Sweetser staff participate in the American Foundation for Suicide Prevention Out of Darkness community walk in Bath, Maine in Sept. 2022. (Photo courtesy of Sweetser)
While legislators from each political party have their own perspective on how the negotiations behind the faltering budget plan to address the imminent $118 million Medicaid funding shortfall have gone down, health care providers and those in the forest industry say they are not focused on the “he said, she said.”
“Not passing this bill now, by a two-thirds majority, will impact people’s lives,” said John McAnuff, chief financial officer of Sweetser, a statewide behavioral health organization, referring to the vote total necessary to pass the measure as an emergency in order for funding to be immediately available.
“The clients that we serve are not numbers on a spreadsheet,” McAnuff said. “They are real people with real challenges, and disruptions in service will negatively impact their lives and the communities in which they live.”
Some disruptions are already happening because of the delay in passing an emergency supplemental budget. On Wednesday, the Maine Department of Health and Human Services started capping payments owed to health care providers in an attempt to ensure some level of funding is available for the duration of the current fiscal year.
The department is only paying 70% of prospective interim payments to critical access hospitals and is withholding payments for all hospital claims greater than $50,000. All payments are being withheld to large retail pharmacies, large durable medical equipment providers and out-of-state providers of hospital, ambulance, pharmacy and durable medical equipment services.
At this point, Sweetser and other health care providers are planning to exhaust their minimal cash reserves and then tap into lines of credit while waiting out for lawmakers to finally decide when the funding for MaineCare, the state’s Medicaid program, is going to be available.
While the main purpose of the supplemental budget is to shore up MaineCare funding, it also seeks to address other issues, such as provide funding to spray forests in northern Maine to protect against spruce budworm, a destructive insect that threatens Maine’s forests.
Bipartisan compromise over Medicaid funding shortfall falls apart
“It is crucial to have this funding in place in time for the narrow treatment window this spring,” said Krysta West, deputy director of the Maine Forest Products Council.
The plan is being taken back up in the Senate on Thursday.
“The negotiations are over,” Daughtry told Maine Morning Star on Wednesday. “We’re talking about people who could potentially die from not being able to have access to health care, and we could literally have Aroostook County go up in flames.”
On Tuesday, both chambers initially passed an amended version of the change package that included some of the minority party’s key demands. However, when it came time for enactment votes, the bulk of Senate Republicans rejected the budget. The House enacted it with two-thirds support and later cast another vote insisting on passage of the amended version as an emergency.
In a statement on Wednesday, Democratic Gov. Janet Mills called the failure to enact the supplemental budget with two-thirds support in the Senate a “grave disappointment.”
“Senate Republicans turned away from bipartisan agreement — unlike their House counterparts — and are causing harm to Maine health care providers and patients,” Mills said. “This brinksmanship is senseless and counterproductive. Senate Republicans should honor the bipartisan agreement and pass this bill.”
Shortly after, the Senate GOP issued a statement explaining that the majority of their caucus won’t back the emergency measure unless it reforms the MaineCare system, specifically by adding work requirements for childless, able-bodied adults.
One of the two Senate Republicans who supported the amended plan, Sen. Rick Bennett of Oxford, said he agrees that reform is needed.
“On some of the specific issues, I do think our Medicaid system in Maine is overextended,” Bennett said in an interview. “We’ve got 400,000 people on MaineCare. It’s not sustainable.”
The negotiations are over. We’re talking about people who could potentially die from not being able to have access to health care, and we could literally have Aroostook County go up in flames.
– Senate President Mattie Daughtry (D-Cumberland)
One aspect of the amended proposal is to require a review of MaineCare for fraud, waste and abuse, which Bennett sees as a good start, particularly in light of likely reforms on the federal level under President Donald Trump.
As someone who has been critical of the Mills administration for late payments to health care providers in the past, Bennett said he supported the amendment because, “I don’t want to exacerbate the problem and become part of the problem.”
The weeks-long back-and-forth with floor votes — the “whiplash,” as McAnuff put it — has already caused strain for those creating contingency plans to provide health care and protect Maine’s forests in light of uncertainty. A party-line budget that would result in funding not being available for months would present even more dire consequences.
Jeffrey Austin, vice president of government affairs for Maine Hospital Association, which represents 36 community-governed hospitals, said the delays in Medicaid funding will impact most of its membership. While the group doesn’t have a survey of each hospital’s cash on hand, Austin said he does know that many have very low cash reserves.
“Maine hospitals have some of the lowest operating margins in the country,” Austin said. “This means that the money that comes into hospitals goes right out to pay employee salaries, to pay for our vendors from the people who plow hospital parking lots, to food providers to professional services.”
While Austin said the hospitals are committed to treating all patients regardless of ability to pay, “an extended period of underpayment will create hardships.”
McAnuff estimates capped payments will result in Sweetser seeing about $750,000 less cash each month and said the nonprofit could last about three weeks on its cash reserves and then another three to four weeks if it then taps into its line of credit.
“We have a very short time frame, about a two month time frame, before we are out of cash, essentially,” he said.
An extended period with decreased pay from the state would likely mean having to cut programs, though that would be the nonprofits’ last resort, he said. Sweetser has four major program areas: community-based and outpatient care, residential care, a school, and crisis services.
More immediately, Sweetser would consider not filling vacant positions, which would lead to longer waitlists and more people receiving delayed care or none at all. Payments to vendors may have to be delayed, in turn eroding those relationships, or employees may face pay cuts, McAnuff said.
“If your caregiver is not at 100% when they’re delivering care to you, the service that you’re receiving is going to be less than what we need it to be, so that is also a direct impact on client care,” he said. “It’s really just a vicious cycle here.”
Up in the County, a spruce budworm outbreak has been building on roughly 300,000 acres of land.
The supplemental budget would provide $2 million for the implementation of an early intervention strategy to stop that outbreak before it becomes unmanageable, said West from the Maine Forest Products Council.
“Without the support of two-thirds of the full Legislature, this funding will not be in place in time to treat the full acreage indicated as ‘hot spots,’” West said, referring to monitoring conducted by the University of Maine’s Spruce Budworm Lab.
If left untreated, areas with quickly building spruce budworm populations have the potential to grow exponentially this summer. For context, female moths lay approximately 200 eggs each. Failure to treat an outbreak would also cause mass loss of spruce and fir tree leaves and eventually tree death.
“With a predominant spruce and fir composition, northern Maine’s forest provides critical wildlife habitat, clean air, clean water, carbon storage and sequestration, and abundant recreational opportunities while supplying the fiber needed to fuel our $8.1 billion industry,” West said. “For our industry, this is the most important bill that will be considered this session.”
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