November 26, 2024

The settlement recognizes progress made and underscores commitment to improving children's behavioral health services

Governor Janet Mills announced today that the State of Maine and the United States Department of Justice (U.S. DOJ) have reached a settlement agreement in the September 9, 2024 lawsuit, United States of America v. State of Maine. Maine is one of several states where the U.S. DOJ had issued findings or pursued other legal action related to compliance with the Americans with Disabilities Act for children's behavioral health services.

The agreement follows years of work and robust investments by the Mills Administration and the Legislature to strengthen children's behavioral health services across the state. The Administration and the Legislature have invested $260 million to increase accessibility, availability, quality, and consistency of children's behavioral health services in recent years.

As a result of these efforts, the Department has reduced the total number of Maine children in residential treatment, lowering in-state care numbers from 290 to 192 and reducing out of state care numbers from 250 to 69. Since June 2022, the Department has also reduced the waitlist for home and community-based services by 42 percent and reduced the waitlist for rehabilitative and community support services by 21.8 percent. Additionally, according to the 2024 Consumer Survey, 90 percent of families with MaineCare reported positive feelings or satisfaction about their participation in Treatment Planning.

"For more than two years, my Administration negotiated in good faith with the U.S. Department of Justice to address its concerns about children's behavioral health services in Maine. I shared many of the U.S. DOJ's concerns, many of which preceded my Administration, and we have worked closely with the Legislature to invest hundreds of millions of dollars to strengthen the system -- important reforms which we believe in and we that we continue to implement," said Governor Janet Mills. "While I am confident that the State of Maine would have prevailed if we pressed forward with a defense, I asked myself, 'At what cost?' Protracted, expensive litigation would only have detracted from what's most important -- continuing to improve our children's behavioral health system. And I prefer to solve problems through conversation and negotiation, rather than litigation. I welcome this agreement because it recognizes the work we have done while outlining a path to continue our progress. We all strongly agree that in-community behavioral health services are critical, and we are committed to continuing to strengthen the delivery of those services for Maine children who need them."

"I applaud the work of Governor Mills, the Maine Department of Health and Human Services, and the U.S. DOJ in reaching this settlement that recognizes not only meaningful progress in improving access to children's behavioral health services, but also the State's commitment to ensure this vital work continues," said Aaron Frey, Maine Attorney General. "I also want to recognize the attorneys in my office who dedicated significant skill, talent, and time in working with the Mills Administration to negotiate this complex and important outcome. My office remains committed to providing the best legal advice to support the State in achieving the commitments in this settlement."

"I'm pleased that the U.S. DOJ and the Department have agreed on a path forward to strengthen Maine's children's behavioral health services. The settlement allows the Department to prioritize the critical work needed to improve access to services over litigation," said Sara Gagné-Holmes, Commissioner of the Maine Department of Health and Human Services. "The State of Maine agrees that it has an obligation to protect and care for children with disabilities and behavioral health needs, and that's why we've dedicated years of time and investments to rebuild Maine's children's behavioral health services.

The settlement agreement recognizes the initiatives undertaken by the State, assuring that Maine is in compliance with Title II of the ADA and fully resolving and settling the claims that gave rise to this lawsuit.

Through the agreement, the State will increase the availability of community-based behavioral health services for children, while also honoring families' informed choice for services outside of a family home.

The agreement includes long-term commitments by the State to provide timely assessments of children's behavioral health needs and care coordination, guided by wrap-around principles, to all children covered by the agreement; restore wrap around services for children with high acuity behavioral health needs; reduce wait lists for behavioral health services; and reduce the need for short term stays in hospitals and other institutional settings based on behavioral health needs.

To that end, actions being taken by the Maine Department of Health and Human Services to improve children's behavioral health services include:

• investing $2.5 million to train providers to implement therapeutic intensive home treatment for resource families (foster parents) based on the evidence-based, Treatment Foster Care Oregon (TFCO) model and $5.2 million to add TFCO as a service covered by MaineCare
• investing $3.3 million annually to implement High Fidelity Wraparound services and establish a Center of Excellence to train providers on this service. These trainings were launched in August 2024, in addition to $5.8 million to establish High Fidelity Wraparound as a service covered by MaineCare
• investing $15.4 million annually in crisis system reforms to expand staffing, training, and accessibility of services at the Maine Crisis Line, Mobile Crisis, and the Cumberland County Crisis Receiving Center, including doubling the amount of staff at the Maine Crisis Line, which has an average response time of two seconds
• piloting a children's behavioral health urgent care walk up center in Bangor which provides access to immediate mental health support and follow up services while coordinating higher intensity services as needed. This pilot has already served 150 youth experiencing anxiety, depression, suicidality, and other behavioral health needs, providing them with follow up support and coordination of direct admission to higher levels of care within their community
• investing a total of $237 million -- an unprecedented amount -- in rate reform for behavioral health services through revision of reimbursement rates for MaineCare providers

In collaboration with the Legislature, the Mills Administration has budgeted another $2.2 million to streamline the assessment of youths' eligibility for medium and high intensity services; implement multi-dimensional family therapy that will be delivered in home, focusing on strengthening parental skills with the aid of an in-home clinician; expanding the children's behavioral health workforce by funding the Behavioral Health Professional Certification for providers; and permanently expanding DHHS' team of children's behavioral health staff to add new positions that will conduct quality assurance reviews for behavioral health providers and offer technical assistance to providers to support the delivery of high quality care.

The Mills Administration remains committed to continuing this work with partners and providers across Maine, and with the Legislature, to further strengthen the behavioral health continuum of care for Maine children and youth.