October 18, 2018
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Maine’s history of serving — and not serving — children with mental health needs

Troy R. Bennett | BDN
Troy R. Bennett | BDN
The State House pictured in January 2016.

What exists today of Maine’s system for serving children with mental illness, autism and intellectual disabilities has its roots in key actions in the courts and state Legislature in the mid-1990s.

January 1997: A class-action lawsuit filed in federal court, French v. Concannon, alleges Maine has failed to provide a number of mental health services to children covered by Medicaid, a violation of federal law.

Spring 1997: Lawmakers pass LD 1744, charging a commission to design a mental health services system for children.

Dec. 15, 1997: The commission delivers “A Plan for Children’s Mental Health Services,” with a multi-year implementation plan for expanding mental health services to children provided in their homes and in the communities where they live, as opposed to institutions in Maine and outside of Maine.

Spring 1998: Lawmakers pass LD 2295, establishing a children’s mental health program. A supplemental budget passed the same year allocates more funding for children’s mental health services to serve children on waitlists.

June 30, 1998: The Maine Department of Human Services agrees to a number of measures to expand behavioral health services for kids as part of the settlement for French v. Concannon. It agrees to use new assessment tools to determine behavioral health needs, create a new provider category to provide in-home services, abide by timelines for serving children outlined in federal law, and develop new regulations to implement these measures. The case is dismissed the next month.

June 2000: Another class action lawsuit, Risinger v. Concannon, is filed in federal court, alleging Maine hasn’t delivered timely and consistent services to children with behavioral health needs — again violating federal Medicaid law.

May 2002: Risinger plaintiffs and the King administration arrive at a settlement agreement. The state pledges to abide by timelines in federal law for providing services, closely track youth and how long they’ve been waiting for services, and act quickly when staff turnover causes interruptions in children’s services.

July 2003: An outside expert hired by the state finds that hundreds of children are still waiting longer than six months for in-home mental health services, a violation of federal Medicaid law, which generally sets a six-month limit.

August 2003: The Maine Department of Behavioral and Developmental Services unveils an implementation plan for complying with the Risinger lawsuit, but the plaintiffs allege the state still isn’t doing enough (in part because of its resistance to raise reimbursement rates for care providers) and remains out of compliance with the settlement more than a year after the agreement was signed.

June 2007: Lawmakers approve a new state budget that books nearly $40 million in savings from children’s behavioral health in fiscal years 2008 and 2009 due to plans to contract out the state’s care management function for children’s mental health services, which authorizes services before they are provided and tracks waitlists.

Sept. 1, 2007: The plaintiffs in the Risinger lawsuit agree the state has complied with the settlement agreement for at least three months, setting the stage for the court to relinquish its oversight of the matter in 2009.

February 2009: The Legislature’s watchdog agency, the Office of Program Evaluation and Government Accountability, releases a report with recommendations for reining in administrative costs associated with children’s behavioral health services.

September 1, 2009: The federal court’s oversight over Risinger v. Concannon ends.

January 2015: The LePage administration proposes a 10-percent cut to MaineCare rates paid for key children’s behavioral health services under MaineCare Sections 28 and 65. The administration also proposes cutting reimbursement for another service, medication management. The administration’s justification is that it seeks to redirect the funding to another population waiting for services: adults with developmental disabilities.

June 2015: Lawmakers don’t agree to the rate cuts, but they pass a budget provision requiring that DHHS hire an outside firm to conduct a study evaluating the rates paid for children’s behavioral health services.

2016-17: Maine DHHS releases proposed rate changes assembled by its consultant, Burns and Associates. Key in-demand services are slated for rate reductions after a decade or so of stagnant rates. The consultant proposes increases for other services.

July 2017: The Legislature passes a moratorium to stop any rate reductions for MaineCare-funded behavioral health services until a future legislature approves them.

May 2018: Maine DHHS releases proposed rules governing psychiatric residential treatment facilities, a type of secure, psychiatric facility for children that would be new to Maine.

June 2018: Legislation that would raise reimbursement rates for a number of children’s behavioral health services awaits final action following the Legislature’s adjournment. LD 1737 would raise rates paid for medication management services by 15 percent. LD 1868 would temporarily raises rates paid for multisystemic therapy and functional family therapy by 20 percent. Both bills won initial approval in the House and Senate.

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