Change package proposal tackles immediate needs for community services while advancing long-term efforts to strengthen and improve Maine’s behavioral health system

Governor Janet Mills announced today that she will propose an additional $19.7 million in state funding to address immediate needs in Maine’s behavioral health system and support ongoing improvements to MaineCare rates for behavioral health providers. The added funding will leverage $17.1 million in Federal matching funds for a total of $36.8 million, which more than doubles the total behavioral health funding proposed ($28 million) as part of the Governor’s supplemental budget. The Governor will propose the additional funding as part of her forthcoming change package to the supplemental budget for Fiscal Years 2022 and 2023.

The proposal, which was developed in collaboration with behavioral health providers, supports children’s residential care, assertive community treatment for those with severe and persistent mental illness, targeted case management, and outpatient therapy for children and adults through one-time supplemental payments and ongoing rate adjustments – services that were included in a set of four bills that passed unanimously in 2021 (LDs 432, 582, 496, and 415) but whose $16.5 million in state funds were not appropriated by the Legislature last year. Most of the funding is for one-time COVID-19 related payments to offset pandemic-related losses, reduce utilization of hospital emergency departments for behavioral health crises, meet increased demand due to the long-term mental health effects of the pandemic, and stabilize and hopefully reduce wait lists for services. Some will be used to fund long-term rate reforms upon completion of studies for behavioral health services.

In total, the Governor will now propose $65 million in Federal and state funds to support behavioral health through her supplemental budget. If passed by the Legislature, the Governor’s supplemental budget, the biennial budget ($112 million), and the Home- and Community-Based Services (HCBS) Plan’s bonus payments funded by the American Rescue Plan ($53 million) would yield an unprecedented total investment of $230 million in behavioral health in Fiscal Years 2022 and 2023 to support the workforce, capacity, and resilience of providers during this challenging time.

“The pandemic has taken a toll on the mental health of Maine people, increasing the need for services at the very same time that it exhausts the hardworking professionals who provide these services,” said Governor Janet Mills. “This investment aims to stabilize our behavioral health system in the short-term as my Administration advances the critical structural reforms that will improve and strengthen the system in the long-term. Fundamentally, we must ensure that our behavioral health providers are paid adequately in order to provide high-quality, widely available services for Maine people. These initiatives are an important step in that direction.”

“The Department worked in collaboration with providers of these behavioral health services to develop this one-time payment initiative to quickly expand capacity to reduce use of emergency departments and wait lists for services,” said Jeanne Lambrew, Commissioner of Health and Human Services. “This unique stop-gap funding will help address the pandemic-related surge in behavioral health crises as the historic investments in the biennial and supplemental budgets build on the significant improvements already made during the Mills Administration.”

“Addressing the behavioral health crisis with this immediate infusion of funds will stabilize a system of care for consumers who are in need of help and providers who are desperately trying to maintain current services as the demand grows. The investment of these funds will assure the stabilization of our system as we work to continue to improve access to the services that are the backbone of a healthy Maine. We are grateful for the recognition of the crisis and the commitment of these emergency funds as we work together to continue the structural improvements the Department has already begun,” said Betsy Sweet on behalf of the Behavioral Health Community Collaborative.

“Members of the Alliance appreciate the Mills Administration’s collaboration in developing this funding for behavioral health services. We have been able to effectively target these funds to some of the most critically needed mental health and substance use services in our continuum of care, and some of the hardest hit by the pandemic,” said Malory Shaughnessy, Executive Director, Alliance for Addiction and Mental Health Services. “While today’s investment does not fix our very stressed system of care, it takes an important step toward stabilizing services as we work together with the administration on the longer term structural changes to improve the behavioral health of our communities.”

“This budget proposal takes a critical step towards stabilizing community behavioral health services that are needed to better meet the needs of Maine people,” said Katie Fullam Harris of MaineHealth. “Every day, children and adults in behavioral health crisis get stuck in our emergency departments for days – and sometimes weeks or longer - awaiting access to appropriate levels of care. Maine’s behavioral health system was neglected for nearly a decade, and we appreciate the Mills Administration’s willingness to collaborate on this proposal that will help stabilize services that are needed now more than ever to address the unprecedented levels of behavioral health need facing our communities.”

