appropriate) to implement any reduction in eligibility."
This is the full link to the memo from CMS http://www.cms.gov/smdl/downloads/SMD11001.pdf so that you can get a sense of the context.
I hope that the current debate over words "waivers" versus "exemptions" in Augusta quickly boils away so that we can address both a deficit in our MaineCare program and current directive from CMS to amend our state Medicaid plan within 90 days (starting this past December 23) or face severe repercussions due to several factors not mentioned in this current debate for some reason.
A step in the right direction
For years I have been concerned that Mainers assume the only valid education happens under the aegis of the four walls of traditional schools. I see the Commissioners proposal as a step (needing guidance from our local teachers and administrators) in the right direction. Education happens everywhere and while there are aspects which are very essential which take place at a school and opportunities on line that directly address some of our STEM focus such as MIT's SCRATCH program http://scratch.mit.edu/ (helping children learn the math and logic required for computer programing and other fields), education also takes place out in our communities, but without guidance of teachers and parents, that can be overlooked or potentially lost. I've been very involved with following the efforts of such programs as FutureLab http://www.futurelab.org.uk/ in the UK which is very skilled at linking technology with formal education and education as it happens in a childs community or travels - and in that way capturing and helping transform some of those "ah ha!" moments into a deeper understanding. I think it's within those types of educational experiences, we might, as a state and a nation, regain some of the our lost ground that has helped make this state and country great. I appreciate all those who dedicate themselves to education of our children and am rooting for them to take it to the next level.
Maine is a small state, and
Maine is a small state, and it stands to reason there will be instances where people in the Legislature, Judicial, or Executive branch will have situations where they're creating laws, rulings, proposing bonding, etc which could have a positive impact on themselves, organizations they're associated with, family or close friends. That in and of itself is not necessarily bad, as long as there's not a disproportionate benefit. I happen to agree with the Governor, having transparency in these matters is essential to both improve public trust and address actual conflicts of interest. I also agree with Joe Brannigan, “The more transparency, the better." and it should start at the top.
There are several issues
There are several issues going on within Maine's Department of Health and Human Services which I have yet to see anyone from within the Department clearly articulate to the Legislature or public for that matter. Let alone tackling the intricacies of the ACA.
In my mind this raises the question of whether there is really anyone who understands the full range of problems and as a result appropriate ways to address them. Having worked in behavioral health for many years I am familiar with mental health policy, services and practices which are often mismatched. I hear from friends who work in primary health care there are comparable issues. In terms of our behavioral health service system, we clearly have some issues which have been brewing for years.
Maine clearly has some long standing issues with its Medicaid program which are outside the debate over the ACA or the politics embroiled between the Blaine House and Legislature; 1) Maine had/has some PNMI programs with more than 15 beds allowed by CMS, 2) there were/are questions from CMS about whether our state has mixed room & board costs (which are not reimbursable through Medicaid) into some of costs we billed the Federal government for, 3) Maine has consistently told CMS that PNMI is just a billing method and not a service despite Section 97 of the MaineCare Benefits Manual clearly stating PNMI is a bundled service - this is an important distinction because since 2009 Maine DHHS has denied people access to certain PNMI services which it offers to others.
These are real, serious, and systemic issues which require the Department to address through modification of our state Medicaid plan, and the Legislature to understand the nature of the problems to better understand funding requirements.
I hope that this "loop hole"
I hope that this "loop hole" will be closed, and possibly an inquiry held to assure there are no more such loop holes and determine if there was any breech of the public trust by these officials.
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?
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".
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.
Maybe its time Lewiston
Maybe its time Lewiston should make a proposal to Carbonite for a long term joint venture. Carbonite gets a deeply subsidized location for a server farm if they agree to having that proposed hydroponic farm described in the article. We have the ideas thanks to the SJ and readers, now it's time for our Mayor to lead and find out what the possibilities are, with some new city counselors not bound by old assumptions about the city, and some savvy local business leaders, even a low cost local energy producer to possibly get in on this 2012 has many opportunities. Let's go.
