Enrollment in Maine’s Home and Community-Based Waiver Programs Increased 7% During Pandemic

February 22, 2021

Maine has five MaineCare-funded Home and Community Based Services (HCBS) waiver programs that provide flexible supports to older adults and individuals with disabilities to assist them in their daily lives and prevent admissions to nursing homes, intermediate care facilities and other institutional settings. As in other states, these programs operate under special permission from the federal agency that oversees Medicaid, which is why they are called “waiver” programs. Maine operates HCBS waiver programs for older individuals and adults who have intellectual disabilities or autism, brain injuries, physical disabilities and certain other conditions such as cerebral palsy and seizure disorders.

Despite the significant challenges of operating in a pandemic, participation in Maine HCBS waiver programs increased 7% in 2020, from 7,435 individuals on 1/1/20 to 7,920 on 1/1/21 (Table 1). This was driven by increases in the three largest waiver programs, Section 19 for Older Adults and Adults with Physical Disability (up 15%), Section 21 for Adults with Intellectual Disability (up 2%) and Section 29 for Adults with Intellectual Disability (up 7%).

Table 1. Participants Enrolled and on Waitlists in Maine’s Waiver Programs, January 2021 and January 2020

  Participants Wait List (WL) WL with Other Coverage WL without Other Coverage (Percent of Participants)
  1/1/21 1/1/20 1/1/21 1/1/20 1/1/21 1/1/20 1/1/21 1/1/20
Brain Injury (18) 205 203 95 63 48 22 47 41
Older Adults and Physical Disability (19) 2,080 1,805 0 0 - - - -
Other related Conditions (20) 38 41 23 24 8 6 15 18
Comprehensive Services for IDD/ASD (21) 3,240 3,179 1,864 1,621 1,420 1,123 444 498
Support Services for IDD/ASD (29) 2,357 2,207 247 368 94 159 153 209
Totals 7,920 7,435 2,111 2,076 1,503 1,310 608 (8%) 766 (10%)

Four of the 5 waiver programs have wait lists. The number of people on wait lists increased by 35 people (up 2%) over the year. Of those on wait lists, the number with no other public coverage decreased by 158 (down from 10% of participants to 8% of participants).

Maine’s waiver program for older adults and individuals with physical disabilities (Section 19) does not have a waiting list and remains open to new participants. The Department’s strategy for individuals with intellectual disabilities and autism is to add 30 new individuals per month to Section 29 over the next two fiscal years, as proposed in the Governor’s biennial budget. The Department will also continue to reserve spaces in Section 21 for priority 1 individuals. For participants of Sections 18 and 20, a new self-directed option has been added under emergency pandemic provisions, enabling individuals who have spaces in those waivers but no providers to seek alternatives to traditional agency services. Alternatives may include aides hired directly by the participant, including friends or family members. A fiscal intermediary helps self-directing participants by paying the aides and handling tax withholding and other payroll-related requirements.

Maine waiver programs have proven to be resilient and flexible during the pandemic, serving more people as nursing homes and residential care facilities have experienced outbreak-related declines in census. In addition to serving more people, the Department expanded access to services under emergency provisions outlined in Appendix K of the waivers, including:

  • Increased the number of home-delivered meals under Section 19;
  • Improved support for care coordination;
  • Increased personal care, respite, and home supports;
  • Increased assistive technology and reimbursement for monthly data transmission charges and environmental modifications;
  • Expanded flexibility to deliver services in alternate settings, and via telehealth;
  • Expanded options to pay families for providing supports;
  • Added a new option for agency staff to support participants in the hospital;
  • Expanded the number of individuals who may be served in shared living homes;
  • Added new self-directed options to Sections 18 and 20 to expand choices; and
  • Added a new emergency service for individuals with COVID-19 so they may be isolated in a different location during their treatment and recuperation.

These emergency provisions will last until six months after the federal emergency declaration ends. The Department is assessing which of the emergency provisions should be considered for continuation once the declaration ends.