The proposal aims to help address immediate challenges facing Maine’s behavioral health system in the wake of the winter COVID-19 surge while strengthening the system in the long-run. As with hospitals, the pandemic severely impacted the workforces of residential facilities and crisis services for people with behavioral health challenges this winter, as it also increased demand for those behavioral health services at the same time. This has led to unmet need as well as care for individuals in settings like emergency departments that may not best meet their needs.

Part of the change package would provide immediate, one-time support for behavioral health services to address urgent needs and expand capacity. This initiative would provide one-time general fund payments to providers of Home and Community Treatment (HCT) under Section 65 ($3.55 million), Assertive Community Treatment under Section 17 ($3.55 million), outpatient therapy for children and adults under Section 65 ($3 million), and Targeted Case Management ($2 million). It would also include a MaineCare supplemental payment ($9.1 million) to children’s residential services (PNMI-Ds), which received a significant rate increase last November but experienced significant reductions in the amount of services they were able to provide due to COVID-19 over the previous year. Payments would be based on a methodology that is responsive to documented need with providers reporting results such as additional people served.

Additionally, the change package would provide funding to implement ongoing rate reforms for key services to strengthen Maine’s behavioral health system by making services more sustainable in the long run. MaineCare has launched studies on the best way to pay for behavioral health services in Maine, with the goal of completing those studies for implementation on January 1, 2023. This includes considering alternative, more flexible ways of paying for services like HCT and ACT and broadening eligibility for Opioid Health Homes to other substances to expand these team-based case management services. Under the Mills Administration MaineCare has already significantly increased 18 rates and created 25 new rates for mental health and substance use services.

Strengthening Maine’s behavioral health system is a priority for the Maine Department of Health and Human Services under the Mills Administration. Every budget signed into law by Governor Mills has increased funding for behavioral health, while Medicaid expansion has covered $244 million in services related to members’ behavioral health needs from January 2019 through June 30, 2021. In addition to this biennial budget’s investment in behavioral health, more than $50 million in additional one-time Federal funds have been provided to Maine through various COVID-19 related appropriations for substance use and mental health treatment and prevention activities.

Meanwhile, the Mills Administration has worked to bridge gaps in Maine’s behavioral health continuum of services, including expanding crisis services. For example, the Mills Administration has:

• Opened Maine’s first close supervision residential facility in January 2022 to provide an alternative to incarceration and hospitalization for justice involved patients who do not meet the criteria for inpatient psychiatric care;
• Opened Maine’s first comprehensive Crisis Center in February 2022 in Portland to provide an alternative to emergency departments or jails for people in need of crisis services, and;
• Expanded crisis support for youth and children statewide, based on the successful pilot of Crisis Aftercare in Aroostook County.

Additionally, the Maine Department of Health and Human Services has set a long-term, comprehensive plan in motion to strengthen the behavioral health system in Maine. Such efforts are described in the:

• Behavioral Health Plan for Maine (PDF) which is being updated to reflect recent investments, including reforming mobile crisis to provide faster response times, adding a Mental Health Intensive Outpatient level of care, and developing a Certified Community Behavioral Health Clinic Model.
• Children’s Behavioral Health Services Annual Report (PDF) which describes reforms including a rate study by the Mills Administration that resulted in the first rate increase in more than 10 years for children’s residential services, rebuilding evidence-based home and community services, including Trauma Focused Cognitive Behavioral Therapy, and adding new providers for adolescent substance use disorder treatment.
• Maine’s Home- and Community-Based Services Plan (PDF) which includes unprecedented investments in crisis services, the behavioral health workforce, high-fidelity wrap around services designed to keep people out of residential care, and long-term “lifespan waivers” to align services with individuals’ own preferences and needs. It also specifically includes funds to address needs of individuals with intellectual disability who have challenging behaviors, which are currently being assessed by the New Hampshire’s University Center for Excellence in Developmental Disabilities.

Recognizing the need to address the workforce challenge exacerbated by the COVID-19 pandemic, Governor Mills included $20 million in the Maine Jobs and Recovery Plan to support health care workforce training. This includes significant investments in the behavioral health workforce.