Maine seeks waiver for mental disease exclusion

Sen. Joe Baldacci, (D-Bangor) is proposing a bill that would force the Maine Department of Health and Human Services to apply for a federal waiver to provide funds for mental health facilities in Maine.

This waiver, known as the Institutions for Mental Disease (IMD) waiver, grants an exception to the IMD exclusion which prohibits the use of federal Medicaid financing for care provided to the majority of patients in mental health and substance use disorder residential treatment facilities with more than 16 beds.

Maine has already received the waiver for substance abuse disorder, but not for serious brain disorders. So far, more than 30 states have obtained the waiver for mental disease exclusion.

The inaccessibility of mental and behavioral health care is a growing issue in Maine; a crisis, in the eyes of many of the state’s health professionals. For years, the state’s health system has failed to meet the needs of its residents in need of mental health treatment. Up to one-third of MaineHealth’s emergency department beds have been filled by behavioral health patients waiting to receive care.

In many instances, patients wait for weeks in emergency departments because of extensive waitlists for the services they require. At the start of 2022, more than 2,000 residents were waiting for outpatient mental health treatment openings.

Jeanne Gore, coordinator and co-chair of the steering committee at the National Shattering Silence Coalition, said first and foremost, she wants to see funding from the IMD waiver used to provide more hospital beds.

“People in crisis need to be getting help much sooner. When they first become ill it often takes a hospital stay to initially figure out what medications are going to help them and it can take up to a month for the medication to kick in to see if it’s actually working right,” she said.

She added that the Progressive Treatment Program (PTP) needs to be utilized across the state. The PTP program requires housing and active community support for its patients, something Gore believes where the IMD waiver can be helpful.

She believes that if Maine used the PDP program as an early treatment option the way other states use similar programs, it could take close to 100 people out of mental health hospitals and keep them safely and intensely supported in the community.

Former Maine Sen. John Nutting has advocated for more mental health resources in the state since the early 2000s and agreed that the best use of federal funding would be to build more robust community supports so that people can get treatment more quickly and stay on their court ordered plan.

“What we’re seeing in other states, such as Vermont that have received the IMD waiver, is that they’re using it for hospital beds, but they’re also using it for community support services,” he said.

Not everyone is in favor of this legislation. The Consumer Council System of Maine doesn’t believe that more beds (inpatient or residential) are a helpful solution.

“A lot of programs are short-staffed, so they take beds off line. Maine doesn’t track live data on beds and that’s one thing we have recommended to the Office of Behavioral Health, which is part of DHS, so that we can better understand the problem,” said CCSM Executive Director Simonne Maline.

The CCSM doesn’t believe forced treatment is a valid solution to the current mental health crisis in Maine. Maline thinks peer support programs would be a more effective solution than an increase in the number of beds.

“I would like to see people receiving the services that they choose, in the communities that they live in. A big part of that is peer support services. This is something that we’ve been advocating for in Maine—for more places to have peer support specialists working in the mental health field,” she said.

Gore, Nutting and Maline all expressed hope that both sides will be able to come to an agreement through conversation in a public hearing and in a work session while the bill is under review. The bill will likely go before committee in early February.