Advocates for foster parents who take in some of Maine’s most difficult-to-care-for children say they are worried an upcoming overhaul to the system could cause reimbursement rates for certain foster parents to be slashed. But state Department of Health and Human Services officials say there are no current plans to cut the reimbursement rates.
The foster children belong to one of the most vulnerable populations in the state – about 400 children who were abused or neglected and also have severe mental or developmental problems. Currently, they are placed by nonprofit agencies with foster parents who care for the children in homes across the state.
Rep. Richard Farnsworth, D-Portland, House chairman of the Legislature’s Health and Human Services Committee, said he’s heard from officials with many different agencies who fret about changes that could take effect in 2015 to bring Maine into compliance with Medicaid funding rules. Federal officials have told DHHS that it has been improperly billing Medicaid for the room and board provided by foster parents.
The potential overhaul has been discussed for three years, Farnsworth said, but the DHHS has so far not been forthcoming enough about what’s happening.
“They (DHHS) should be transparent about funding changes and not dictate the terms,” said Farnsworth, pointing out that a promised written briefing on the issue by DHHS has never materialized. “They should get everyone at a table and say, ‘Here’s the problem. Help us solve it.'”
Currently, foster parents are reimbursed on a sliding scale depending on the functional level of the child, with parents of foster children who are easier to take care of earning about $10 per day, while foster parents who care for the most severely disabled foster children receive about $65 per day.
John Martins, the DHHS spokesman, wrote in an email response to questions that there are no planned cutbacks for foster parents who take in children for “treatment” care, which is care for children who have severe mental or developmental problems.
“There have been no changes or rate reductions. And at this time for treatment foster care, … there are no planned cuts or rate reductions,” Martins wrote.
Farnsworth said he’s glad to hear that there are no proposed reimbursement cuts, and he hopes that stays true, because parents are reimbursed at higher rates for good reasons.
“They put up with a lot more. They have more appointments to take the kids to. It’s a lot harder work. If the reimbursements were cut, many foster parents would just say, ‘Forget it. We can go do something else,'” he said.
Candace Rowell, state vice chairwoman of the Foster Family-based Treatment Association and a Spurwink Services executive, said health care providers believe changes are coming soon – based on conversations with state officials – but there’s much uncertainty surrounding the changes.
“We don’t know what this new service is going to look like. We don’t know what the support system for the parents is going to be,” Rowell said.
Paul Nau, executive director of Woodfords Family Services in Portland, said he hopes a meeting in August between DHHS and health care providers will provide clarity.
“There are a lot of people concerned because we just don’t know what’s going to happen,” Nau said.
According to letters from the U.S. Centers for Medicare and Medicaid Services to Maine’s DHHS, one reason that Maine is out of compliance is that foster care “room and board” is being billed to Medicaid, which is not permitted. Health care providers are grouping a number of services, including room and board, into one bill that is reimbursed by Medicaid.
“Costs related to room and board and other unallowable costs must clearly be excluded,” wrote CMS regional administrator Richard McGreal in a December 2011 letter to the Maine DHHS.
Farnsworth said he believes Maine is charging Medicaid for room and board for a number of Medicaid programs, not just treatment foster care, and that is a major reason CMS is demanding changes.
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