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Critical mental health teams in Maine under financial strain

Assertive Community Treatment (ACT) teams provide community-based mental health treatment and services.

BANGOR, Maine — For decades, Assertive Community Treatment (ACT) teams have provided a critical safety net for Mainers struggling with severe mental health issues. The vital treatment services allow patients to stay in their communities and out of mental health facilities.

But nonprofit providers who run more than a half-dozen ACT teams in the state said low reimbursement rates for MaineCare, the state's version of Medicaid, have put these critical mental health services in severe financial jeopardy. 

Despite snow piling up outside, Tina Lyttle and Kenneth Chase are getting ready to hit the streets of Bangor. They are members of the ACT team run by Community Health and Counseling Services in Bangor.

Lyttle is the team's case manager. She helps patients find housing, food, and clothing. They do home visits, take patients to medical appointments and job interviews, and run errands. 

"Seeing people and meeting them where they are builds a rapport and actually allows the work to happen," Lyttle said. 

Chase, who struggled with mental health issues and is in active recovery, knows the importance of human contact. He was on Lyttle's caseload. Now, 25 years later, as the team's peer support specialist, he helps others facing similar challenges. 

"It's a gift. By helping others you help yourself," Chase said. 

Team members also deliver medications dispatched by the agency's in-house pharmacy. A psychiatrist and nurse provide treatment to about 50 patients within a 25-mile radius. 

Evidence-based services allow patients to stay in their communities and out of behavioral health care units. Dale Hamilton is the executive director at CHCS. He said the services are expensive and even more in demand during the pandemic. But ACT teams are becoming unsustainable because reimbursement rates for MaineCare are not keeping up with rising costs and wages. 

"Not having rates that support our current costs prevent us from recruiting staff for these highly-specialized services," Hamilton said. 

Tri-County Mental Health Services is an ACT team and includes a psychiatric nurse practitioner who supports 100 patients in the Lewiston-Auburn area. 

Executive Director Catherine Ryder said the program is operating six figures in the red at a time when waiting lists for mental health beds are sky-high. 

"There is no other place for them to go. State hospitals do not have capacity at this time," Ryder said. 

"We are in crisis," Katie Harris, the government affairs officer for MaineHealth, said. She said every day at MaineHealth, one-third to half of the emergency beds are filled with patients with behavioral health issues.

MaineHealth oversees four ACT teams for adults and children in Portland, Sanford, Biddeford, and Brunswick. But Harris said programs are operating with a $1 million shortfall due to low MaineCare reimbursement rates. She said funding is needed now to help keep these wraparound mental health services afloat.

"We need to invest in the short term before the services disintegrate," Harris said.

State Rep. Colleen Madigan, D-Waterville, is a licensed social worker who worked on an ACT team. She sponsored a bill, LD 582, to increase the MaineCare reimbursement rate by 25% for ACT teams. Approved by lawmakers during the last legislative session, the bill was carried over and is now before the Appropriations and Financial Affairs Committee. 

"My fight is going to be making sure those critical mental health services get funded and get into the supplemental budget," Madigan said. 

Meanwhile, the Maine Department of Health and Human Services has been conducting a rate study to improve the state's mental health system over the long term. DHHS spokesperson Jackie Farwells released the following statement: 

"The department agrees that support for community mental health services is needed as we complete these rate studies, which is why we are investing $126 million in MaineCare funds available through the American Rescue Plan for bonuses for new and existing home- and community-based services (HCBS) direct support workers and shared living providers, including providers of behavioral health services. 

"Behavioral health providers will also be receiving monthly supplemental payments throughout 2022 to assist them in increasing pay for direct care workers to at least 125 percent of the state's minimum wage. During this time, the department is prioritizing rate studies for these services to ensure that permanent rates, to go into effect January 1, 2023, support the 125% of minimum wage. 

"Lastly, these behavioral health services will begin to receive annual cost of living adjustments, starting July 1, 2022. Additionally, if this new legislation were to pass and be funded, the department would need to obtain federal approval for the changes proposed and go through the rule-making process, meaning new MaineCare rates would not be in place significantly faster than on the existing timeline. The proposed rate increase under this legislation would complicate our plans for a rate study to commence this quarter, in collaboration with stakeholders, in preparation for the January 2023 rate adjustments. 

"This would only further delay the more comprehensive reforms outlined in Maine's HCBS system improvement plan, which was developed in consultation with stakeholders, including providers and families, to improve access to high-quality services for Maine people of all ages living with disabilities and behavioral health challenges."

Another bill, LD 496, would increase the MaineCare reimbursement rate by 25% for prevention-based community programs. It is also before the Appropriations and Financial Affairs Committee. Sponsored by Rep. Lori Gramlich, D-Old Orchard Beach, the bill would authorize a much-needed boost to recruiting staff to provide mental health services to kids while living at home.

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