July 7, 2023
Yesterday, the Legislature passed the final piece of the FY24-25 biennial budget that Governor Janet Mills indicated she will sign. It includes a number of initiatives that advance the health and well being of Maine people. Highlights include investments in services for children, older Mainers, people with disabilities and behavioral health challenges, and continuing support for comprehensive MaineCare reform and sound financial management.
Promoting Health, Education, and Safety of Children
- Child Care: The budget includes $59.1 million in the biennium to increase existing wage support for child care workers, expand eligibility for financial assistance for parents, and strengthen Head Start, among other important changes. This ongoing state funding further advances the improvements in Maine’s child care system that have gained national recognition for supporting children, families, and the workforce.
- Children’s Behavioral Health: The budget invests nearly $20 million in Federal and State funds for the next biennium to accelerate and intensify implementation of Maine’s comprehensive children’s behavioral health plan. The COVID-19 pandemic escalated stress, anxiety, and substance use disorders for children, youth and families and strained the behavioral health workforce. As such, these initiatives fund efforts to improve the accessibility, availability, quality and consistency of children’s behavioral health services.
- Child Safety and Family Well Being: The budget includes just over $1 million for the coming year to fund an education campaign and resource hub aimed at parents, acknowledging the importance and challenges of parenting, as well as funding for Maine-based organizations to develop enhanced and coordinated strategies to strengthen families in Maine communities. This is part of a comprehensive plan to prevent child abuse and neglect and keep children safe by keeping families strong.
- Oral Health Programs in All Schools: The budget provides $1.5 million over the biennium to expand school-based preventive oral health services (e.g., screening, fluoride varnish applications) from 219 to all 707 Maine schools by January 1, 2025. Promoting oral health among children and youth improves physical and mental health throughout their lifetimes.
Strengthening Income, Food, and Personal Security for Older Mainers
- Low-Income Older Residents’ Health Costs: The biennial budget provides approximately $67.5 million in Federal and State funds to eliminate the asset test for the Medicare Savings Program and the Maine Low-Cost Drugs for the Elderly and Disabled Program. It also increases eligibility for the programs that pay for Medicare premiums and cost sharing. This will lessen the cost of health care for additional older residents, improving income security.
- Home-Delivered Meals: Due to the budget’s investment of $5.5 million, older adults can continue receiving home-delivered meals as one-time federal COVID-19 funding tapers. The budget will support approximately 270,000 meals annually in SFY 24 and 375,000 meals in SFY 25, enabling the Area Agencies on Aging and their partners to sustain the delivery of close to 1 million meals per year. This will improve both nutrition and social connection for older Mainers.
- Elder Justice Roadmap: The budget invests over $4 million to implement key elements of the Elder Justice Roadmap (PDF), developed at the Governor’s request by a public-private partnership to reduce abuse, neglect and exploitation of older Mainers. The funding will make permanent the Elder Service Connections program to connect Adult Protective Services clients to services; expand Adult Protective Services capacity; and support civil legal services for older adults.
Improving Quality Care for Older Mainers, Residents with Disabilities
- Lifespan Waiver: The budget includes approximately $37 million in Federal and State funds to add 40 individuals per month to the Section 29 home- and community-based services waiver program while a new “Lifespan” waiver is developed. Currently, individuals with intellectual and developmental disabilities (IDD) can experience abrupt and confusing transitions as they age or need different services. Lifespan will enroll individuals at age 14, enabling the development of a life plan and access to different services over time without changing programs. The budget includes the authorizing language for this program, as well as funding for projected launch in 2025. This Lifespan program builds on $45 million additionally included in the current services (Part1) budget enacted in March.
