January 11, 2023
Governor Janet Mills’ biennial and supplemental budgets propose $169 million for initiatives to expand and improve home-based care, invest in the safety of older residents, and continue to invest in long-term care facilities, including nursing homes. This includes full funding of home-delivered meals to ensure that eligible older adults continue to receive meals as one-time federal funding is depleted.
Elder Justice Investments: Included in the biennial budget is over $4 million to implement several recommendations from the Elder Justice Roadmap (PDF), developed at the Governor’s request by a public-private partnership to reduce abuse, neglect and exploitation of older Mainers. This includes proposed funding to:
- Make permanent the Elder Service Connections program, based on the nationally recognized RISE model piloted in Maine (Repair harm, Inspire change, Support connection, Empower choice). The program assigns Adult Protective Services clients to advocates at the Elder Abuse Institute of Maine who connect them to services and facilitate meaningful changes in their lives. The pilot program successfully reduced the incidence of repeated abuse among participants;
- Support civil legal services for older adults, including but not limited to eviction matters, which are increasing in Maine’s tight housing market; and
- Expand Adult Protective Service (APS) capacity to investigate the growing number of reports received by the Department.
In addition to these budget items, the Maine Department of Health and Human Services (DHHS) has also proposed legislation, LD 35 (PDF), sponsored by Senator Marianne Moore, to implement a Roadmap recommendation requiring training for mandated APS reporters.
Sustainable Living: The budget includes $48 million to make community living sustainable for older adults in Maine. “Sustainable living” is a key theme that emerged as Governor Mills’ newly formed Cabinet on Aging gathered input from older adults and other stakeholders across the state in 2022. The budget addresses a range of items that will help older adults continue living in or near their preferred communities, including $10 million for cost-of-living adjustments in light of higher inflation, and funding to:
- Ensure that older adults can continue receiving home-delivered meals as one-time federal COVID funding tapers. The budget will support 270,000 meals in SFY 23 and 375,000 meals in SFY 24, enabling the Area Agencies on Aging and their partners to sustain the delivery of about 1 million meals per year;
- Sustain the expansion of home-based care (Section 63) that was approved in last year’s supplemental budget;
- Increase 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. These rate increases will preserve and expand availability of these services as Maine’s older population grows; and
- Expand capacity of Aging and Disability Resource Centers (ADRCs) at Maine’s five Area Agencies on Aging. ADRCs provide information and referral services to families seeking options as they need more support to sustain their community living arrangements. The Cabinet on Aging heard repeatedly that families find information and assistance difficult to access and challenging to navigate. Expansion of ADRC services will help address this need.
Another key theme identified by the Cabinet on Aging is “community connections.” Maine is fortunate to have the highest number of local Age Friendly and Lifelong Community initiatives in the country. The Cabinet seeks to strengthen the connection among state government, municipalities and local volunteer initiatives in the areas of housing development, information and referral, transportation and social engagement of older adults.
Support and Reforms for Nursing Homes and Maine Veterans’ Homes: Maine’s nursing homes, including those operated by Maine Veterans’ Homes, have been slowly increasing their occupancy levels from all-time lows during the height of the COVID-19 pandemic, but they continue to struggle with staffing. The pandemic has also underscored the need to reform payments to focus on outcomes. As such, the biennial and supplemental budget propose $116 million, including $47 million for cost-of-living adjustments in light of higher inflation, and funding for:
- A second one-time COVID-related payment of $25 million for the current year (SFY 2023) which will be available into SFY 2024 to facilitate pandemic recovery as the Department works with stakeholders to reform how nursing homes are paid;
- Nursing facility payment reform to reward quality and make payments less administratively cumbersome; and
- A special supplemental payment for the Maine Veterans’ Homes in light of the quality care they provide to individuals who served our nation in the line of duty, making permanent the one-time payment Governor Mills and the Legislature made last year.
