AUGUSTA, Maine — A state advocate is warning that overspending by the Department of Health and Human Services is leaving people with intellectual disabilities no place to turn in a crisis.
A DHHS account that pays for residential services for adults with intellectual disabilities and autism is projected to run into the red by $4.3 million this quarter. More than 600 people covered by the state’s Medicaid program are already on a waiting list for those services.
Without resources to take those recipients off the waiting list and place them into assisted living or other support facilities, the state is leaving people with intellectual disabilities in the lurch, said Richard Estabrook, head of DHHS’ office of advocacy.
In the most dire cases, such as those involving a risk of violence or neglect, wait-listed residents are sent temporarily to crisis facilities. But only a handful of crisis beds are available across the state, sometimes located hundreds of miles from the resident’s community, Estabrook said.
“Many families now are struggling to provide services to their loved ones,” he said. “A certain number cannot do it. What has happened is those people then go to the crisis service beds and fill those up. So what has happened is, particularly now in the southern part of the state, there are no beds left for people to move into.”
As of Friday, two crisis beds were open in Caribou and one bed each in Bangor, Monmouth and Gray, according to DHHS. The daily count fluctuates as people move in and out of temporary crisis services.
“There are crisis beds available and there are crisis staff available,” said Ricker Hamilton, acting director of the department’s office of adult cognitive and physical disability services.
Crisis services will continue as his office works to get a handle on the overspending and better assess consumers’ needs, he said.
The $4.3 million in red ink projected by the end of June is in an account that has been historically overspent, he said. In 2010, the account was overdrawn to the tune of $3.4 million, Hamilton said.
More wait-listed residents may have been set up with services than the account could pay for, he said.
His office is reassessing that spending and reviewing a waiting list to ensure that recipients are matched with the appropriate services, he said.
“We want to find out exactly what the number is and what the needs are of the people we serve,” Hamilton said.
Another $6.4 million was transferred out of the account as part of the Legislature’s efforts to close a $120 million shortfall within DHHS this fiscal year, Hamilton said. The transfer was temporary and those funds will be shifted back, he said. Details were unavailable Friday about when the money was transferred and to which specific accounts.
Residents with intellectual disabilities and autism who already are receiving housing will continue to receive those services, Hamilton said.
No federal matching funds will be lost as a result of the overspent account, he said.
Only the neediest residents come off the waiting list and are set up with permanent housing. In 2011, 84 adults with intellectual disabilities and autism began receiving residential services. So far in 2012, two have come off the waiting list, both in January, according to DHHS.
For the first time since the waiting list began in 2008, the department earlier this year directed that no one come off the list for the indefinite future, Estabrook said. He cited a March 26 email from program manager Karen Mason to a regional manager who had inquired about crisis situations.
The one-sentence email reads: “For the foreseeable future there are no funds available to place anyone on to Section 21 services.”
Residential and other services are provided under Section 21 of the MaineCare benefits manual.
“It is a mathematical certainty that a certain number of those individuals who are on the wait list either will not have families at all or will not have families capable of providing the intense, really nursing home-level care, that these individuals have been determined to need,” Estabrook said.
Estabrook is slated to lose his job in July with the elimination of the office of advocacy, an independent division within DHHS. A bill to restructure the department will outsource advocacy services to the Disability Rights Center.
Hamilton said no one came off the waiting list in March, but two people were identified this week to be removed from the list and connected with services. The goal over the next four to six weeks is to remove two more each week, he said.
His office is reviewing the waiting list to ensure that adults with intellectual disabilities and autism are appropriately prioritized, he said.
“That really is our daily focus,” Hamilton said. “The first thing I think about when I come in the office each morning is that wait list.”
The DHHS restructuring will steer administrative firepower from vacant positions toward quality assurance staff tasked with improving care plans for people with intellectual disabilities and autism, he said. That could lead to cost efficiencies, Hamilton said.
