Governor Mills delivers on March proposal to tackle immediate behavioral health needs in Maine communities

AUGUSTA— The Mills Administration announced today that it has begun issuing one-time payments to eligible Maine behavioral health providers totaling $15.4 million in State funding to address immediate needs exacerbated by the COVID-19 pandemic.

The Governor proposed this initiative in March and the Maine State Legislature passed it in its bipartisan budget.

The policy, which was developed in collaboration with behavioral health and targeted case management providers, supports assertive community treatment for those with serious and persistent mental illness, targeted case management for individuals with behavioral health needs, intellectual and developmental disabilities, and other special healthcare needs, outpatient therapy for children and adults, and children’s residential care through one-time supplemental payments. 

The purpose of the payments is 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 help reduce wait lists for community-based services.

These one-time pandemic-related payments, to be issued to providers between June 23 and June 30, are part of the Governor’s historic investment in Maine’s behavioral health system. As passed by the Legislature, the Governor’s supplemental budget ($65 million including other initiatives) and the biennial budget ($112 million), along with the Home- and Community-Based Services (HCBS) Plan’s bonus payments for behavioral health workers funded by the American Rescue Plan ($53 million), invest $230 million in state fiscal years 2022 and 2023 in behavioral health to support the workforce, capacity, and resilience of providers as well as sustainable MaineCare rates into the future. The Governor has included investments in behavioral health in every one of her budget proposals.

“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 behavioral health and case management services to develop and issue these payments quickly to support Maine residents experiencing pandemic-related crises,” said Jeanne Lambrew, Commissioner of Health and Human Services. “This unique stop-gap funding will help stabilize the system as we work toward long-term reforms to strengthen community-based and crisis behavioral health services for Maine people.”

"The need for expanded behavioral health care services in Maine is clear,” said Sen. Cathy Breen, D-Falmouth, Senate Chair of the Appropriations and Financial Affairs Committee. “Far too many Mainers and their families are struggling to find care — whether it's community support, outpatient, residential or in-patient care. The measures we funded in the supplemental budget will make a real difference for Mainers struggling with behavioral health issues, their families and their caregivers.”

“These supplemental funds are coming at a critical time,” said Betsy Sweet for the Behavioral Health Community Collaborative. “With the challenges of staffing, access in rural areas, and meeting the priority of providing services in the community, this money will be put to immediate use. It is an excellent investment by Governor Mills and the Legislature to prioritize this funding and get it out so swiftly to the programs and people where the needs are greatest. There is certainly more to be done, but these funds are meeting a critical need to stabilize services for both children and adults who desperately require services and support.”

“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 this investment does not fix our very stressed system of care, the quick delivery of these payments is 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.”

“We appreciate the Mills Administration’s quick distribution of these funds to help stabilize community behavioral health services when the need has never been greater,” said Katie Fullam Harris of MaineHealth. 

These payments aim 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. The pandemic severely impacted the workforces of residential facilities and crisis services for people with behavioral health challenges this past winter, while simultaneously increasing demand for those behavioral health services. This has led to unmet need as well as care for individuals in settings that may not best meet their needs.

On Thursday, the Department made one-time general fund payments to providers of Home and Community Treatment (HCT) under MaineCare 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). Within a week, it will also make the general fund part of the MaineCare supplemental payment ($9.1 million) to children’s residential services (PNMI-Ds), which received substantial rate increases 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 are based on a consensus methodology developed with key providers on an expedited basis in light of the need.

Additionally, the budget provides funding to implement ongoing rate reforms for key services to strengthen Maine’s behavioral health and case management system by making services more sustainable in the long run. MaineCare has launched studies on the best way to pay for behavioral health and case management 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 the Opioid Health Home service model to individuals with other substance use disorders to expand these team-based case management services. Under the Mills Administration, MaineCare has undertaken comprehensive rate reform and has already significantly increased rates for numerous 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.