Some options
While quite familiar with PNMI's Clovers cost structure is not made clear in the article, though it appears people using their services pay their SSI, SSDI or straight Social Security to the state which then pays Clover the room and board leaving the individual with $70/month. The cost of the PNMI service which is negotiated on a per Diem rate is then billed to MaineCare. If this is the case it would appear the people living there do not have their own housing voucher e.g. Section 8, or food benefit e.g. EBT which is problematic in a PNMI level service since it is considered a short term or medium term rehabilitation service. Maine has had a tendency to use PNMI as a funding mechanism such as it appears with Clover, which appears to be licensed as an Assisted Living Facility, though likely also licensed and funded as an Appendix C PNMI - this is where the problem lay in our states system.
In the short term, assuring people are not displaced from housing is important, as is maintaining core IADL supports and medical services. These are not being proposed as areas to cut since they're required. Along with what appears as a mini nursing home fiscal structure, if people at Clover are turning their Social Security over to the state already, the housing should not be a problem even if the Medicaid service changes e.g. shifts to fee for service since the Governor has indicated he has approximately $40 million set aside for this issue.
In the Medium term the state could look at whether people at Clover might better fit into Section 19 HBC services since the article is describing medical conditions. In the medium to long term, the state should pursue a 1915(i) waiver to allow the flexibility to target populates it identifies as important while continuing to address our states fiscal realities.
Hopefully as the Legislature grapples with the issues of cost, loss of services, etc it keeps an eye on the future system design to assure there is both oversight of our DHHS and developing a safety net system which is never at risk.
My deep regards to all those at Clover and similar PNMIs and their families and friends anxious at this time of year which should be focused on matters of the heart and family.
Is there a problem at MSHA?
While I certainly understand MSHA wanting to work with and develop house options for Mainers with owners, they do have obligations in administration of federal funds, to assure both parties abide by HUD rules. The response from MSHA representative didn't make sense, hopefully they were misquoted, this is a pretty clear violation by the owner of the HQS (thermal environment requirement, possibly Access too since the implied habitability is in question if it's that cold) which either the local PHA or certainly MSHA is absolutely supposed to vigorously remedy with the owner i.e. rent can be withheld, the owner can be removed as a vendor, lost rent during in habitability recovered. I hope the owner addresses the deficiencies he has accepted rent for and the tenants receive the housing they signed their rental agreement for.
I hope the snow we're getting
I hope the snow we're getting this morning sticks around and helps out these businesses, and helps to get the season feeling, well, more seasonable. I'm actually looking forward to running out at 6:30am in my longjohns and boots to pay the plow guy, as the cold and wafts of diesel and cigar smoke hit my nose, catch up on the gossip he's heard, mechanical challenges his F250 has been having that he has overcome and dash back in the house for that cup of hot black coffee. Happy holidays!
From cutting to transformation
The Governors proposed budget cuts to MaineCare our state’s Medicaid program are as sweeping as the proposal years ago to add those optional services.
The proposed cuts the Legislature must now struggle with are for optional Medicaid services, one of them in particular, PNMI medical and rehabilitation services has been found in five cases to be in violation of Federal rules and were required to cease operation by CMS this past November. Still at risk is how the state had developed and allowed many PNMI’s to operate, most seriously co-mingling room and board costs with the cost of medically necessary services. An ongoing risk is how the state developed PNMI’s in recent years to require people to give up their housing and move into group homes in order to receive medically necessary services, this pretty clearly is contrary to the Americans with Disabilities Act, the Olmstead Act, and common sense.
Having participated in the state PNMI service provider meetings the state held in October to try and understand what provider agencies thought could be done and what services were important to save, I was surprised at the range of non-reimbursable services most agencies offered and proposed as essential to retain. Many of those services were ones which are indeed important for a persons overall wellbeing; housing, food, recreation, spiritual needs, etc but are not paid for by Medicaid. There are a host of other programs already in existence, which can and should be, utilized for these needs to avoid duplication of services and to assure the state and service providers are not attributing non-medical costs to MaineCare.
The debate around PNMI’s isn’t so much the services, most medical services still remain since they are required services under Medicaid. The real delema is about how to assure people whos housing was bundled with their medical services gets untangled so that we do not have several thousand senior citizens and other adults and children with serious disabilities literally homeless.
There are a number of options including utilizing the existing service provider tax from those PNMI’s, estimated around $38 million, to create a temporary board and care network with their existing PNMI service providers in the short term, to assure peoples housing remains intact while the state develops and seeks approval from CMS of a new system. We also have a strong partner with VA system which is currently under a mandate to end homelessness for all veterans, Maine should fully utilize this initiative to assure veterans in PNMI services do not become homeless.
