NAMI Maine Report Managed Behavioral Health Care in Maine: A Plea for Caution

In 2005, the Maine State Legislature approved a $10.4 million reduction in spending on behavioral health services based on the implementation of managed MaineCare. The Department of Health and Human Services (DHHS) was charged with developing and implementing a plan to make these savings. Their preliminary plan was released in December of 2005. It was developed internally by the Behavioral Health Work Group (BHWG) without the input of families, consumers, or providers. That plan includes a timeline for quick implementation, including a sole source contract with Beacon Health Systems and implementation of managed behavioral health care by July 1, 2006.

In NAMI Maine's opinion, the state's current plan does not follow the approach suggested by research - it has been formulated without stakeholder input, has a precipitous timeline for implementation, and seeks immediate substantial cost savings. NAMI Maine called for the following actions:

• The DHHS Behavioral Health Work Group should include at least two consumer and family representatives as full, voting members and issue no contract, requests for proposal (RFP), or other documents that determine the future of managed MaineCare without enough non-advisory input from families and consumers
   
• The DHHS should conduct an evaluation of the quality of and outcomes associated with Beacon Health Care's (the proposed sole source ASO or MCO) current work in Maine and its work managing Medicaid in other states and, based on this evaluation, consider a full RFP selection process, rather than a sole source contract
   
• The DHHS should review the results of the state's earlier voluntary managed Medicaid initiative and use that information to design a plan to manage MaineCare, all of it, instead of carving-out behavioral health
   
• The DHHS should limit their first implementation of managed MaineCare to one region of the state where there is significant fragmentation and high cost, and use that regional pilot to understand the impact of, benefits of, and best ways to manage Medicaid
   
• An external organization should evaluate the implementation of managed Medicaid to assess the impact of the pilot on consumers and families, costs, ease of access, quality of care, and health outcomes
   
• Pharmacy benefits, state hospital needs, and other state provided services should be included in the managed plan

While the effort to obtain a federal waiver and develop a contract is underway, DHHS should collect data about the financial impact of managed care in other states, and the effect it has had on service provider budgets and service provision, particularly those states that have carved-out behavioral health care. DHHS should also assess the ability of the current provider system, in the pilot region, to absorb the proposed changes and the shifts in service utilization. NAMI Maine also suggests delaying the implementation of the project by creating an extended timeline.