AUGUSTA — Social service organizations are concerned that some of their clients with mental illness may be harmed by state rule changes that would create new requirements for those who manage the patients’ support services.

“It’s these preventive services that are keeping people out of the homeless shelters, the jails and the hospital emergency rooms,” said Betsy Sweet, an advocate with the Behavioral Health Community Collaborative, which represents mental health agencies at the State House.

But Mary Mayhew, commissioner of the Department of Health and Human Services, said the changes are simply about aligning patients with the most appropriate services. Starting April 8, people with mental illness – except for those with schizophrenic disorders or who successfully convince the state that their services should continue – will be barred from what are known as Section 17 community support services provided for the mentally ill under Medicaid. The federal program is operated by the states and funded with a blend of federal and state money.

“There are a number of individuals whose needs are not at the level of intensity that should exist for them to receive Section 17 services,” Mayhew said.

Under Section 17, services are not capped and people can receive an unlimited amount of help.

Some people deemed not eligible for the Section 17 services would be transferred to “behavioral health homes” where certain services are limited to one to two hours per month.


Mayhew said people who need the help will still be able to receive it, and could receive Section 17 services by having a physician write a letter to DHHS explaining why the services are necessary.

Mayhew didn’t have an estimate of how many Mainers would be affected, but Sweet believes it would be about 8,000 people.

Sweet said the community support services include having someone stay on top of chronic conditions and help people live their daily lives. For example, a person with severe depression might need a case manager to remind them to take their medications, go grocery shopping and keep their therapy appointments.

“There are a lot of people who could be falling through the cracks” without the support, she said.

Sweet acknowledged that some people currently receiving Section 17 services might not need them, but she said DHHS is trying to find those people in a clumsy way that is sowing confusion.

“They are taking an ax to this, when what they need is a scalpel,” she said.


Mayhew said the changes are “not a budget initiative,” and it’s unclear whether they would save the state money.

She said having case managers provide extensive daily life services for people who don’t need it is in some cases encouraging a dependency on those services.

“This is about what level of case management is clinically appropriate,” Mayhew said. “In some cases, we are creating dependencies by providing Section 17 services over a long period, which is counterproductive for their recovery.”


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