Chapter 101, MaineCare Benefits Manual, July 1, 2025 Cost-of-Living Adjustment

Date posted: Jun 30, 2025

Attachment(s):

• Methodology Notice

Notice of MaineCare Reimbursement Methodology Change

AGENCY: Department of Health and Human Services, Office of MaineCare Services

SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, July 1, 2025 Cost-of-Living Adjustment

NATURE OF PROPOSED CHANGES: The Department plans to submit a state plan amendment to increase reimbursement rates to support essential support workers within the following sections with a 1.95% cost-of-living adjustment (COLA) which was appropriated by the Maine State Legislature.  

 

Section	Title
Section 2	Adult Family Care Services
Section 12	Consumer Directed Attendant
Section 13	Targeted Case Management Services
Section 17	Community Support Services
Section 26	Day Health Services
Section 28	Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations
Section 65	Behavioral Health Services
Section 92	Behavioral Health Home Services
Section 96	Private Duty Nursing and Personal Care Services
Section 97 – Appendix C	Private Non-Medical Institutions, Medical and Remedial Service Facilities

 

Additionally, the Department plans to submit a state plan amendment to increase reimbursement rates for the following sections by a 1% cost-of-living adjustment (COLA) which was appropriated by the Maine State Legislature.

 

Section	Title
Section 23	Developmental and Behavioral Evaluation Clinic Services
Section 25	Dental Services
Section 30	Family Planning Services (select codes)
Section 31	Federally Qualified Health Centers
Section 40	Home Health Services
Section 45	Hospital Inpatient reimbursement, including acute care and Distinct Psych/SUD unit base rates, and acute care GME add-on rates and outlier thresholds.
Section 89	MaineMOM Services
Section 91	Health Home Services – Community Care Teams
Section 93	Opioid Health Home Services
Section 97 – Appendix B	Private Non-Medical Institutions, Substance Use Treatment Facilities
Section 97 – Appendix C	Private Non-Medical Institutions, Medical and Remedial Service Facilities
Section 97 – Appendix D	Private Non-Medical Institutions, Children's Residential Care Facilities
Section 102	Rehabilitative Services

 

REASON FOR PROPOSED CHANGES: All changes are pursuant to Maine P.L. 2025 Ch. 2 - An Act Making Certain Appropriations and Allocations and Changing Certain Provisions of Law Necessary to the Proper Operations of State Government and Maine P.L. 2025 Ch. 388 - An Act Making Unified Appropriations and Allocations from the General Fund and Other Funds for the Expenditures of State Government and Changing Certain Provisions of the Law Necessary to the Proper Operations of State Government for the Fiscal Years Ending June 30, 2025, June 30, 2026 and June 30, 2027

ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will result in an increase of $22,687,120 in state fiscal year 2026 which includes $15,290,753 in federal funds and $7,396,367 in state funds, and will cost $22,687,120 in state fiscal year 2027 which includes $9,691,120 in federal funds and $12,996,000 in state funds.

ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES:  The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926. The Department will hold a hearing for the proposed rulemaking and will be publishing a notice which includes information on the hearing date and location.

CONTACT INFORMATION

FOR RECEIPT OF COMMENTS:                   Kristin Merrill  

                                                                          Kristin.Merrill@maine.gov

AGENCY NAME:                                              Office of MaineCare Services

ADDRESS:                                                         109 Capitol Street, 11 State House Station

                                                                             Augusta, Maine 04333-0011

TELEPHONE:                                                  (207) 624-4006 FAX: (207) 287-6106

                                                               TTY: 711 Maine Relay (Deaf or Hard of Hearing)

See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.

State Plan Amendment

Office: MaineCare Services

Email: Kristin.Merrill@maine.gov

Comment deadline: Jul 10, 2025

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