While the MoE provision in
While the MoE provision in the ACA indeed protects Medicaid enrollment status for medically needy beneficiaries, there is indeed a process for states to petition for exclusion of populations such as childless adults (though not children who meet the increased FPL limits) due to fiscal deficit under section 1902(gg)(3) of the ACA, even so the MoE is only in place until the Feds verify that a state has an operational Exchange, this is stipulated under section 1311 of the ACA. Once that is in place states can revert to core Medicaid coverage, except for those under 19 years of age who will need to be covered regardless until mid 2019.
We are in very challenging
We are in very challenging times and I hope the Governor and Legislature fully understand the variety of human risks from inaction or action which is based on political objectives and not the human needs of fellow Mainers. The sense of dispare is heart wrenching and I hope that maybe some commentary might lend to helping those in need. I hope Mrs. Bouchard does not lose her oxygen or other medical necessities, if she has life sustaining needs she would qualify for regular MaineCare though she would likely be faced with a spend-down (Medicaid terminology for deductible), she should pursue this ASAP. Pine Tree Legal offers an easy to understand explanation of the process http://www.ptla.org/mainecare-deductible-how-does-it-work
In the article it is not clear whether Mrs. Bouchard has enrolled in Dirigo Choice, which is still active http://dirigohealth.maine.gov/Pages/dirigo_choice.html though it is slated to transform into the health exchange called for by the Affordable Care Act (ACA). It is also not clear why she does not have SSDI since the article indicates Mrs. Bouchard has a work history but is not able to work due to her injury, this should qualify her for SSDI http://www.socialsecurity.gov/applyfordisability/
I wish the best for all the people in fear of losing medically necessary services and hope that will pitch in to try and help those in need with information and support.
My deepest sympathy to the
My deepest sympathy to the Paradis family in this time of great loss, my prayers are with all of you. God bless.
Nick, I don't think your post
Nick,
I don't think your post was impulsive as much as cathartic, most of us are feeling the pressures of a bad economy and feeling a bit hypervigilant. I am.
Regarding your concerns though, states do not have the ability to impose drug tests to qualify people for federal entitlements (with out a federal amendment), we certainly can amend our state plan so that we only cover the basic services and populations required by CMS. This is much of what Governor LePage and Commissioner Mayhew are proposing in the budget plan just released.
There are actually a number of us in health care supportive of bringing our state Medicaid plan back into alignment with federal rules, and in so doing strengthening our safety net system and reinvigorating civil rights for people with disabilities (I'll explain that below). However, how the Governor introduces such large and sensitive changes leaves much to be desired and in the process, can undermine some of the necessary changes our state needs.
For example, in my field, adult mental health, the state has missed virtually every opportunity to implement a recovery based system - though it has done a lot of talk about it, whether from funding, regulatory or practice perspectives. One of the reasons behind the the proposed elimination of Private Non Medical Institute (PNMI) services is because of; 1) lack of actual rehabilitation practices necessary for Medicaid reimbursement, 2) including custodial care in rehabilitation funded services, 3) likely violation of the Olmstead Act by requiring beneficiaries to live in congregate group settings when the services they need can and already are delivered safely in the community.
Ironically right now, several prominent civil rights groups in the state seem to be arguing for keeping PNMI services, versus arguing for services which are least restrictive, and frequently the most effective and least costly. Countless research has shown people do better if treated in their own communities, families, and homes. Institutional care is best for acute treatment, or when there is a forensic component.
I hope that once the dust settles from the Governors communication style, people will be able to look at our states needs and challenges more pragmatically and compassionately, and make those passioned arguments for our most vulnerable citizens.
I definitely understand your
I definitely understand your frustrations Nick, Maine has always had challenges crafting public policy.
MaineCare (our states Medicaid program) is a joint state and federal program, as such each state writes its own plan (which must be approved Federally by the Centers for Medicare and Medicaid aka CMS) which needs to include certain basic coverages in certain ways as statutorily required under the Social Security Act (Medicare and Medicaid fall under the Social Security Act) while leaving room for each state to target additional populations or areas of need.
While I suppose it's possible to "play" the system to get Medicaid (this was attempted recently in a video taped publicity stunt - and went no where), the real issue I think the Governor is attempting to address is because we have a waiver to allow income eligibility, the bar is set quite high allowing non-disabled working people with considerable assets to qualify - legitimately. Yes this comes across to some as playing the system.
