Governor Mills’ biennial budget proposal for state fiscal years 2024 to 2025 is balanced, does not raise taxes and leaves the Rainy Day Fund untouched. It continues the Governor’s free community college initiative and invests in health care, housing, and infrastructure.
As the largest department in State government, the Maine Department of Health and Human Services (DHHS or Department) is a central component of the Governor’s budget proposal. The Department provides health care and social services to approximately one-third of the state’s population, including children, families, and older Mainers, as well as individuals with disabilities, mental health, and substance use disorders.
Overall Budget
Governor Mills’ proposal for the biennial budget continues policy efforts that were initiated at the beginning of her Administration, such as expanding access to health care and child care, as well as rebuilding critical parts of State government. The budget makes historic investments in behavioral health and increases supports for older Mainers. The budget also provides funding for cost-of-living adjustments in numerous MaineCare and related provider payment rates in the wake of high inflation, consistent with MaineCare rate reform as codified in P.L. 2021 ch. 639.
For Maine DHHS, the Governor is proposing funding of $638 million ($316 million general fund) for fiscal years 2024 and 2025. This would be partially offset by $59 million in one-time deappropriations and lapse of prior year carrying balances. The supplemental budget for fiscal year 2023 is proposing an additional $55 million ($17 million GF), which will be offset by lapsing carrying balances.
Highlights
Investing in behavioral health: The biennial budget proposes to invest $237 million ($94 million GF) in behavioral health services over the coming biennium. The primary initiative behind this historic investment is a $166 million ($63 million general funds) increase in MaineCare and related behavioral health rates. The new reimbursement rates support mental health and substance use disorder services and “targeted case management,” which helps MaineCare members access and coordinate mental health, medical and social services in their communities. The new rates are the result of a series of rate studies conducted by the Department with public input in 2022, as part of MaineCare’s nationally recognized, new rate system reform process. Rates for other behavioral health providers, such as children’s residential facilities (PNMI Ds), will increase by an estimated $46 million ($14 million GF) over the biennium for cost of living adjustments consistent with MaineCare rate reform efforts. In addition to these MaineCare rate increases, the budget also proposes an additional $25 million, including:
- $17 million ($10 million GF) to bolster children’s behavioral health services; and
- $7 million general funds to maintain the substantial expansion of the system of care for substance use disorder (SUD) services. This funding will increase the baseline appropriation, which has not meaningfully increased in years, to support evidence-based programs to address SUD prevention, treatment, and recovery services.
Strengthening and improving care for older Mainers: The FY23 supplemental budget and FY24-25 biennial budget propose to provide $169 million ($78 million GF) to expand and improve home based care, the safety of older Mainers, and continues to invest in long term care facilities, including nursing homes. Budget initiatives include:
- $4 million to implement several recommendations from the Elder Justice Roadmap, developed at the Governor’s request by a public-private partnership to reduce abuse, neglect and exploitation of older Mainers. This includes making permanent the Elder Service Connections program that successfully reduced the incidence of repeated abuse among participants and expand capacity of adult protective services (APS);
- $48 million ($30 million GF) to make community living sustainable for older adults in Maine. The budget addresses a range of items that will help older adults continue living in or near their preferred communities, including supporting home-delivered meals, sustaining the expansion of home-based care (Section 63) that was approved in last year’s supplemental budget, and increasing payment rates for a range of community services including adult day centers, affordable assisted living, supports to individuals living independently in apartments, and adult family care homes; and
- $116 million ($43 million GF) for Maine’s nursing homes, including those operated by Maine Veterans’ Homes, and residential care facilities (PNMI Cs) to support their recovery from all-time low occupancy levels during the COVID-19 pandemic. The supplemental budget proposes another $25 million ($6 million GF) supplemental payment for FY2023/24; the biennial budget proposes $47 million ($17 million GF) for cost of living increases for nursing facilities and residential care facilities (PNMI Cs) and $11 million to continue a high MaineCare add-on payment to PNMI Cs. The budget proposes a $2.4 million permanent MaineCare annual payment ($4.9 million ($1.5 million GF) over the biennium) to Maine Veteran Homes.
Supporting individuals with intellectual and developmental disabilities (IDD) and brain injury: The biennial budget proposes $84 million ($27 million GF) to support access to services for individuals with IDD and brain injury, including $34 million ($11 million GF) to ensure there is no wait for Section 29 at the start of 2025 by requesting services for an additional 900 people, and $3 million ($1 million GF) to fully fund enrolling people served on an emergency basis under Section 21. The budget proposes $5 million ($2 million GF) to transform service delivery by creating a new Lifespan waiver, which will address multiple levels of need over an individual's lifetime within a single program. Beginning January 1, 2025, the Lifespan waiver will enroll 50 adults and 40 children (ages 14-17) per month and offer a range of services currently offered in Sections 21 and 29. Consistent with MaineCare rate reform, the budget also proposes $42 million ($14 million GF) for cost of living adjustments for Sections 18, 20, 21, and 29 and Intermediate Care Facilities and PNMI Fs.
