Case managers are the glue between the widening cracks in the social safety net. They help people dealing with mental illness and intellectual disability navigate the tangle of assistance programs so that they get the support they need to stay healthy, and to live as independently as possible.

So it’s worrisome to learn that the Maine Department of Health and Human Services is moving forward with a policy change that could eliminate comprehensive case management services for about 8,000 Mainers without much warning, disrupting a crucial support system for people suffering from mental illness.

The change affects people who receive services under Section 17 of the manual governing MaineCare, the state’s Medicaid program, which provides intensive case management to adults with a variety of mental illnesses and disabilities.

Someone with an intellectual disability and an anxiety disorder, for instance, could work with a government-funded case manager to apply for and maintain health care, food and housing assistance, and employment skills development. The case manager could help the client access mental health support, coordinate medication and meet medical appointments.

Under the policy change set go into effect next month, however, only people with a primary diagnosis of schizophrenia or schizoaffective disorder will remain eligible for case management (although some exceptions will be allowed). Everyone else will begin receiving a much lower level of services, some of which are also the subject of state cuts.

The change is necessary, DHHS has said, because the demand for services has created a wait list.


Schizophrenia, as DHHS noted, is one of the most serious and persistent forms of mental illness, and people who suffer from it are at the top of the list for those that need services.

But that shouldn’t undercut others struggling from mental illness and dealing with a disability.

Without intensive case management, many of them will be in danger of losing, through lack of attention or understanding of the system, the very basic necessities – food, housing and medication. Ultimately, those Mainers will end up needing more support as their illnesses are exacerbated through lack of care.

It may be, as DHHS has said, that some of these patients can get by with only the lower level of services. But it is unclear how the state will support them in that transition so that their care is not disrupted.

It’s not a good sign that when the letters notifying MaineCare recipients of the change went out March 1, it caught patients and service providers by surprise.

What’s more, the letters are confusing. Under the heading, “What does this mean for you?” the form letter says, “You may or may not be losing services,” leaving already vulnerable recipients in the dark, and scared about what it means for their day-to-day living. Maine, in particular its jails, shelters and hospitals, are already feeling the impact of cuts in mental health services. It is the state’s obligation to make certain that drastic changes in service don’t lead to more suffering.

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