I think the Governors proposal, while approaching the problem with little finesse, is none the less pragmatic in order to save MaineCare for those children and adults who are seriously medically disabled and have no alternative.
MaineCare really can't be set up to act "like unemployment" without an Act of Congress. Our Governor and DHHS Commissioner can, with informed input, be much better prepared to give up waivers we can not afford, refocus our limited resources on our most disabled, and resubmit a new plan to CMS.
Proposed budget just released
Proposed budget just released http://www.maine.gov/dhhs/budget/
Protecting the safety net
It is unfortunate our Governor continues to struggle with developing a voice which elicits hope as much as it does anxiety amongst Mainers, never the less in this instance he is correct to draw attention to the very deep and systemic problems in our states Medicaid plan - MaineCare. Indeed he is somewhat understated as to our dire straits (fiscal and systems) needing immediate attention to assure MaineCares preservation for our most disabled children and adults.
Our entire MaineCare based safety net is, and has been, in a very precarious position for some years now; with DHHS perennially millions if not hundreds of millions of dollars in deficit, a still unresolved class action lawsuit (AMHI Consent Decree), ongoing problems with MIHMS billing system, heavy and potentially illegal state service taxes upon non-profits, non compliance with Federal rules for PNMI services, and potential trouble with the Department of Justice looming; heartbreaking, decisive and compassionate decisions must somehow be made to protect our citizens who are elderly and frail, and our most disabled children and adults.
The proposed elimination of our state 1115 waiver from CMS allowing non-disabled adults (so-called non-categorical) to enroll in MaineCare, will indeed result in people becoming uninsured. However, people who receive non-categorical MaineCare by definition qualify for MaineCare because of income, not disability, illness, or age. It is important to keep in mind children and adults who are disabled or seriously ill will remain enrolled in MaineCare, and those who become disabled in the future will still qualify for MaineCare.
The a Governor would do well, as he proposes very painful changes, to simultaneously call on all Mainers to help identify and work towards rebuilding a more sustainable, effective, and accessible system for all Mainers.
It's about their vision
I am hopeful that both candidates tonight will rise above the "blame game" and instead focus on their visions of how to help Lewiston and her citizens return to prosperity. We have a tremendous resource in our people, businesses, schools and colleges, access to road, rail and air and a quality of life hard to find else where. What we're lacking is a strong vision of how to move ahead, with those assets, tonight should be about vision, the Mayor can set the tone and lead or become mired in the politics - du jour. I wish both candidates well and look forward to hearing their respective visions.
The Chinese aren't racing us to the bottom
What is unfortunate about the iPad debacle in Auburn is how the school board has chosen to present their (believe correct) assertions about the importance of incorporating technology, iPads at the moment, into education. While there is no research I am aware of at the present which shows iPads improve early childhood education there is ample research demonstrating the benefits of computers in education starting as far back as the 1950's (1954,Skinner) (2002, Angrist & Lavy). Though fleshing out correlation from causation is the perennial issue.
I hope that local parents and children take the time to look at and become regular users of MIT's "Scratch" site http://scratch.mit.edu/ developed for teaching very young children the mathematics and underlying logic used in software development and enineering. Maine, indeed the country needs more of these creative and relatively cost effective approaches to teaching and exciting our children in the math and science they desperately need to be competative in the 21st Century and that our nation will rely on to remain vibrant and strong.
As the author Thomas Friedman wrote in his book The World is Flat, "the Chinese are not racing us to the bottom" our place in the world is not guaranteed.
Hopefully the school board can find a better way to communicate the important message I suspect they want to convey.
1 BF Skinner (1954), ‘The Science of Learning and the Art of Teaching’, Harvard Educational Review 24, 86-97; and BF Skinner (1958), ‘Teaching Machines’, Science 128, 969-77.
2 Heather Kirkpatrick and Larry Cuban (1998), ‘Computers Make Kids Smarter – Right?’, TECHNOS Quarterly for Education and Technology 7(2), 1-11.
3 Joshua Angrist and Victor Lavy (2002), ‘New Evidence on Classroom Computers and Pupil Learning’, Economic Journal 112, 735-65.