- Long-Term Care: The budget includes $45 million for long-term care facilities including nursing homes, on top of $47 million in Federal and State funds in the current services (Part 1) budget for the biennium for cost-of-living adjustments. This includes an amount equal to rebasing rates for use in long-term care payment reform, an extension of a one-time high Medicaid (MaineCare) utilization adjustment for residential care facilities (PNMI-Cs) as a bridge to payment reform, and an ongoing supplemental payment to Maine Veterans’ Homes. Additionally, the budget authorizes the Department to approve extraordinary circumstance allowance payments to maintain access to nursing facility beds for Maine residents prior to rate reform.
- Family Caregiver Grant Pilot Program: The budget expands supports for caregivers through the “Respite for ME” program from $2,000 annually to $5,171 annually, which would achieve parity with the benefit available through the Department’s Respite Care Services for Adults with Alzheimer’s Disease or Related Disorders. The grants can be used for respite care, training, and services such as physical therapy for caregivers of people living with a disability, Alzheimer’s Disease, or other related dementias. This is funded through an existing $5.1 million in federal funding through the Maine Jobs and Recovery Plan.
- Parent Caregiver Program: The budget includes language and funding to allow qualified parents to provide MaineCare-funded home health aide services to their children with disabilities. This supports home-based care and family economic security, while also providing relief during ongoing workforce challenges.
Filling Gaps in a Strengthened Behavioral Health System
- Comprehensive Behavioral Health Rate Reform: The budget provides $22 million to fund full implementation of new MaineCare rates for inpatient hospital psychiatric care over the biennium. This builds on $230 million invested in behavioral health payment rates in the last biennium and over $200 million included in the current services (Part 1) budget for fully implementing January 1, 2023 reforms as well as cost-of-living adjustments. The budget separately invests an additional $22.5 million in rate reform for other hospital services starting in FY 2025.
- Substance Use Disorder Services: With $1.4 million in Federal and State funding in the budget, MaineCare will add coverage of a new level of care for substance use disorder, filling a gap in the behavioral health continuum of care as recommended by the American Society of Addiction Medicine and MaineCare’s recent rate study. The budget includes $3.2 million for a treatment facility for substance use disorders in either Kennebec or Washington County. Additionally, the budget provides $4.4 million in General Funds to support the ongoing and unprecedented demands of Maine’s opioid crisis, supporting activity like medication-assisted treatment programs for people who are uninsured or in jails, recovery residence expansions, and Treatment and Recovery Courts.
- Housing First: The budget creates a Housing First (PDF) service program in Maine, along with staff to run it, to connect people who are chronically unsheltered with permanent housing with up to 24-7 services to support them to maintain that housing. This model is part of the Governor’s comprehensive plan for affordable housing in Maine, with the budget including $12 million for emergency housing for state fiscal year 2024 and additional funding for housing supports.
Tackling Budget Challenges
- One-Time Funding for General Assistance, State-funded SNAP: The COVID-19 pandemic along with the influx of asylum seekers in Maine contributed to large, unexpected, and potentially temporary surges in the cost of the General Assistance and State-funded SNAP programs, which provide housing, food, and other assistance for low-income residents not eligible for other programs. The Department is committed to better understanding program demand and developing reforms for General Assistance to improve its effectiveness, efficiency, and sustainability. In the meantime, the budget includes one-time funding for state fiscal year 2024 of $7.5 million for the State share and $8.5 million for the municipal share of General Assistance, and $4.3 million for State-funded SNAP, to serve as a bridge to such reforms.
- Service Provider Tax: The budget removes health care providers from the Service Provider Tax on January 1, 2025 and replaces that lost revenue, which supports MaineCare services. This limits the State’s liability going forward, clears the path for payment rate reform, and reflects Governor Mills’ commitment to responsible State budgeting and support for MaineCare, which provides vital services to residents with health and long-term service and supports needs.
To implement the current and new initiatives, the Legislature approved new legislative count of 70.5 permanent positions plus an additional new 9 limited-period positions for DHHS along with administrative changes for appropriate accounting and fiscal responsibility. This added capacity will help the Department to meet growing and changing operational needs and carry out critical work to best serve the people of Maine.