Monday, December 9, 2013
Long before she died from Alzheimer's disease a few years back, my mother had an often hilarious habit of mixing her metaphors.
Faced with what looked to the rest of us like imminent disaster, for example, Mom would wave away our trepidation and say, "Don't worry, dear. We'll cross that cliff when we come to it."
I thought of my mother last week as I spoke with Sally Soule, 47, of Kittery.
Soule, too, has a mother with Alzheimer's -- her name is Pat, she lives in an assisted-living facility in southern Maine and, because she's in no position to decide if she wants her full name and address splashed across the newspaper, we'll just leave it at that.
Soule also sees a crisis on the horizon: Thanks to a reported $120 million hole in the Maine Department of Health and Human Services' current two-year budget, the MaineCare insurance coverage that keeps Pat safe and sound appears headed for an out-and-out free fall.
"I am freaking out," said Soule in an interview last week. "I feel like I'm a pawn in (Gov. Paul) LePage's political games."
It remains to be seen how much of the DHHS dilemma is politics and how much is a genuine fiscal collapse that, according to the LePage administration, has been building for the last decade.
But this much is certain: Under the supplemental budget unveiled by LePage last week, roughly half of the $120 million in cuts to DHHS in the 2013 fiscal year would be achieved by eliminating private nonmedical institutions, also known as PNMIs, from the state's Maine-Care coverage.
That means 302 Mainers in residential substance abuse treatment centers could, as of July 1, have no place to live. Ditto for 696 children receiving behavioral health and other services, 608 adults with mental illness and 379 adults with cognitive and physical disabilities.
And last but by no means least, 4,291 elderly Mainers with Alzheimer's, dementia or various other late-in-life maladies would, as the euphemism goes, have to make other arrangements.
People like 80-year-old Pat.
Soule moved her mother into the Alzheimer's unit just after Soule's father died in 2008. She remembers an estate attorney looking at what was left of her parents' assets -- around $200,000 at the time -- and advising Soule to "hide the money" so her mother could go on MaineCare immediately and thus not burn through Soule's inheritance.
"But I didn't really believe in that," recalled Soule, who works as a project manager for the New Hampshire Department of Environmental Services. "I didn't think I could sleep at night if I had done that."
So she paid privately, to the tune of $8,000 per month, until the money ran out last year. Only then, with both the state's and the facility's blessing, did Soule enroll her mother in MaineCare.
At first she worried the switch might make Pat a "second-class citizen" within the Alzheimer's unit. But the staff told her to relax.
"I'll never forget this because it's so poignant now," Soule said. "They said to me, 'She will always have a place to live with us here -- even if she is on MaineCare.'"
Pausing, Soule added, "Until about two days ago."
"MaineCare can no longer be all things to all people," countered Bonnie Smith, DHHS deputy director for programs, in an interview Friday. "We simply don't have the money."
Few would dispute that. As Smith noted, the supplemental budget's trimming of some 65,000 people from various MaineCare services still leaves upward of 290,000, or about one in five Mainers, enrolled in the program.
But the panic now seizing much of the MaineCare system -- hundreds are expected to converge on the State House on Wednesday for the first in three days of hearings before the Legislature's Appropriations Committee -- is fueled by one yet-to-be answered question: Without MaineCare, what will happen to these people?
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