The hidden problem with Mainecare and services for people with disabilities

There’s  been much discussion about MaineCare and how it’s costs are unsustainable.  There is very little discussion about how MaineCare is the primary funding source for services to   people with disabilities.  Since the 1990’s,   the state has  transferred costs for services to people with disabilities from local state to federal Medicaid funding in an effort to have the federal government pay a  for an ever growing state bureaucracy.  I’ve discussed this in past blogs. Please read if you have any interest.

The flaw with the idea of  MaineCare funding all services to people with disabilities is that most people with developmental disabilities aren’t sick or elderly.  And MaineCare, by all definitions, is a medical model, that is rife with restrictions on potential personal growth, independence and productivity.  It was designed to care for the terribly infirmed or people with little or no hope of personal growth.  The majority of people with disabilities don’t fit this restrictive funding model.

So why are we restricting options and services for personal development of disabled citizens with a medical model?  Why have we compromised personal developement options for disabled people?  I think MaineCare created an industry that supports the state bureaucracy and people working “for” disabilities through Medicaid (MaineCare) rather than  developmental service delivery.  As a result,  our citizens with disabilities have a Medicaid ceiling imposed on them.  They are the recipients of very mediocre and very expensive services that emphasize maintenance over personal development.

There has to be flexibility in how Maine funds worthwhile services for its citizens with disabilities.  A medical model doesn’t meet the needs a people who want options for growth in their personal lives.

Why Maine Care won’t meet people’s employment needs?

There had been a Department of Health and Human Services race to the well, the medi- (care or caid ) or what-ever, well.   It’s been going on for 20-30 years.  Typical of bureaucratic state accounting,  we’re now just realizing that the well runs dry when its contents are used at  more than intended capacity.

 Its’s been perceived as a way for previous  Maine state governments to tell their tax payers that the money coming from the federal government is , “like  free money“, so let’s really run it up!   In place of fiscal  responsibility, we , as a state, chose to  conform to the model that pays us back  more than we invest whether it’s truely cost-effective or not!

Unfortunately, that medical model (MaineCare)  doesn’t pay us back enough for the necessary efforts to encourage work and  for  motivating  and training people to work.  It  discourages it!  It’s a bad resource match to get people working.

 Actually,  there are other misconceptions assumed,  that these   entitlement guarantees will always be there and that the federal government will always pick up the increased costs.    We pay taxes to the feds, too!  So,  there had been  a previous mind-set in Augusta,  that asserts,  “let’s run up our Maine care (medicare /Medicaid) billings to make the darn feds pay!”.    Guess what!   We’re paying twice.  And the ultimate irony is after we created a bloated system,  the federal government is going to cut the overwhelming increase of  services anyway.   Why did we go this route?

 Providing quality services with fewer dollars will be our measures of  success   as social purpose entrepeneurs.  Can we maintain the dignity of the individual in need and dramatically decrease the expense of the current  “delivery system”? 

Point is, don’t live beyond your means because you think someone else( the Fed Gov.) is paying for it.   Provide Maine services to people  because they really need it and  make sure of the best per dollar ratio goes to the people in need, not to the state beauracracy or top heavy non profits operating under the current system.

The private sector must share in this responsibility to make this new service delivery system work.  It will be higher taxes  or calculated altruism, the for profit private sector has to make the difference.  Our experience is they will, given incentives from service delivery professionals and basic good will to give back to their Maine communities.