As political season draws nearer, most of the attention is focused on women’s rights, immigration, and the economy. These issues are great topics to discuss, and will make a huge impact on the future of the country. Another key issue of many, healthcare, is at the top of some voter’s minds. We begin to round the corner of one president into another, and like so many voters, healthcare is a top priority. How affordable can it be, what insurance will cover and how much they’ll pay, and what insurances will take it are just a few questions to the curious mind.
I wanted to dig deeper into the healthcare industry, specifically in Maine, with MaineCare. With the help of a close friend, a case manager in Maine, I looked into researching MaineCare, and what’s going wrong with this nation’s healthcare industry, using Maine as an example. We discussed roadblocks case managers (and their clients) face, the horrendous pay structure, as well as a mini-guide to building a strong healthcare system.
“What are some roadblocks you face, as well as those your clients faces?”
The biggest roadblock my friend faces as a case manager is no-shows, which connects to policies set by each individual agency, as well as state healthcare systems. Through MaineCare, a client can no-show or be absent for up to two times before being discharged. At their agency, three no-shows equal the ability to discharge a client, although every agency varies. Every no-show to a scheduled appointment severely deducts the case manager’s pay, which isn’t salaried. Instead of receiving an hour’s pay for an appointment, they would be lucky to escape with fifteen minutes paid time.
On a typical schedule, my friend is on the calendar for thirty-five hours per week, but usually ends up at twenty-two. More often than not, there is no punishment for no call, no show clients, as services with MaineCare are free. Clients are also apt to manipulation, making excuses for their absences. Even if served a discharge from an agency, they may text or call and request services, thus, repeating a never-ending cycle. In a personal experience, my case manager friend dealt with a client who missed twelve appointments, seven in a row.
Case managers and other mental health providers aren’t the only ones suffering in this crooked relationship. A general roadblock most clients suffer is the path of self-victimization. The question “Why are these things happening to me, only me” is a common escape to missing appointments. Some clients are are actually able to work and do other daily things, but choose not to, then complaining about it.
Another roadblock clients face, especially those who actively try to better themselves, is the government and its agencies. Through personal experience, my friend states their experience with such agencies (CPS or DHS, for example) have been mostly negative. Some people attempting to be reunited with their children after not seeing them for years are denied, or status is revoked. One client may have visitation rights for weekends, then at random, it’s demoted to supervised weekends, then no rights. These government agencies, in her opinion, are making rules at random, possibly targeting specific groups.
“If given control, what is one thing you would change about case management?”
The most important thing, and something that most, if not every worker in the world thinks about, is money. Some may claim other factors for choosing a job, but at the end of the day, what pays the bills matters most. If you can’t afford a house, or at the very least, an apartment, you’ll be on the streets.
Currently in Maine, the average salary of a case manager is $79,002 (which equals roughly $38 per hour). This figure looks great on paper, but fails to account for the large number of case managers well below. There has to be a number of case managers dragging down the average, and unfortunately, my friend is one. They didn’t feel comfortable sharing wages, but stated they’re close to the poverty line. They revealed what needs to change: the pay structure.
As stated above, my friend begins every week with close to thirty-five hours. An average week is close to twenty-two. No shows would account for over thirteen missed hours per week, which is thirteen hours of lost pay (according to the math). Double booking, or preemptively trying to make up for time they know they’ll lose is not allowed. “I can never get ahead, I can only catch up”. They are required to wait fifteen minutes before moving on and stating the client was a no show. They can then receive pay for those fifteen minutes, and those fifteen only; not including the rest of the hour. While they can’t state this is the same policy nation-wide, it’s close to it at the very least. The reasoning behind this is insurance, as most insurance has similar policies state to state.
My friend’s solution: make case management a salaried position. In fact, all mental health positions should be salaried in their opinion, and it makes sense. Why should a case manager, one who waits fifteen minutes for a no show, get penalized. They waited for fifteen minutes, taking a severe cut in pay, and more often than not, the client isn’t even penalized. Whether seeing a client or not, the healthcare professional is working. It may be administrative work, research, or whatnot, but typically, the work is constant.
“What needs to be changed to make healthcare work?”
Let’s be honest, the United States’ healthcare system is struggling, and has been for years, if not decades. Public enemy number one is insurance companies, greedy and cold. Insurance companies will often reject medically necessary things, simply due to the fact that the person asking doesn’t have doctor’s permission. If providing a doctor’s note, they’ll be more apt to accept giving the medication. However, the former is all the more likely. As long as they can turn a profit, they don’t care who gets hurt or who suffers. One of the largest struggles my friend has is writing progress notes on individual clients. The wording in these progress notes has to be specific, precise, and if worded incorrectly, the punishment could be a large fine, or prison at worst.
There are things that they can do (within the scope of their practice) and things that they cannot. For example, putting a client in their personal car and driving them to the store needs to be worded properly for the insurance company. If the incorrect language is used, or the way the trip is documented is not portrayed in a way that shows the provider is working off the treatment plan, MaineCare may not accept it. If a client sees two case managers, and both use similar descriptions of doing something, both could be fined for double billing.
A lot of clients, especially at my friend’s agency, are low-income. By low-income, they mean the lowest income (living in section 8 housing, not paying rent, crashing on couches). My friend works with homeless populations, those on the street with PTSD and other mental illnesses. There are programs that seek to help these populations (i.e. Habitat for Humanity, PENQUIS, KVCAP, to name a few) although there is little money being allocated to them. Through my friend’s personal experience, it’s disheartening and frustrating to tell clients about the issue of money. Halfway through the year, in June, telling people there’s no funding is hard.
Food banks typically don’t have anyone to monitor what goes in and comes out. Sometimes, clients will attempt to get food at these banks, and come away with rotten meat and expired produce. The state of Maine’s waitlist for a one bedroom is over four years, although some programs estimate a little shorter (2 years, 3 months). “How do you tell that to a homeless person with PTSD and belongings and doesn’t want to go to a homeless shelter because everything is going to get stolen?” There is no outreach for people like this; an amputee client of theirs doesn’t have electricity or running water. He can’t afford insulin, nor does he have a refrigerated space to put it, all because he lives in an RV and not a “house”.
Documentation and laws need to be rewritten to encompass more types of people. The system is designed to give out as little money as possible. Schools don’t teach anything about the industry, other than simple billing. Burnout is real as well. Since January, at my friend’s agency, three case managers have moved on, as well as one mental health counselor. According to the U.S. Bureau of Labor Statistics, around 70,000 mental health workers quit their professions on a yearly basis. Most social workers enjoy what they do, but the toll on their own mental and physical wellbeing isn’t worth it.
If the 42nd most populated state is a trend, the rest of the country is slowly heading into disastrous terrain. It only takes one state to enact change for the rest to follow suit. Hopefully for the sake of social workers everywhere, Maine can be a trendsetter. If there is one policy I’m looking for this election year, it’s a dedication to reforming healthcare in this country.
Sources used throughout this article include: USAFacts, CaseWorthy, Maine Policy, and The Bollard. The cover image is taken from Bangor Daily News.