Who should get help from the state? That has been the central question raised by the Department of Health and Human Services under Gov. LePage, and it has set off a years-long and ongoing debate over what circumstances warrant taxpayer-funded government assistance.

However, there has at no time been any disagreement that Mainers with intellectual and developmental disabilities are at the front of the line. In fact, along with seniors they are the residents mentioned at every turn by LePage administration officials to justify cutting Medicaid rolls and other services – they are the “most vulnerable” for whom state funding in other areas must be sacrificed.

Yet it’s that very population that has been so egregiously let down by DHHS.

FAILURE TO REPORT

According to a federal audit released last week, DHHS failed to follow federal requirements and state law for reporting, investigating and recording incidents in which the care for people with developmental disabilities was compromised in some manner, from minor medication errors to sexual abuse and death.

The audit concerned the 2,640 recipients of Medicaid (known here as MaineCare) being cared for by community-based providers, including about 1,800 adults with intellectual disabilities who live in group homes.

Those Mainers are cared for in the community, rather than in an institution, under a federal waiver that requires providers who run the group homes to report to DHHS “critical incidents”: abuse, medication issues, deaths, restraint usage, injuries and exploitation.

Examining the period between January 2013 and June 2015, the Office of the Inspector General within the U.S. Department of Health and Human Services found that one-third of critical incidents went unreported.

When incidents were reported, the audit found, the state did not ensure that the most serious incidents were investigated, with a detailed final report submitted to DHHS, nor did the department refer appropriate incidents to law enforcement, or investigate any of the 133 beneficiary deaths.

In short, the department failed in meeting even its most basic obligations to the federal waiver, and to Mainers whose disabilities leave them unable to fully care for themselves. It placed at risk those Mainers, many with serious disabilities, unable defend themselves or even communicate, and prevented the kind of systemic review that can lead to better, safer care.

RESPONSE RINGS HOLLOW

Maine is not alone in getting this wrong; the OIG has issued similar reports regarding care in Massachusetts and Connecticut. But that doesn’t excuse it, particularly when it appears the state was aware of the system’s faults during the time in question.

Care providers say the system for reporting incidents is in “disarray,” with no clear guidance from the state. Some say the state told them not to report most incidents.

They say they have approached the department with concerns over the system repeatedly through the years, with little or no response.

DHHS disputes that characterization. Officials deny telling providers to forget the incident reports, although one wonders how thousands of missing reports went unnoticed by DHHS.

And they say any shortcomings identified in the audit have been corrected, though providers say problems persist, and the department has offered no data or other hard facts to back up that assertion.

This is not the first time that DHHS has argued a position in opposition to all available evidence. Officials said they had heard nothing of a shortage of opioid treatment options while everyone involved in treatment was screaming for resources, and they said conditions at Riverview Psychiatric Center were fine while employees pleaded for help, to name two.

But those were both political fights in nature.

There may be disagreements over the proper level of Medicaid reimbursements for the caretakers of the developmentally disabled, but there is no controversy over the state’s obligation to oversee that care, to track and investigate when things go wrong.

If DHHS can’t do that correctly, what can it do?