AUGUSTA — At the Health and Human Services Committee on Tuesday, all seats were taken for the public hearing on L.D. 1737, a proposal by state Sen. Cathy Breen to increase MaineCare reimbursement rates for psychiatric medication management. Testimony lasted nearly four hours as community members, people living with mental health challenges, law enforcement, judges, doctors and behavioral health providers took turns at the podium telling the tale of a system coming undone.

Representatives of community-based providers like Spurwink spoke about running their medication management programs at an annual and growing loss of hundreds of thousands of dollars per year, for as long as they could, before finally – and with tremendous heartache – shutting down this service

Others told the committee they were still hanging on – but barely – in the hopes that maybe this year is the year that policymakers finally hear them and the countless others who are clearly and repeatedly telling them that we need more, not less, proven, evidence-based medication management by psychiatric specialists. They are asking, practically begging, because they know how vital these services are and because they know the waiting, the suffering and the deaths of some of Maine’s most vulnerable people. And they are hanging on as costs and demand continue to increase, and as they watch their colleagues close and their waiting lists swell.

At one Maine agency alone, there is a waiting list of 1,200 adults and children, 700 covered under MaineCare. The average wait time is nearly three months.

Psychiatric medication management connects individuals struggling with mental illness and addiction with medical professionals who have the expertise to help them navigate the specific dosaging, type, side effects and combination of medications for their often-complex needs and conditions. These services require a level of skill and knowledge related to psychiatric medications that general practitioners simply cannot provide. The services are provided often by community-based agencies, so they can be accessible and have the ability to provide or link to other services, if needed.

For many who depend on medication management services, there is increasing anxiety as they face longer drives and longer waiting lists with no viable alternative. And for those who try to provide these services, they face a scarcity of psychiatrists and reimbursement rates that are lower today than they were 14 years ago. This is not only unsustainable but also fiscally irresponsible.


Medication management allows people to stay in their homes, and safely integrated in their communities, rather than the much more costly emergency room, psychiatric hospital or jail, which can run up to $1,500 per night. And if there are children, jobs and other commitments, those too benefit from people being able to remain at home as they treat and live with their mental illness or substance dependence. The indirect costs to the individual, their family and the state of their ending up behind bars or in an institution are both large and long-lasting.

This rate increase – which would be the first in a decade – is so modest it will not even cover the full cost of providing these services, which include psychiatric evaluation, prescription and patient education. It will simply get these agencies closer to the actual cost so they can try to remain afloat.

A doctor from Martin’s Point pointed out clearly Tuesday that “the reason it is so much easier to find a cardiologist in a crisis rather than a mental health provider boils down to reimbursement. Our payment model favors high-tech interventions over cognitive services. In my own practice, l can make more money freezing warts with liquid nitrogen than treating someone’s depression.”

As described by retired Chief Justice Daniel Wathen, courtmaster for the Augusta Mental Health Institute consent decree, medication management is a “much-needed foundational service that makes many of the other services meaningful and possible.” He adds that “Maine people are waiting far too long for this service, causing backlogs in psychiatric hospitals, blocking them from being able to accept those who truly need a hospital level of care and preventing others from being able to be released back to their homes in the community.”

With this critical tool, people remain productive members of society – working, coaching Little League, raising their children, volunteering and paying their taxes. Without it, for many, life simply comes apart at the seams.

— Special to the Press Herald

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