LD 1887 should be scrapped. It doesn’t save one red cent of $$, and will probably cost taxpayers even more. To lose seasoned advocates, dismiss experienced intensive case managers for the more needy (and dangerous) of mental health consumers, this state is setting itself up for crisis and chaos. In fact, this bill adds managers and removes workers who serve the most vulnerable. Crazy…but true. The legislators must have been lobbied long and hard to have passed this…they should ask the people who do these jobs what they really do, and what they accomplish.
Maybe the Lepage should go without insurance for the rest of his term. I would think the state must have a good insurance for him. I do not have insurance can’t afford it. Instead of cutting Maine Care lets get the Feds to stop the earn income credits each year. That would more then support the system from state to state.
Streanlining will only mean cutting case managers to cover too many cases. Efficiency does not mean much only good managers who need time to asses the problems. Case manement is not like car repair.
These people will find housing its called hospitalization “Riverview” (inappropriate setting, but at last resort) or Jail (again, inappropriate setting, but at last resort, they will land). If we aren’t properly housing and educating these individuals with disabilities as well as seeing that they recieve their medicaitons, then we will have an expensive issue on our plates. Not to mention legal aspects to deal with. Sad for ALL involved. The innocent victims. Yes, the disabled person is a victim as well as their victim. I’m not saying that all people with disabilities have violent behaviors by any means, but many needing group homes have multiple diagnoses needing proper medication and some do have violent behaviors including pedefile behaviors.
Get buses, load them up, head to the Blaine House and say “Here you go Pauly”. Families who have struggled for years and years are going to get nothing unless they unite and file a lawsuit. The only thing that makes a mark on the Republican fascists is if you get in their face with a dose of reality. That reality needs to be a Class Action lawsuit against the state to rectify this situation, i,e, Pineland Consent Decree or AMHI Consent Decree.
I have developed programs for individuals that require 3:1 staffing because of their impulsive proclivity toward violent outbursts, 2:1 staffing is common too. Yes this costs money, a pile of money as you can imagine, but the clients/kids/humans involved most certainly can not control their emotions or behavior. We need to pay for what we need, nothing more.
Now however, families and those less qualified are left to deal with behaviors and their aftermath, while the state says they are unable to process everyone because they need to provide tax incentives for the “job creators”. Which means that unless those affected by LePages Draconian paradigm take immediate and drastic action, they will get nothing. Parents getting injured by their children who are out of control never make the news, and if it ain’t in the news, no one cares…
How did Maine survive before all this spending of one person’s money for another.
1. Families had to do it, until the economy required two working people in a family, just to survive.
2. AMHI warehoused many of them, as did BMHI and Pineland. The Consent Decree mandated they be mainstreamed into society, instead of shuttered away behind iron bars.
The solution? Require one parent to quit earning an income and stay home. Their new “poverty level” might make them eligible for more state and federal help.
Or we could go back to the Dark Ages and reopen these institutions. Out of sight, out of mind and problem solved.
Doesn’t appear to be a (humane) solution that will make all the “I shouldn’t have to pay for someone else’s care” people happy, is there? So we bite the bullet and accept it as fact.
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Clean out the DHHS departments, take that money to help cover the cost. DHHS is the states most money spending, and unfair department that is destroying this state. Maybe a few of the departments should be closed. Along with closing them I’d take a look at the Department of Labor too. What a waste of tax payers money.
Well I will go you one better we will all agree and close DHHS while we are at it let’s get rid of the DOT — there is a real saving of tax dollar expence. Oh and while we are closing the Department of Labor we will also do away with the Small Business Administration.
How’s that work for you ?? What you mean we can not close the departments you feel are important just the ones you do not happen to like ?
This state is made up of many people of varying priorities. Government was established to serve the majority. There are lots of things in our state government that I do not whole heartedly support but I also realize that goverrnment was established to support all the Citizens of Maine not just splinter groups.
Can’t we get rid of food inspection, pharmacy licensing, elevator inspection, too?
