New Recommendations Guide Reform of Aging and Long-term Services and Supports

Office of Aging and Disability Services

January 8, 2020

New Recommendations Guide Reform of Aging and Long-term Services and Supports

The Maine Department of Health and Human Services (DHHS) is pleased to share new recommendations for how to improve care and services for older Mainers and adults with disabilities, under our Aging and Long-Term Services and Supports (LTSS) initiative.

Through this initiative, DHHS convened a group of stakeholders in May and formed an Aging and LTSS Advisory Committee consisting of individuals representing consumers, advocates, legislators, providers, and experts to advise us on how to reform Maine's system of services. In addition, DHHS held eight public listening sessions on aging issues throughout the state in October 2019, which complemented the Advisory Committee's work and included many Advisory Committee members and other stakeholders. Following four meetings over the summer and fall, the Advisory Committee has now released its recommendations.

The recommendations focus on two major goals:

  • Expanding access to home care to support aging in place; and
  • Improving coordination with the federal Medicare program as the state's population grows older.

Maine currently provides a range of Home and Community Based Services (HCBS) for older adults and adults with physical disabilities through MaineCare, under a federal waiver. Relatively new federal Medicaid options now allow states to offer HCBS without waivers, as a Medicaid State Plan option. In Maine, we will take advantage of this option to expand access to home care, creating a new Community First Choice benefit. This benefit comes with an enhanced federal matching rate of 6%, which will allow the Department to better serve MaineCare members with more assistive technology and environmental modifications. In addition to helping more people stay home, assistive technology can help address workforce shortages by making staffing more efficient.

The Department is also looking at ways to extend the reach of care coordination when consumers need both LTSS and other kinds of health care, including doctor visits and behavioral health services.

The second goal involves about 50,000 Mainers who have both Medicare and full MaineCare coverage. These dually eligible persons encounter two separate service systems that often do not align well with one another. The Department will continue to explore two possible approaches to improve coordination. One approach could be based on MaineCare's existing health homes, adding Medicare services and LTSS to the array of care coordinated by health homes. Another approach is to work with Maine's existing Medicare Advantage plans to improve how they coordinate with MaineCare.

The Department thanks the Advisory Committee for its time and invaluable insights, which will help the Mills Administration to better serve the State's aging population. We will now turn to implementing the recommendations as we begin working with five other state agencies on age-friendly policies in related areas such as employment and transportation.

The Aging and LTSS initiative is part of the Department's broader work to strengthen the system of services for older Mainers and people with disabilities. This work also includes becoming an Age Friendly State, increasing nursing facility rates by roughly 5.5 percent, adding 167 home- and community based waiver slots (Section 21), expanding crisis services to include direct intake of adults with intellectual or developmental disabilities, requiring the licensing of one- and two-bed group homes to ensure client safety, increasing the number of workers for adult protective services, establishing an Elder Justice Partnership through executive order, and developing a draft strategy to serve more adults with responsive and inclusive services.