Although all available state-administered funding data has been captured and analyzed, it is still difficult to get a comprehensive picture of mental health expenditures for the following reasons

• All adults in Maine, including elders, are eligible to access the full range of adult mental health services provided by DMHMRSAS, but the use of these services by the elderly is not tracked;
• Data are not available for elderly mental health services paid for by private insurers or out-of-pocket;
• Information about the total cost of Medicare mental health benefits in Maine, and the total number of Medicare beneficiaries receiving outpatient or inpatient mental health services, was not reviewed for this report;
• While an analysis of Medicaid claims data is useful, it must be kept in mind that only a small percentage of elderly persons are eligible for Medicaid; and
• Data do not include substance abuse services.

In FY98, 14,912 elders received mental health services (excluding mental retardation services), costing $15,236,150 via Medicaid and DMHMRSAS administered state funds. The overwhelming majority of these individuals, 12,720 or 85%, received medications only. See below for service and cost breakdown.

The Medicaid program is the largest source of publicly-funded elderly mental health services, accounting for $13,890,753 in FY98. Maine's Medicaid program is administered by DHS, and covers the cost of outpatient and inpatient mental health services and prescription drugs for the 16% of older Mainers who received Medicaid benefits. No recent comprehensive review of Medicaid policies and expenditures has been undertaken to determine how well they meet the needs of older persons with mental illness.

The Home Base Care (HBC) and Medicaid Waiver programs are also sources of funding for mental health services when the need for such services is identified and included in the consumer’s care plan during the assessment process.

Although 55% of older persons assessed at home for HBC or the Waiver program have either a diagnosis or indicator of mental illness, HBC and Waiver funds are rarely used to purchase mental health services.

Medicare, which is administered directly by the federal government, provides limited coverage for inpatient and outpatient mental health services for persons age 65 and over. Co-payment for outpatient Medicare-reimbursed services varies greatly from 20% to 50% depending on type of provider and service. Reimbursement rates for outpatient services are set by Medicare and are substantially less than providers' normal fees. Medicare also covers inpatient psychiatric care, but there is a 190-day lifetime benefit cap. Medicare does not cover prescription drugs.

Medigap, a private supplemental insurance available to Medicare recipients through a number of insurance companies, covers the Medicare co-payments (less an annual $100 deductible). However, the cost of this insurance and the deductible are often not within the reach of older adults who have limited incomes and are not Medicaid-eligible.

There are no substance abuse programs specifically funded for elders. Medicare funding of substance abuse services is even more limited than for mental health services.