Supporting children and families through increased funding for child care, child welfare: In addition to the $17 million ($10 million GF) investment specifically for children’s behavioral health services included above, the biennial budget provides $25 million ($25 million GF) for additional supports for children. The budget requests nearly $8 million to fully fund the child care salary supplements enacted in the FY2022 supplemental budget to so that child care workers will continue to receive increased pay for the critical services they provide. Building on the substantial funding provided in prior budgets, this biennial budget requests nearly $12 million for foster care and adoption assistance and also provides $2 million for foster care reimbursement rate increases. The budget also proposes $5 million for ongoing support for programs like the early childhood consultation program, enacted under Public Law 2021, chapter 679.
Providing funding for the General Assistance program: Due to the COVID-19 pandemic and other policy changes, the General Assistance program has experienced increased demand and costs in recent years. The supplemental ($5 million) and biennial budgets propose one-time funding support to both the state ($8 million) and municipalities ($3 million) to support increased caseload while working with the Legislature, municipalities, and stakeholders toward sustainable policy changes to support the program’s goal of serving people in need effectively in the long run.
Providing funding for other priorities and initiatives: The budget provides funding for numerous other critical areas of healthcare and human services, including:
- $23 million ($6 million GF) as an initial investment for hospital rate reform and an additional $25 million ($6 million GF) in the supplemental budget for another COVID-19 supplemental payment for this fiscal year into the next;
- Several MaineCare initiatives to fully fund initiatives enacted in the previous budget, including $18 million ($10 million GF) for new rates for Federally Qualified Health Centers; and
- $3 million to support renovation and maintenance activities at Dorothea Dix Psychiatric Center and Riverview Psychiatric Center.
Background
Maine DHHS is comprised of ten offices and divisions that deliver critical programs and services for Mainers. Not included below, the Commissioner’s office is seeking nearly $4 million for centralized shared services, such as Maine IT, and two positions. The proposed General Fund appropriations for these offices in the fiscal year 2024 and 2025 biennial budget, including initiatives already described above, total $316 million:
- The Office of MaineCare Services (OMS): $206 million General Fund. OMS, in collaboration with other offices, provides health care coverage to over one-third of the state. In addition to initiatives described above, the biennial budget includes funding to support cost of living adjustments for numerous sections of policy as required in P.L. 2021 ch.639, annualizes funding for several initiatives enacted in last year’s supplemental budget, and other technical adjustments. The budget also requests $2 million to support capacity and resources to run the MaineCare program, including continuing limited period positions and limited new headcount.
- The Office for Family Independence (OFI): $14 million General Fund. OFI complements health benefits with food supplement payments, work supports, and financial assistance for low-income families. The budget supports continuing limited period positions for workers who help who answer phone calls and verify eligibility for MaineCare, SNAP, Temporary Assistance for Needy Families, and related benefits as well as certain other positions supporting the office.
- The Office of Child and Family Services (OCFS): $31 million General Fund. OCFS oversees programs for early childhood development, children’s behavioral health services, and critical child protective services. In addition to the initiatives described above, the supplemental budget includes funding to support court ordered diagnostic evaluations, and certain limited positions and other positions.
- The Office of Aging and Disability Services (OADS): $36 million General Fund. OADS supports older and disabled Mainers by providing Adult Protective, Brain Injury, Intellectual and Developmental Disability, and Long-Term Care Services to the state, in addition to Aging and Community services. In addition to the initiative described above, the supplemental budget proposes funding to support aging and disability resource centers, new human services caseworkers, and other administrative items like reclassifications.
- The two State-run psychiatric hospitals, Riverview Psychiatric Center (RPC) and Dorothea Dix Psychiatric Center (DDPC): $5 million General Fund. The biennial budget would help pay for infrastructure improvements, such as a new security system at RPC, as well as state line positions to expand outpatient services at DDPC.
- The Office of Behavioral Health (OBH): $15 million General Fund. OBH provides prevention, community-based, and residential services to Maine people with mental health, substance use, and co-occurring conditions. This funding supports state-only contract increases in line with MaineCare payment increases, direct opioid crisis response, limited new positions, and converting certain limited-period positions.
- The Maine Center for Disease Control and Prevention (CDC): $2 million General Fund. Prevention is the core mission of the Maine CDC, which has the additional goal of limiting the spread of acute and chronic illness. General funds represent less than 20 percent of the total Maine CDC budget given other sources of funding. This funding would support positions including but not limited to those working on the Governor’s broader efforts to test for and reduce the harm of PFAS, improve state lab response, expand disease surveillance, and support the expanded drinking water infrastructure projects, and other positions.
- The Division of Licensing and Certification (DLC) and Commissioner’s Office: $3 million General Fund. DLC enforces standards for safety, quality, and public health across the state. The funding provided in the biennial budget would support positions needed to support the expanded demand for survey work at facilities across the state and operating the Certified Nurse Assistant registry; the budget also proposes to finalize a transfer of positions between DLC and OCFS.
- The Office of the Health Insurance Marketplace is the newest DHHS office and operates CoverME.gov, Maine’s state-based health insurance marketplace for affordable health coverage. The Office is funded by health insurance carrier user fees; there is no general fund request for it (although there is a request for three positions using the revenue it generates).