March 14, 2022
The Maine Department of Health and Human Services (DHHS) is distributing this week an additional $4 million in MaineCare payments to home- and community-based services (HCBS) providers to fund bonuses for direct support workers across the state. This additional funding is on top o f$116 million distributed in February, bringing the total number of workers receiving bonuses to 20,925. The Department reopened the application process briefly last month to allow more providers to take advantage of the opportunity. An additional 43 provider agencies registered for the initiative, for a total of 354.
The approximately $120 million in bonus payments are available through the American Rescue Plan and represent a major component of the Department’s plan to improve access to high-quality services that help ensure Maine people of all ages, including those living with disabilities and behavioral health challenges, can remain in their communities. These HCBS services include a broad range of personal care, home health, and behavioral health, shared living, and community and work supports.
Providers may use the funding to retain current workers or for recruitment bonuses to fill vacancies with new workers. The bonuses aim to address short-term health care worker shortages.
Most of the $120 million – $57 million – is supporting providers of services for people with intellectual and developmental disabilities. As described below, this one-time support builds on permanent increases in MaineCare payment rates for home- and community-based waiver service providers as well as an expansion of eligibility through additional slots. Of the $120 million total, another $53 million supports behavioral health providers. The remaining $11 million supports providers of aging and physical disability services. The $120 million allocated for bonus payments is part of the Department’s broader initiative to invest approximately $229 million in Federal Medicaid matching funds for Maine’s HCBS system improvement plan. The plan has received full federal approval, bringing federal matching Medicaid funds to Maine for these bonuses and other elements of the plan. Developed in consultation with stakeholders, including providers and families, the plan reflects the consensus that the most immediate challenge facing Maine’s HCBS system is attracting and retaining direct support workers. As part of the HCBS system improvement plan, the Department is also creating a direct support worker council in partnership with the Long Term Care Ombudsman Program, developing career advancement pathways, making worker certification more portable and pursuing other longer-term initiatives. The Administration has summarized these and other workforce initiatives in a report submitted earlier this year to the Legislature.
Above and beyond the HCBS plan, DHHS is also making historic investments in the HCBS system to support MaineCare rate increases and improve access to services through expanded slots.
Increasing MaineCare Payment Rates
The Mills’ Administration has made historic investments to improve home- and community-based services through the budget as well as new Federal funds. On top of the $229 million in federal matching Medicaid funds for the HCBS plan,
The biennial budget for fiscal years 2022 and 2023 would invest $90.6 million to increase MaineCare rates for HCBS waiver services for older adults and people with disabilities and brain injury. The supplemental budget would add another $68.5 million, for a combined total of $159.1 million.
Section 21, for example, provides a comprehensive array of residential, employment and community membership supports for adults with intellectual and developmental disabilities (IDD). Recent investments for Section 21 providers from the combined $159.1 million include:
The Governor’s biennial budget proposed $53.2 million in federal and state funds to implement current, data-supported MaineCare rate studies on July 1, 2021 for these services.
The addition of LD 1573 to the biennial budget through Part AAAA, which raises rates with the intent of supporting 125 percent of minimum wage for workers who provide these services, added $15.6 million.
To fully implement the minimum wage policy (Part AAAA) and to accelerate a cost-of-living adjustment, the Governor’s supplemental budget would add $46.4 million for Section 21 payment rates – triple the amount included in the biennial budget for the rate increase to support 125 percent of minimum wage.
To put these numbers in context, spending on Section 21 would increase by an estimated 18.4 percent between fiscal years 2020 and 2023 should the supplemental budget proposal be enacted—not counting the HCBS bonus payments. No payment rates for individual services covered under Section 21 have been reduced– and the rates for commonly utilized services would increase by as much as 48.8 percent from June 30, 2020 to July 1, 2022 if the supplemental budget proposal is enacted.
Improving Access Through Expanded Slots
The Mills Administration has also worked with the Legislature to expand access to home- and community-based waiver services with expansion of “slots” for individuals needing these services. Each year since 2019, the Governor has supported increased funding to provide greater access to these services, including:
The fiscal years 2020 to 2021 biennial budget provided funding for 167 Section 21 slots not funded in a previous budget.
The fiscal year 2020 supplemental budget added 362 slots for Section 29, which provides shared living services, employment, community membership and other supportive services to adults with IDD.
The fiscal years 2022 to 2023 biennial budget added 720 Section 29 slots and provided funding to implement a standardized assessment to ensure that waiver services for individuals with IDD are fair and consistent across the state.
The 2022 supplemental budget requests 50 Section 21 reserve slots to ensure that urgent needs may continue to be met.
The 2022 supplemental budget also requests 600 slots for Section 63, which provides state-funded home care for older adults and individuals with physical disabilities who are not MaineCare eligible. Section 63 is the only home and community-based (HCBS) service among these waiver and state-funded services for this population that experienced a decline in people served during 2021, in part because the intensity of need among the people served has meant that the same staff can serve fewer people. Home care continues to be available for MaineCare-eligible adults through Sections 19 and 96.
The result of this consistent investment is that over 10 percent more Maine residents were receiving services under the HCBS waivers and their state-funded equivalent (Section 63) in January of 2022 compared to January of 2019 (8,669 compared to 7,791). This is despite the fact that January 2022 was when the Delta and Omicron surges were at their peak, which resulted in staff vacancies due to COVID-19 isolation or quarantine.