As a member of the MPBN
As a member of the MPBN community advisory board I am very concerned with the Governors recent proposal to cut state funding to MPBN. The MPBN we know and rely on today simply would not exist if this happens, it's likely that programs would be reduced or even eliminated everything from News, to Click and Clack, to Basket Ball. Most importantly to me it would greatly impact whether MPBN could continue to provide service state wide. Hopefully people understand that MPBN is the only broadcaster that covers the entire state, we are just too small a market with scattered populations for commercial broadcasters to build the infrastructure. As such, MPBN runs our states Emergency Alert System and is the conduit for EAS transmissions broadcast by all the other stations.
Though I appreciate the hard job to develop our states budget the Governor and Legislature have before them, I expect at the minimum our elected officials to have the public safety in mind. I also expect that they have the vision of what Maine should be, reflective of the people, to assure the quality of life as well as economic opportunities we need to thrive. This proposal does not accomplish any of that.
I hope that others will contact their elected officials as I have and encourage them to oppose the Governor's recommended cuts to MPBN.
Using technology correctly
I think Auburn is going down the correct path exploring this option, I hope Lewiston considers a similar option, though it will, in my experience have some challenges as people learn how to use the iPad - iOS and touch screen, getting it to interact correctly with some of the popular local email systems exchanges (Time Warner, Microsoft Outlook) but in the end will indeed accomplish what the city hopes, and then some.
After teaching a class at Lewiston Adult Ed to local people on how to use iOS devices https://www.lewistonadulted.org/courses.php?q=search&s=200980531.1.311 particularly the iPad, and writing for iPhone Life Magazine, I am certain Manager Aho will be able to accomplish what he has outline, and then some. For example using the iPad to make low cost/no cost phone calls with apps like "Whistle" or "Skype", several people working on one document with "cloud computing" feature of "iWork", doing statistical analysis with "Biostatistics 1.0" etc, etc. Manager Aho is just hitting the tip of the iceberg (or is that iCeberg?) of what the iPad could do for the city.
Auburn in my opinion, is correctly using affordable off the shelf technology in a practical, effective and efficient way to doing city business, not eliminating paper per se (paper has an important place) but reducing its use and human time spent shuffling it. I think in time the Managers strategy can help the city with it's stated goals for reducing some costs, while further moving Maine into the 21st century in use of technology - our technology infrastructure and savvy is important to making Maine a great place to do business. I used personal iPad for taking all official minutes for the Lewiston Auburn Community Forest Board and distributing minutes to Board members.
Good luck Manager Aho.
Defining welfare
The public, news organizations, and the Governors office use the term “welfare” too liberally, and imprecisely. Hopefully we all will start to discuss specific programs, which are believed problematic so that they can be reviewed, and if needed, improved. Working in behavioral health for many years, I believe it imperative that we help Mainers on their pathway to recovery from whatever vicissitude of life they encounter – this is what makes our society great.
However, as a state, we have not had a lot of public discourse about our values and what we wish to accomplish with the multitude of public programs we offer, including whether the programs are actually effective and indeed improve peoples lives. While some do, certainly other likely do not.
What is welfare? There are many programs which are federal, state, local or some combination of all, which use public money to help those in need. I think it more helpful to discuss the merits of specific programs and not generalities. While it possible to change state or locally funded programs (through the Legislative process) such as General Assistance, it is not possible to do so with federally funded programs, except through acts of Congress.
An example of something we can not change, is a state may not require residency for Medicaid aka MaineCare, this is within Title XIX of the Social Security Act, though with the proper waivers Maine can do other things such as change the Co-pay requirement, qualifications for services - so long as they are applied across the board, and adjust the Protected Income Level (Maine has a high PIL of $315/mo) of MaineCare beneficiaries, this is the amount people who are over income but qualify medically must “spend down” to. Maine could even; possibly, opt out of the Medicaid program, though risky, it is an option.
Some things which we may want to look at, and consider changing is our states General Assistance statute, and how the rules are promulgated and how Maine citizens experience (or not) assistance.
For example, we might want the Legislature to change the state statues that there is currently no residency requirement for GA, nor is there a requirement for the municipality to check an applicants immigration status. We may want to amend the statute to allow for time limitations and residency.
http://www.maine.gov/dhhs/OIAS/services/general-assistance/index.html
While there is a work requirement under GA, including working for the municipality, the “Just cause” for failure to meet work requirements may be so broad that many may benefit from remaining disabled, etc. We may want to add, that along with a person seeking work, or attending educational or job preparation; that they should be active in a physical, behavioral rehabilitation program.
http://www.mainelegislature.org/legis/statutes/22/title22ch1161sec0.html