June 9, 2021
Ensuring that Maine people with age-related, physical, behavioral, intellectual, and cognitive health needs have access to high-quality care that supports independence is vital to Governor Mills’ vision for improving Maine’s health care system.
While work toward this vision began in 2019, the COVID-19 pandemic hit Mainers living with disabilities and behavioral health issues, as well as their families, caretakers, and providers, especially hard. Cases and outbreaks in long-term care settings were high and devastating. The pandemic also exposed and deepened existing needs in the current system for home- and community-based services (HCBS).
The good news is that the American Rescue Plan (ARP), signed into law in March, offers unprecedented Federal support for Mainers living with disabilities, and for their families, caregivers, and providers. The law will provide over $200 million in Federal Medicaid matching funds to invest in MaineCare’s home and community based service (HCBS) workforce and system improvements. This includes an estimated $75 million in one-time Federal Medical Assistance Percentage (FMAP) funds, which are expected to leverage $131 million of additional federal match.
When the passage of the ARP was announced, DHHS Commissioner Jeanne Lambrew, the Office of Aging and Disability Services (OADS) and the Office of MaineCare Services (OMS) hosted virtual listening sessions with stakeholders, welcoming the HCBS community of providers and families to offer comments and recommendations as to how the resources from this unprecedented opportunity should be allocated.
Stakeholders’ primary concern was the immediate need to address the HCBS workforce challenges – noting that the shortage of direct support workers is the most significant barrier to people receiving the services they need to live independently and thrive. Other recommendations included funding all HCBS waitlists, integrating wraparound services into case management, improving behavioral health support for persons with disabilities, supporting technologies like telehealth and remote monitoring, and exploring creative solutions to expand housing and transportation options and improve the health and quality of life of MaineCare members.
To address these recommendations and further improve the HCBS system, DHHS has developed a preliminary plan which is being refined and is subject to change pending federal guidance and approval. The plan aims to improves community services for persons enrolled in MaineCare HCBS services, which include five waiver programs and many other MaineCare services, including home health, mental health and substance use services. The preliminary plan would invest the FMAP funds in three areas: timely access to services, innovating service delivery, and improving quality and accountability. Approximately 60% of these funds will directly increase wages for the HCBS workforce through special recruitment and retention bonus payments. The specific investments in the draft plan include:
Timely Access to Services
- Providing retention bonuses for current direct support workers (DSWs) and providing sign-on bonuses for new hires
- Reimbursing employers for payroll taxes and other expenses related to higher payrolls, including the payment of bonuses
- Providing respite supports for family caregivers
- Developing recommendations to expand the range of transportation options eligible for MaineCare reimbursement through HCBS waiver programs
- Expanding self-directed care options to intellectual disability programs, enabling participants and their families to choose their own caregivers, including family members
- Improving access to telehealth services
Innovating Service Delivery
- Implementing intensive wraparound services for youth awaiting services, including behavioral health services
- Expanding opportunities for employment among persons with disabilities and behavioral health issues
- Funding grants for providers to assist with costs of complying with new HCBS quality improvement initiatives
- Supporting training for DHHS and provider-agency staff on new initiatives
Improving Quality and Accountability
- Developing and adopting quality metrics for HCBS
- Reviewing quality oversight systems for home care and other HCBS and implementing more effective compliance strategies
- Updating the DHHS case-management information systems
A summary of the preliminary HCBS FMAP plan is available here (PDF).
DHHS will hold a virtual information and listening session on the preliminary HCBS FMAP plan Tuesday, June 15 from 12-1pm. To RSVP and receive the link for the event, please email HCBS-FMAP.DHHS@maine.gov.