Reframe Maine's debate on Medicaid "versus" funding the developmental disabilities services waiting list

by Sharon Wachsler

During the months of February and March, I kept seeing articles and editorials in Maine newspapers about whether to expand Medicaid to Mainers who are uninsured OR whether to provide the necessary funding to adults with developmental disabilities who have been waiting for services for much too long.

I kept thinking, "This is a really screwy way to frame this question! Why is it that those who are writing about and discussing these topics are putting these two issues together as diametric opposites? Why is this discussion being framed this way -- as if the pie MUST be sliced so as to either leave out uninsured Mainers from receiving Medicaid or letting Maine PWDs continue to languish on the waiting list? Surely there are other options for funding that don't involve shafting either disabled or low-income Mainers (as if those two groups are separate)."

I have some theories as to why the debate was being framed this way (and that it was a debate at all), and who was benefitting from packaging the issues in this bizarre binary, but nevermind that! Nancy Cronin, the executive director of the Maine Developmental Disabilities Council, has written a terrific editorial that really gets to the heart of the matter in a sensible and articulate way.

In the March 20 "Maine Compass" feature of the Kennebec Journal, Cronin's op-ed, "Expand Medicare [sic] or fund waiting list? Question compares apples to oranges," addresses the question head-on. (Note: Although someone at the Journal gave the piece a title that says "Medicare," the expansion under debate was Medicaid, not Medicare.) Here's how the piece starts:

Should Maine expand Medicaid or fund the waiting list? That seems to be the question.  It is a strange question, however, from the point of view of the Maine Developmental Disabilities Council. It’s like asking if insurance should provide coverage for dialysis or for heart valve replacements. It’s not an either/or question and, frankly, pitting one vulnerable population against another one is not helpful or productive for any of those involved.

Cronin outlines the basics about how the waiting list came about and what the real questions are for moving forward, focusing always on the issue of sustainability.

The question, therefore, becomes: How do we obtain enough money to serve everybody who is eligible and in need of the service?
Are the conversations happening in the State House regarding the expansion of MaineCare yielding a sustainable answer? Unfortunately, no.
If only there were simple answers. In order to adequately serve people with developmental disabilities in Maine, we need to analyze our system of services to find methods that would serve more people at lower cost. This is easier said than done, of course. Those receiving services today might be afraid of how changes would affect their future and security, and those delivering services might fear for the security of their jobs. It is easier and more comfortable to stay within the current system, but it is not more sustainable.

Hop over to the online edition of the Kennebec Journal and read Cronin's essay!