Maine’s Department of Health and Human Services is facing a significant budget shortfall once again. But this time, there is a new administration in place that will not shy away from making the structural changes that must be made to put the department on sound financial ground while protecting Maine’s most vulnerable citizens.

It cannot happen overnight, but we must begin now.

During the past eight fiscal years, the previous administration pursued a path which required multiple budget adjustments. From fiscal years 2005 to 2009, for example, DHHS’ shortfall alone totaled more than $466 million.

It was clear that instead of tackling the problems before they became reality, budgets moved forward with the internal knowledge that it wouldn’t be in balance for long. They would create a budget, get it passed, then submit a supplemental request — but they never addressed the structural funding problems.

Over 10 years, total spending in Medicaid has increased more than $1 billion and total enrollment has increased by 42 percent.

During the past three years, the money used to fill in the gaping budget hole was from one-time, federal stimulus funds. This allowed the department to sustain its expenditures, despite structural funding problems, and make it appear that everything was in balance.

Not addressing the evident structural shortfall further extended the problem — bolstering a Medicaid program that, for years, had lived beyond its means and grown out of control.

Maine’s Medicaid program simply cannot be all things to all people. The financial burden to this state and to working families in the form of increased taxes is too great and is unsustainable. We must define our priorities and redefine Maine’s Medicaid program as a true safety net program.

The shortfall we recently shared with the Legislature did not come to light until the pattern of spending started under the previous administration came into focus. The first quarter of the fiscal year merely exposed the crumbling foundation that the current budget was built upon — a foundation that was weakened by decades of financial mismanagement and the lack of political will to make structural changes.

The same financial reality that confronts our nation is confronting this state. Unlike the federal government, we cannot increase our borrowing — we must balance our budget and pay our bills.

We have a higher percentage of Maine’s population enrolled in Medicaid than the national average. We spend more per person on Medicaid enrollees than the national average. We have increased our Medicaid spending at a higher percentage than the national average.

It is not sustainable.

Hard-working families and individuals are shouldering this burden. We must return our Medicaid program to at least the average national standard.

The DHHS and the LePage administration will take the steps necessary to balance this budget. We will have a state government that lives within its means, while meeting the needs of our most vulnerable and disadvantaged citizens. Here’s how:

At Gov. LePage’s direction, the DHHS is undertaking a thorough analysis of its $2.4 billion budget — beginning from zero, rather than using the previous years’ baseline as a starting point. We are working to ensure that every taxpayer dollar spent is spent wisely.

We will build our future budgets from zero, looking at the services we are obliged to provide and, from there, rescaling and redefining a safety net that Maine can afford.

Doing this analysis and going through a quarter of financial spending exposed the shortfall we made public recently.

As the commissioner of the Maine Department of Health and Human Services, I am committed to being held fiscally accountable. Though the politics of announcing an additional $50 million in deficit soon after the initial $70 million shortfall was revealed was certain to bring criticisms from the Legislature, the public and the press, I believe it was my responsibility to share it as quickly as possible.

What is clear, as we move forward in these bleak economic times, is that we must discontinue the practice of “balancing” the budget with staggering supplemental requests, one-time money, furlough days and other gimmicks.

We must move past decades of deception, muster up real political will and make necessary, difficult and permanent structural changes to live within our budgetary means.

It is a tall task and one that can only be accomplished with an acceptance of the current economic landscape and a willingness to prioritize services.

We must set partisanship aside and work together toward a sensible solution for all Mainers.

Mary Mayhew is commissioner of the Maine Department of Health and Human Services.