Confusion about MaineCare and The Obama Public Option

I read an article in The Wall Sreet Journal about how MaineCare is a bad example of  the Public option for National Health insurance. This was quite an eye opener since Maine doesn’t seem to realize that it is a bad example.      http://online.wsj.com/article/SB10001424052970204619004574322401816501182.html  .  Maybe Maine doesn’t understand what the current State of Maine administration is doing.  I hope that’s it!

I think part of the problem is the lack of transparency in the whole MaineCare approach.  For years it has been a Baldacci driven initiative with very little disclosure or input from the developmental disability service provider community.  The Baldacci administration was supposedly saving money by putting services for the developmentally disabled under one umbrella of The Maine Department Of Health and Human Services.  It had previously been a separate bureau.  The notion that people with developmental disabilities’ services should fall under a medical model is flawed from the get go.

I continue to ask how does universal health care relate to services for people with developmental disabilities.  I have not heard one interview or read a single article that  addresses the cost of providing services to people with developmental disabilities in relation to health care.  If MaineCare is the State’s model for universal health care, are services for the developmentally disabled a legitimate Medicare expense?  Are people with developmental disabilities all elderly and sick?  I think not.  Should their genuine needs be compromised by the one box fits all accounting that pervades current state governments.  I hope not, because the years that were dedicated to increasing development of individuals lives over mundane maintenance will have been for nothing.

People with developmental disabilities have special needs.  Most of them have nothing to do with medical model reimbursement from the Feds.  The state is trying to push all the services for everybody into the MaineCare model.  It’s not innovative, its just a strategy to get federal funding to  support the ever growing DHHS state budget.  Mainecare medical model and services for the dynamic population of ambitious citizens with developmental disabilitities is a bad match.

Report Card for MaineCare Services for People with Developmental Disabilities

The great State of Maine currently funds all of  it’s services to people with developmental disabilities through Medicaid.  The rules and regulations determined by the Maine Department of Health and  Human Services have culled out and stopped supporting  many private community services that had long histories of success and also had a history of  providing additional options to people with developmental disabilities.

The state money that used to support Maine grass roots initiatives for the past several years has been reappropriated to provide seed money to draw down federal medicaid dollars.    The result of this is that private non profit organizations are closing their doors or reinventing their missions around the MaineCare “one size fits all” philosophy.  Ultimately,  the whole state infrastructure of services has become totally hog-tied by rigid MaineCare regulations compliance.   The grass roots State funding that had previously supported creative private initiatives has been withdrawn to support the “feed” money for the federal draw down.  This state “feed” money and federal draw down of money is what feeds (pays for) the ever expanding appetite of the Bureaucracy of The Department of Health and Human Services.

This would be fine if there was some back up in case the rules in Washington change.  Imagine the House of the State of Maine.  Full of well crafted furnishings and  hand made railings and stairways providing direction from room to room.  Well, let’s imagine a winter cold sets in on the domestic budget of the House of Maine and you, as the resident can’t afford the fuel to heat this winter budget.  Suppose you have a rich and  powerful Sugar Daddy who says, “give me your dining table and I’ll give you two units of heat”.  Okay,  you say,that works, I’m heating my budget.  So what if the kids and Ma have to eat without a table.  Before long the two units of heat are gone.  The Big Shot Sugar Daddy, feeling some loss of heat of his own, offers two more heating units but you have give up some other crucial pieces of furniture, the railings and the stairways.  All these units of heat are getting used up in the winter time budget and before too long all the furnishings that you purchased and constructed over decades are gone to the Big Fella with the evaporating heating units.  The Big Guy starts having trouble heating his own winter budget and stops offering you the heating units.  Your cold, freezing and everything you’ve built up in your House of the State of Maine has been seeded (fed) to the Big Guy.  Your house is a shell and it used to have such optimism and promise.  And it turned out to be a much longer winter budget than anyone expected.

The United Cerebral Palsy Organization has done an objective Analysis of Medicaid for Americans with Intellectual and Developmental Disabilities. It gives state rankings.  Its an honest effort but is too dependent on the spin of state respondents and, unfortunately, is in the language of the bureaucratic glob that it trys to measure.  The report is called The Case for Inclusion 2009.  You can find the entire report at www.ucp.org/uploads/inclusion%20ReportLR.pdf  or go to www.disabilityscoop.com and follow the trail.