The reimbursement rate for providing in-home services to mentally ill kids has remained stagnant for four years.
As one local agency discontinues its program, an Auburn mother worries that her 5-year-old is headed for jail.
The reimbursement rate for providing in-home services to mentally ill kids has remained stagnant for four years.
AUBURN – Michael knew the deal: He had to finish at least one page in his activity book before he could go outside to play.
But, as his mother and his caseworker waited for him at the kitchen table, he acted as though he couldn’t see or hear them. He walked to the coat rack, put on his jacket and gloves and headed for the door.
“I’m going out by myself,” the 5-year-old mumbled through grinding teeth.
The boy’s mother, Debby Cornish, closed her eyes and took a long breath.
Would he pick up the phone and throw it at her again? Would he bang his head on the wall until it bled? Would he swipe his hand across the kitchen counter, pushing everything onto the floor?
The caseworker from Richardson Hollow Mental Health Services darted to the door to stop the boy. Cornish prepared for the worst as her son clenched his fist.
Then, Michael surprised everyone. He punched the wall once, then ran into his room and slammed the door.
“That’s good,” the caseworker assured Cornish. “He walked away. That’s what we want him to do.”
Signs of improvement. Cornish has been waiting for them for three years, ever since Michael started punching or throwing things when he didn’t get his way.
The single mother from Auburn is now afraid that her son’s progress is about to come to a sudden halt.
A week ago, Cornish received a letter from Richardson Hollow Mental Health Services, letting her know that the Lewiston-based organization was discontinuing its children’s behavioral program.
She was informed that her son’s caseworker would stop visiting as of Feb. 1 because the state’s Medicaid reimbursement rate for the service was simply not enough.
“The financial reality is that this service has lost hundreds of thousands of dollars every year,” Richardson Hollow Director Linda Hertell wrote in the letter. “Not only has it never broken even because of its low reimbursement rate, but it has lost ground every year as our costs have gone up while the rate has stayed the same.”
It is a reality that no one denies: The 21 organizations that provide in-home support to low-income children with mental illnesses, such as bipolar disorder and attention-deficit disorders, are not making enough money.
The reimbursement rate for agencies that work in homes with these troubled kids is $25 an hour, compared to $37.50 for adults and $62.45 for families in which a child is at risk of being taken by the state.
That $25-per-hour rate must cover the salary, transportation and any health benefits for caseworkers, as well as salaries and benefits for their supervisors and administrative staff.
Pending bill
According to Jamie Morrill, a spokesman for the Maine Department of Behavioral and Developmental Services, which oversees mental health organizations that provide services to Medicaid recipients, Richardson Hollow is the first agency to cancel its children’s behavioral program.
But nearly all of them have complained about the $25-per-hour rate, which was set four years ago as a standardized rate and has never been increased to reflect hikes in health insurance or general cost-of-living increases.
“I am aware that providers have expressed a great deal of concern, and frankly I agree with them,” Morrill said. “We recognize that the rate makes it very, very difficult for them to provide the service.”
Since the rate is already low, it managed to stay off Gov. John Baldacci’s plan to trim Medicaid spending by $22 million.
In fact, the opposite has been proposed. A pending bill in the Maine Legislature would increase the hourly rate to $30. It could takes months before the bill is decided, and with a $109 million deficit in the state budget, people in the field are not optimistic.
‘Couldn’t do it’
Hertell, the chief executive officer of Richardson Hollow, said she considered discontinuing the program three and a half years ago, but she held off because she was told at the time that the rate would increase.
The agency kept the program alive by using money from its other programs. But eventually that stopped working.
“We have a society in crisis,” Hertell said, referring to the many people with mental illnesses. “You have to start with the kids. But we just got to the point where we couldn’t afford to do it anymore.”
The decision to cut the service will affect 63 families in central and western Maine.
Mark Rush, the chief operating officer of Richardson Hollow, estimated that the agency would need the rate to increase by $12 an hour to support the program and to continue to offer health and other benefits to its employees.
“In order to provide quality service, it’s important to attract a staff committed to this field,” Rush said. “These caseworkers need full-time work and health benefits. You can’t provide a quality service if you have a revolving door.”
‘So much hatred’
The situation leaves Cornish and other parents frustrated. And afraid.
“I’m so worried that by the age of 8 or 10, he’s going to have a criminal record,” Cornish said of her son, Michael. “That’s what he is heading for if we don’t continue to get help.”
Michael was diagnosed with attention deficit hyperactivity disorder and obstinate defiant disorder when he was 2 years old .
His mother started noticing the problems before he could walk. He hollered at her for no reason and thrashed his arms and legs with the mere mention of the word “no.”
His behavior got worse as he got older.
One morning, Cornish told her 10-year-old daughter to go to a neighbor’s house because she was afraid Michael would hurt the girl. Another day, he threw the base of the telephone at Cornish’s head, then pushed her brand-new stereo onto the floor.
So far this year, Michael’s kindergarten teacher has sent six letters home about his behavior. Most recently, he got a detention for punching another boy in the face and splitting his lip simply because the boy wanted to stop playing tag.
“He is too hyper, too aggressive,” Cornish said. “He just has so much hatred inside of him.”
Spiderman
Cornish eventually told Michael’s pediatrician about his behavior, and he referred her to a child psychiatrist. After a series of tests, Michael was placed on a waiting list for Richardson Hollow.
The family was assigned a caseworker in June, and it was decided that the worker would spend about three hours with Michael and his mom every weekday.
Although the changes have been slow, both Cornish and Michael have learned some things.
Cornish has learned how to stick with punishments, such as no toys and TV, no matter how loud Michael screams. Michael has learned to punch, kick and stomp on his stuffed Spiderman doll instead of his mom and sister.
“We have a long way to go,” Cornish acknowledged. “But things are getting better. If we have to go without a caseworker, even if it’s just a few more months while we are on another waiting list, I don’t know what will happen.”
The Department of Behavioral and Developmental Services has promised the families that it will do everything it can to hook them up with other agencies.
According to Joan Smyrsky, the director of children’s services for BDS, several agencies have already expressed interest in picking up Richardson Hollow’s clients.
“The goal is to try to avoid any break in services,” she said.
In the meantime, Cornish hopes that Michael continues to go to his room when he is too angry to talk and that he doesn’t forget to look for Spiderman when he feels like throwing punches.
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