Homeless worry looming MaineCare cuts might take away their clinic, chance to turn lives around [Bangor Daily News, Maine]

Dec. 28--PORTLAND, Maine -- Eric Rustad had a good life. He was a proud father and loving husband, a productive software developer with a bright future. It's a life Rustad is painstakingly climbing back toward.

But now he's worried his safety net -- in the form of Portland's multifaceted Health Care for the Homeless Clinic -- will be taken away because of Gov. Paul LePage's proposed cuts to MaineCare.

His alcoholism snowballed from casual drinking, to lying about how much he was consuming to physical and mental destruction. He couldn't open letters with a letter opener because his hands wouldn't stop shaking. He lost his job and his wife finally kicked him out.

"For a year and a half I was in a sort of walking comatose state," Rustad recalled. "I had an awareness of what had happened, but my emotional awareness had been deferred."

But then he remembered. Rustad and his then-new wife were riding bicycles together along Winn Road in Cumberland. He playfully told her that biking isn't as effective an exercise as running, and she sped ahead just to prove how much of a workout it could be.

More memories trickled back. Good times, friends and family -- his young daughter -- began appearing from the ether, first sporadically, then regularly. The trickle of memories became a flow.

For Rustad, after the warm memories came the cold reality. Instead of contentment, he was left with this echoing thought: Oh God, what have I done?

The memory of the bike ride came back. Then another memory. Then another.

"I cried for six months," he said. "It was all the harm I'd done, the sense of loss and deep grieving."

This is the tipping point where Dr. Shuli Bonham said drug addicts and alcoholics, without proper help, often fall back into a life of abuse. Bonham is the medical director at Portland's Health Care for the Homeless Clinic, a Portland Street institution where Rustad -- and hundreds of others like him each year -- eventually ended up.

"A lot of people do well for awhile, but then they finally get clear enough to remember what they've lost due to their addictions," Bonham said. "And people will do anything to avoid dealing with those memories."

"Most of the people I see here did really well for themselves at some point in their lives," Bonham said. "They were successful. But there's this concept that homeless people just appeared out of nowhere and are this blight on society. There's no recognition of where they've come from."

Or, Bonham said, where they're going. Portland city officials, including Mayor Michael Brennan, have argued that Gov. Paul LePage's proposed MaineCare reforms will sap so much state revenue from the clinic that it may have to close.

Douglas Gardner, director of Portland'sDepartment of Health and Human Services, told the Bangor Daily News that of the clinic's approximately $1.9 million annual budget, about $785,000 is funded by MaineCare reimbursements. And although some of that revenue is safe from the governor's proposal to eliminate state health care coverage for childless adults, Gardner said "the majority" of MaineCare reimbursements to the clinic will be cut if the Legislature accepts LePage's reform package.

The governor's administration is proposing the overhaul of MaineCare -- the state's version of the federal Medicaid program -- to help address a $220 million shortfall in the Maine Department of Health and Human Services budget.

His proposal called for tightening eligibility requirements, eliminating services and repealing coverage entirely for thousands of MaineCare recipients to bring Maine's program closer to national averages. The projected impact of the governor's plan would be a loss of health insurance coverage for 65,000 MaineCare recipients.

The administration has defended the cuts as necessary to curb spending on a program that has swelled beyond national averages and far beyond taxpayers' ability to pay for it. Administration officials have noted that since 2002, Medicaid enrollment in Maine has grown by 78 percent while the state's population has grown only 7 percent.

LePage has more recently said there are more welfare recipients in the state than income tax payers, seeking to drive home the point that the state's systems are financially unsustainable.

But those who have fallen as far as Rustad did, Bonham said, don't have jobs to qualify for employer health insurance and can't afford to buy it themselves. Bonham acknowledged that people in those positions must assume a certain amount of "personal responsibility" for their predicaments, but she said eliminating health care for many of them would leave them no path to become productive members of society once again.

"So many people say, 'You're an addict? Go deal with your addiction,'" said Rustad, who is now sober, lives alone in an apartment, is allowed to see his daughter a few times each week and earns money doing odd jobs. "It's very easy for us to cast stones at addicts and alcoholics, but it's pointless to do so. We demonize the alcoholics and the addicts, [saying] 'Why don't you just stop drinking?' Not everybody is the same. It's naive to say, 'I have to figure it out, so they have to figure it out.'"

After being checked out at the clinic, Rustad learned that alcoholism was just one of his ailments. Among other problems contributing to his inability to keep his life together were social anxiety and panic disorders.

Other clients who stopped in at the facility this week told similar stories of being unaware of health problems until clinic staff, admitting the patients through MaineCare provisions, made life-saving diagnoses.

Mark McForbes, for instance, said he learned at the clinic he has diabetes. Jon Pomerleau said he's HIV positive and faces thousands of dollars in monthly medication bills he couldn't afford without his MaineCare coverage.

Appointments at the clinic are typically not set up too far in advance, as the clientele can be unpredictable, Bonham said. But nearly all manners of care can be given at the site, including behavioral health, medical and dental services -- a suite of programs that allows patients several contact points and familiar faces in the building and creates a network capable of detecting signs of trouble in the clients' mental or physical health on the road to recovery.

"We want to take care of things before they turn into crises," she said, "which can happen very quickly for many of these people."

Without the clinic, Bonham said, many of the patients would wait until their conditions became impossible to ignore, and if they seek help at all, would go to an emergency room. There, health care costs are statistically much higher, in part because hospitals must cover the costs of treating patients who are not insured -- such as those Bonham said would be cast away from the Health Care for the Homeless Clinic.

"I would have cost the state a whole lot more money had the clinic not been here," Rustad said. "For a lot of people, it's not a matter of going back out and getting sick again. It's a matter of not making it at all."

Bonham said the clinic, located in an old box factory on Portland Street, provides full medical or dental visits for 2,285 patients per year, and many more less formal interactions to point potential clients toward other DHHS resources. The medical director said the clinic has become a key hub for people discharged from both prisons and the military, where access to the appropriate medications was regulated but is now left to the patients to figure out.

She said 41.5 percent of the clients are backed by MaineCare, and the "vast majority of those who aren't in that 41.5 percent don't have any insurance at all." Gardner said the remainder of the clinic's budget is covered by "federal grants, other reimbursements and city funds." Clients who have incomes pay on a sliding scale.

On a recent Monday morning, nearly a dozen seats in the waiting area were full. Some patients sat quietly, while others exchanged pleasantries. Members of the clinic staff appeared at staggered intervals from down a short nearby staircase or around a corner, calling for individuals on a first-name basis to join them.

"If we lose our MaineCare, we'd be looking at a situation where we'd have to drastically reduce our services or even shut our doors," Bonham said. "I don't know what we'd do. And I don't know what our patients would do. There aren't really any other options for them."

Rustad now welcomes back the warm memories and has suppressed urges to drink. He worries that if MaineCare cuts force the clinic to close, others like him won't get a chance to turn their lives around.

If the state can't find the resources to work with Portland's Health Care for the Homeless Clinic, he said, "they'll end up having to collaborate with the morgue."

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