The Maine Department of Health and Human Services offices on State Street in Augusta are seen in this December 2017 file photo.

Editor’s note: This story is part of a series examining Gov. Paul LePage’s legacy as his tenure comes to a close, including his impact on the economy, politics and more. You can read the rest of the series here.

During his eight years in office, Gov. Paul LePage has pushed to streamline state government and reduce spending. His path to achieving that objective has cut through the state’s safety net programs, from trimming the number of Mainers who receive food assistance to cutbacks at the Maine Department of Health and Human Services.

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Here’s a look back at drastic cuts to Maine’s social service programs that happened under LePage and what the results look like at the end of his term — most notably how warning signs preceding the deaths of two children allegedly at the hands of their caregivers failed to raise flags at DHHS.

Restricting access to food stamps

In 2014, the LePage administration reinstated work requirements for childless adults ages 18 to 49 who seek help under the federal Supplemental Nutrition Assistance Program, formerly known as food stamps. For five years before that, Maine had received permission from the federal government to waive the requirements amid growing unemployment during the Great Recession.

The change required recipients to spend 20 hours per week working, volunteering or undergoing job training in order to maintain their benefits. If they are unable to do so, the benefits end after three months.

Since his administration announced the policy change, participation in SNAP has fallen from 227,666 in July 2014 to 169,638 in November 2018.

The reduction in the SNAP rolls comes as more Mainers struggle with hunger. Every day more people go hungry in Maine than the rest of New England and much of the nation. About 16 percent of Mainers have a hard time putting food on their table, according to the U.S. Department of Agriculture. More than 50,500 Maine children also struggle with hunger, according to the Annie E. Casey Foundation.

Anti-hunger advocates have pointed to stricter SNAP requirements and low wages as two factors driving growing rates of food insecurity. The LePage administration in 2016 released a report that touted data showing income gains among those targeted by its policy as evidence that work requirements work. But about two-thirds of the adults who lost food assistance as the result of the policy change remained unemployed, and those with jobs had earnings close to the federal poverty level. As for the income gains, the economist who put the report together for the LePage administration didn’t attribute them to the work requirement policy.

Cut back on cash assistance

Under the LePage administration, more than 8,700 Maine families, including nearly 15,350 children, have lost cash assistance since a policy change went into effect.

In 2012, LePage successfully pushed to implement a 60-month lifetime limit for families to receive cash assistance under the federal Temporary Assistance for Needy Families program. Maine had previously opted out of that provision since the program’s inception in 1996.

TANF caseloads have dropped from just over 12,700 in May 2012 to about 4,000 in November 2018. At the same time, the number of children covered by TANF has fallen from 22,425 to 7,081 during that same period.

While the percentage of Maine children living in extreme poverty — where family income is half the federal poverty level or lower — has declined from a peak of 9 percent in 2014 to 6 percent in 2017, it remains virtually unchanged from where it was 10 years ago, according to the Annie E. Casey Foundation.

Even as the number of families receiving TANF has fallen, Maine continues to receive the same amount of funds — $78.1 million per year — from the federal government for the program. The resulting surplus of those funds has been used to cover a range of existing state spending obligations, such as sheltering homeless youth and transportation for families involved in the child protection system, freeing up state money. In one notable episode, DHHS officials spent more than $13 million of TANF funds on services for elderly and disabled Mainers without children, a violation of federal law. The department returned those funds to the TANF account after the BDN reported on the unlawful spending. Later on, the department directed more than $1.7 million in TANF funds to after-school programs, justifying it by using a provision in TANF law that allows states to spend their federal money to curb “out-of-wedlock pregnancies.”

Sliced ranks of public health nurses

Maine’s public health nurses, who served on the front lines of the 2009 influenza outbreak and scores of other public health emergencies, saw their ranks halved under the LePage administration.

When LePage took office in 2011, the state employed 50 public health nurses, who visited new and expectant mothers; trained local health providers on tuberculosis detection and vaccine storage; held immunization clinics; monitored treatment for patients with tuberculosis or latent TB; and contributed to emergency preparedness in the state’s nine public health districts.

By the spring of 2017, only 20 nurses remained in the field even as the Legislature continued to fund the positions.

After the BDN reported on the dismantling of the public health nurses program, the Legislature passed a bill — over a LePage veto — that directed the Maine Department of Health and Human Services, which oversees the program, to restore the ranks of public health nurses.

The lawmaker who sponsored that bill sued DHHS in July 2018 after it missed a March deadline, set in the law, to hire the nurses. In August, a lawyer for the department said it would “take prompt action” to comply with the law and restore its staff of public health nurses.

Dysfunction within child welfare system

The deaths of 10-year-old Marissa Kennedy in Stockton Springs in February 2018 and four-year-old Kendall Chick of Wiscasset last December shocked the state. The horrific cases led many Maine residents and lawmakers to declare that the state failed to protect Kennedy and Chick.

Even LePage blasted his DHHS and others for a “comedy of errors” preceding the deaths of the two girls. The cases also brought to light deficiencies in the state’s child protective services system.

DHHS came under heightened scrutiny after the Bangor superintendent of schools and a former neighbor of Kennedy’s family said the department had been contacted multiple times with concerns about Kennedy’s well-being.

In May, a report from a legislative watchdog faulted DHHS for “poor job management” for its role in one case, while noting the risk of abuse wasn’t evident in the other, without linking findings specifically to either the Kennedy or Chick cases. That report also stopped short of faulting state workers.

But issues within the state’s child welfare system raised plenty of questions.

The state’s child abuse hotline wasn’t able to answer about 1,000 calls per month in 2016. That’s something DHHS has said it wants to reduce and planned changes to make the call-in system more efficient. While the volume of cases referred to investigators has increased, DHHS has decreased its staff slightly, from 28 intake workers and 129 investigators in 2003 to 30 intake workers and 115 investigators in 2016, the most recent year for which the U.S. Department of Health and Human Services has data.

In May 2017, the child welfare program changed how it handled reports of suspected abuse to reduce the number of cases that prompted intervention from Child Protective Services. That change was intended to ensure workers made consistent decisions about when the state became involved in suspected abuse and that caseworkers intervened in those that posed the greatest threat to children. But it prompted concerns among social workers and others that child welfare workers were missing credible reports of parents or caregivers abusing children.

Details about Maine DHHS’ decision-making on the Kennedy and Chick cases haven’t been revealed, making it unclear where the state’s system to protect the girls failed.

Nonetheless, the cases prompted immediate changes in the state’s child welfare system.

The child welfare program revisited months of child abuse reports it received and referred to contractors who intervene in “lower risk” abuse and neglect cases. The number of children taken into state custody increased 10 percent in the first four months of 2018, compared with the same period in 2017. LePage also signed into law a slew of changes to the state’s child welfare system, including funding to replace the state’s aging computerized case management system and to hire 16 new caseworkers, as well as a proposal to de-emphasize family reunification.

Those went into effect Dec. 22.