Categorized | Pushback

Northeast Medicaid Issues: Expansion & Mental Health

Wealth Checking

In early December, a judge in Maine denied a request by lame duck Gov. Paul LePage, R-ME, to block the expansion of the Medicaid program

By Al Norman

In early December, a judge in Maine denied a request by lame duck Gov. Paul LePage, R-ME, to block the expansion of the Medicaid program — even though voters in his state approved the health care expansion. The court ruled that the expansion must begin Feb.

On Jan. 1, newly elected Gov. Janet Mills , D-ME will move forward with Medicaid expansion, as she promised in her campaign. Advocates for Medicaid expansion in Maine applauded the court decision, saying that Gov. Mills “will be implementing the law so that it’s done right, and people will get the care that they’re eligible for.”


Maine adopted Medicaid expansion through a ballot initiative in November 2017. The ballot measure required a state plan amendment (SPA) within 90 days and implementation of expansion within 180 days of the measure’s effective date, but Gov. LePage failed to meet the April, 2018 deadline for submitting the SPA. The governor complied with a Maine Supreme Judicial Court order to submit the expansion SPA to the federal government on September 4, 2018. But at the same time, the Governor also sent a letter to the federal government asking Centers for Medicare and Medicaid Services asking them to reject the SPA.

There is no rational explanation for why the outgoing governor worked so hard to deny the will of Maine voters, and to deny health care for the 70,000 Mainers who will gain eligibility when the Medicaid program expands. Under the Affordable Care Act, states have been allowed to expand eligibility for Medicaid since Jan. 1, 2014. Thirty-seven states have expanded Medicaid. Maine is the only state in New England that has not yet expanded its Medicaid program.

Mental Health Void

A new survey by the Blue Cross Blue Shield of Massachusetts Foundation found that 39 percent of those seeking mental health treatment went without care. One problem was finding a provider who was willing to accept Medicaid payment. According to a Boston Globearticle, “Massachusetts has more mental health care providers per capita than any other state, more psychiatrists than anywhere else but Washington, D.C — yet only about half accept payment from the state and federal Medicaid program,” because these programs “don’t pay enough to practitioners.”

The Baker administration told the Globe“that Medicaid is increasing fees to mental health providers by $100 million between 2016 and 2020.” One provider complained,“For a clinic to have a doctor on staff to see patients on a regular basis, the rates don’t cover their time.’’

Over the years, the issue of inadequate mental health services for older people has not changed much. Twelve years ago, I testified in Boston at a Mental Health & Aging hearing. “Neither Medicare nor Medicaid are good at providing mental health services in the homes of disabled older people,” I said. “As one licensed therapist who works out of a hospital told me, ‘My hospital absolutely forbids me from going on a home visit, because it’s a money loser.’ Medicare payments alone only cover 50 percent of the approved rate, leaving the consumer with a large copayment, and the practitioner with a rate inadequate to cover the cost of making a home visit. Medicaid will cover the 50 percent copayment for low-income seniors, but we still can’t get mental health supports into a senior’s home. We have been told that MassHealth will pay for medically necessary services in a home setting on an ‘intermittent basis’ only if the member has difficulty accessing services at a clinic.”

“If we fail to address the mental health needs of our older citizens on MassHealth in the community, we will see them eventually in an institution,” I testified. “We must begin to put in place a better mental health system for elders on MassHealth, or we will continue to segregate these people from the community, based on a mental health disability, and deny them their civil right to care in the least restrictive setting.”

Finding a mental health counselor in the home of the elderly seems to be as rare as finding a unicorn in their bathtub. By default, many elders with mental health problems find themselves in a nursing home.

Al Norman worked in the aging field in Massachusetts as a lobbyist and advocate for 38 years. He can be reached at:

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