Advocates had a mixed response to rule changes the Maine Department of Health and Human Services recently made for programs that serve disabled children.

The child advocates had raised the alarm earlier this year about the proposed rule changes for Medicaid services that aim to improve behavioral and developmental skills for disabled children. They contended the pending rule changes would restrict access by making it harder for some children to qualify for the programs.

DHHS received hundreds of public comments against the changes when they were pending this winter. The agency made improvements to the final rules, which were adopted at the end of April, but there’s still numerous concerns, said Nancy Cronin, executive director of the Maine Developmental Disabilities Council.

“They fixed what would have been some of the biggest threats to services,” Cronin said.

Cronin said DHHS corrected what would have been a “terrible” change to Medicaid’s Section 28 services, which helps children with life skills, such as how to order food at a restaurant, answer the phone, listen and interact with others. Cronin said the original rule changes would have made it extremely difficult for children with certain diagnoses, such as attention deficit/hyperactivity disorder and cerebral palsy, to access the services. Cronin said DHHS backed off those Section 28 changes.

Lindsay Hammes, Maine DHHS spokesperson, said in a statement that the agency listened to the concerns from a “significant number” of commenters, which helped avoid “potential unintended consequences.”

The goal of the rule changes was to improve access to services and make it easier for families to navigate the system, Hammes said.

In 2024, the U.S. Department of Justice filed a lawsuit against Maine for failing to provide adequate services for disabled children in the Medicaid program. The lawsuit was settled in November 2024 after Maine devised a plan to make improvements.

Cronin said that even though DHHS pulled back from its worst proposals, the rule changes “are not going to improve care” and will instead add procedural hurdles for some, particularly for children with Down syndrome.

“We’ve added additional steps to the process without creating more access,” Cronin said.

Adam Bloom-Paicopolos, executive director of the Alliance for Addiction and Mental Health Services, Maine, said DHHS imposed new rules that are more confusing, which will make it difficult for nonprofits to deliver the services.

Bloom-Paicopolos said DHHS was “able to alleviate some of the concerns we had, but “some things got worse.”

He said in one example, DHHS now requires therapists who provide in-home family therapy to have a master’s degree, when previously the standard was a bachelor’s degree or higher. Requiring a master’s degree will further restrict services because there aren’t as many therapists who have a master’s degree, he said.