MaineCare Cuts Leave Mentally Ill Adrift and at Risk

Jul 18, 2014

When Maine made deep cuts to its Medicaid program last January, 25,000 parents and childless adults lost their health care coverage. More than six months later, staffers at the Maine chapter of the National Alliance on Mental Illness say they are overwhelmed by calls.

The calls are from clients with little or no financial resources who are struggling to find treatment.  The changes in eligibility are also taxing the resources of Maine's jails and hospital emergency rooms that have become the refuge of last resort for hundreds of Medicaid castoffs.

During the three-and-a-half years that the LePage administration has attempted to reform the state's Medicaid program - better known as MaineCare - the governor has reserved some of his strongest vitriol for young parents and childless adults. His advice to these individuals became a clarion call for the administration two years ago.

"To all you able-bodied people out there, get off the couch and get yourself a job," LePage said.

While maintaining that the current number of MaineCare recipients in the state was unsustainable, Gov. Paul LePage zeroed in on these young adults in January by making changes to the program that resulted in 25,000 young parents and childless adults losing their medical benefits. Many of them depended on MaineCare to pay for psychotropic drug therapy, counseling or both. And when Maine stopped writing the checks, the phones at the Maine chapter of the National Alliance on Mental Illness started ringing off the hook.

"As soon as January hit, I'd say easily about 60 to 70 percent of our calls were about needs for medication and needs to get in to see a counselor, therapist, a psychiatrist who accepted people who had no insurance, and could do it for a sliding scale or no cost," says Sophie M. Gabrion.

Sophie M. Gabrion is a mental health outreach coordinator at NAMI Maine, a place that has become ground zero since the eligibility changes in January. She and Jenna Mehnert, executive director of the organization, are working with agencies such as Crisis and Counseling and others to identify what services are available to help these mental health patients who now find themselves adrift.

Without their medications, Mehnert says some and are turning to hospital emergency rooms for care. Others, she says, are winding up in jail when their behavior brings them into contact with the criminal justice system. And sometimes that's not by accident.

"I've talked to lots of family members who, the only advice they've gotten when they've encountered a loved one who's in a mental health crisis, is to get them arrested because then they'll have to get care," Mehnert says.

But Mehnert tries - not always with success - to impress upon family members that a jail is not a mental health facility.

"Now the lists of medications the jails provided is much more limited than the kind of of medications that someone could access if they were accessing it through MaineCare," she says. "So even if someone who had stability and is doing well ends up in the criminal justice system, that doesn't mean they get the medication that helped them to achieve stability."

And  resources within the correctional setting have also been stretched to the breaking point. At the Penobscot County Sheriff's department, Chief Deputy Troy Morton says he can't directly link MaineCare cutbacks to increasing numbers of mentally ill prisoners. But he is sure of one thing: "Whenever there's a reduction of services in the general population, it's going to affect what we see here at the jail," he says.

Morton and other county jail officials say prisoners with mental illness present special challenges because they have to be provided with some level of treatment, along with a safe environment. Suicidal thoughts are not an uncommon response to the sudden loss of treatment. In Bangor, one young woman struggles daily to suppress those thoughts.

"My name is Brianna Walker and most people call me Bree for short," she says. "I lost MaineCare in January and I have real difficult times speaking on my own behalf, so my partner Tallis is going to speak for me."

Tallis Aalyryn, Walker's partner, says in the months that have passed since Brianna Walker lost her MaineCare, she has seen a sharp decline in her mood that can take frightening swings into dark places. Aalyryn and Brianna's family do what they can to pay for expensive drug treatment and whatever counseling they can find. But there are days when Aalyryn fears for the worst.

"I'd like to see her services restored," Aalyryn says. "She's been suicidal on and off and we're back at that place again, and it's terrifying."

For Aalyryn and those on the front lines of coping with cutbacks in state-supported mental health services, their best hope for the moment lies in the next Legislative session where a new state budget may be able to restore some of the services they consider essential.