My taxes pay for the processing and background checks needed to process firearms purchases and right to carry permits.
I am a liberal. I have no problem helping to pay for you to use your rights regardless of my opinion of those rights.
I guess you haven’t had to deal with DHHS or the department of labor, big waste of tax payers money. And no I don’t want to government to support me, I can do it by myself. Thats the problem with you libs you want the government to give you everything, thats why the state is in the shape its in.
What happens if the day comes that you CAN’T do it by yourself? While there is a lot of wasteful spending and fraud, there truly are people that need the assistance. I am pretty sure people who have terminal illnesses or life altering, debilitating diseases didn’t ask for such things. There are also the elderly, who probably have worked their whole lives and contributed to the system, who also don’t enjoy having to ask for help but sometimes you just don’t have any other option.
I figured out the problem to get clients off the wait list, that would not cost the state any money, is fill up the vacant beds the state has been funding for years to all of the big agencies, that can pick and choose there clients, or fold the beds free up the money, for the clients on the wait list. Big agency in the state have alot of one person developments and empty beds in two person homes, but still are able to get paid. What a joke the system has been, and Gov. Lepage and Ricker are doing a great job, keep up the good work!!
Also after working in the field for years, I have seen the big Agency getting larger, when the smaller Agency can do it more cost effective, as they don’t have all the overhead that the Big Agencies have!! Also put two clients in shared living homes together for the price of one, as most clients are out of the home in programs, or working during the week. Make it mandatory that instead,one or two person homes, have four person homes, get rid of the 350,000 one person budgets these big agencies have, that would save alot of money!! Also the State was smart getting private case managers, it is time for knew and start saving money, for the hard workers in Maine, also guardians of these clients need to realize this money comes from taxpayer’s and the Federal Gov. that are willing to help support the Adults and Children on the system, but changes need to be made, so more people can get funding!!
No reimbursement for empty beds have been made for a few years now Ted, get your facts straight. Once upon a time this was true, and some of those beds were Emergency short-term beds which is sometimes all that is required. If you disagree check the MaineCare manual online and check on reimbursable services.
You need to get your facts straight, as there are alot of beds in large agencies with no clients, that the state continues to fund!!
No Matt, they don’t. You are wrong. Accept it. And most of the empty beds they did fund were for children, not adults. There hasn’t been one adult placed in a Residential facility this year. No PNMI, No Intellectually Disabled, no one, zip, nada, nothing, not one thin dime.
No u r wrong, and it is time the state stops funding open beds in Adult Group Homes, last I knew, there were 89 open beds being funded, just two months ago,as agency pick and choose who they want to serve, but why choose anyone when ur getting paid. You also stated there has been no placements since January, wow, put ur glassess back on, just read in the paper this past week how a client was placed in an Agency in the Bangor area, so u need to get ur facts straight. I say it is time we support the Governor and his new appointee’s, as they are cleaning house, and doing a dam good job!!
Just like some raving liberal, using facts to dispute perfectly good ignorance and bigotry. If we can’t blame the disabled and the sick for not providing for their own care, are we supposed to do some Jesus thing and help our neighbor?
Apparently jj16oz u don’t know what u are talking about, there are alot of empty beds state wide that r empty, and the state still funds, so u better get your facts straight, before trying to correct myself. Thanks!!
Most all developmentally disabled people need some supervision. Some need total supervision. Day programs help, keeping them active, and occasionally teaching them some skills, freeing up parents and other caregivers a little free time. Parents worry about the time when they will no longer be able to take care of their children. Where will they go? DHHS is a very important department in developing programs for these individuals, and making sure they have the services they need. How many are on the wait list in Maine?
They are all going to get the jobs created by providing tax cuts to millionaires. Since they will need supervision we can pass a law that the employer does not have to pay minimum wage. Oh, wait, we already do that with those who serve us in restaurants, and grow our food. It may not be a new idea, but look how well it has worked.