In addition to the new initiatives proposed in the Governor’s supplemental and biennial budgets, MaineCare has put into effect on January 1 significant rate increases in a number of services for older adults to ensure that direct support and care workers can be paid at least 125 percent of minimum wage. Wage rates were increased by 8.2 percent in several home and community-based services, including the Section 19 waiver services program for older adults and Section 96, which provides in-home nursing and personal care services.
Background
The emergency supplemental and biennial budget investments build on the Mills Administration’s historic financial and operational support for nursing facilities, which includes:
- In June 2019, Governor Mills signed into law a biennial budget that dedicated $25 million to provide a cost-of-living adjustment to nursing facilities. As a result, nursing facility rates increased, on average, by 5 percent for Fiscal Year 2020;
- In March 2020, at the onset of the pandemic, the Mills Administration began $9 million in temporary payment rate increases to nursing facilities for extra costs associated with COVID-19, including staffing above and beyond customary levels to maintain proper ratios and to monitor residents and screen visitors, supplies and PPE, such as face masks and gowns, beyond the amounts typically purchased;
- In November 2020, the Mills Administration announced that it would reimburse nursing facilities for their costs to conduct Federally-required surveillance testing using commercial laboratories;
- In December 2020, the Mills Administration awarded $5.1 million to health care facilities, most of which were nursing facilities, to cover expenses resulting from the pandemic;
- In July 2021, Governor Mills signed the FY22-23 biennial budget that dedicated $36.4 million in cost-of-living adjustments and rebasing funding for nursing facilities;
- In August 2021, the Mills Administration awarded $12.5 million to nursing and residential care facilities to help them cover expenses resulting from the pandemic;
- In September 2021, the Mills Administration delivered $123 million in one-time funding, including $30 million in General Fund dollars authorized through the biennial budget signed into law by the Governor, for nursing facilities, residential care facilities, and adult family care homes to help address workforce issues by retaining current staff or hiring new staff;
- In December 2021, the Mills Administration announced its plan to increase rates for long-term care facilities by $4.5 million from January to June 2022, and add another $7.6 million through the budget for supplemental wage adjustments for fiscal year 2022;
- Effective July 1, 2022, payment rates increased to support paying direct care workers at least 125 percent of minimum wage, on top of rebasing rates. Rate letters including these amounts are forthcoming, with the higher rates being retroactive to July 1; and
- In August 2022, the Mills Administration issued $25 million in one-time funding for nursing facilities, residential care facilities, and adult family care homes to help address ongoing workforce issues and relatively low occupancy.
This is in addition to at least $50 million in financial relief distributed directly by the Federal government to nursing facilities across Maine.
Pandemic Support: Since the beginning of the pandemic, nursing facilities have submitted and received over 330,000 COVID-19 test results from Maine’s Health and Environmental Testing Laboratory and these facilities have also placed over 6,400 personal protective equipment (PPE) requests and received over 2.1 million pieces of PPE. Since January 2021, the Department has used over $2 million in Federal funds to support 23,910 hours of emergency nurse and related staffing to nearly one-third of Maine long-term care facilities to support care for residents during the pandemic.
Workforce Training: Recognizing the need to address the workforce challenges exacerbated by the COVID-19 pandemic, Governor Mills included $20 million in the Maine Jobs and Recovery Plan to support health care workforce training. This includes scholarships and student loan relief to enable more people to become behavioral health specialists, long term support workers, emergency medical services staff, and other health professionals. The Jobs Plan additionally supports marketing campaigns aimed at promoting health care careers in Maine and Healthcare Training for ME, a program to expand the availability of free and low-cost career training to help health care workers advance their careers, support workforce training needs of health care employers, and attract new workers to fast-growing fields. The Jobs Plan is also supporting the Caring for ME campaign to educate and encourage residents to become direct care providers.
Cabinet on Aging: Governor Mills established the Cabinet on Aging on June 13, 2022 to help Maine prepare for and address demographic changes by advancing policies that will support Maine people in aging safely, affordably, and in ways and settings that best serve their needs. The Cabinet will bring together State government agencies to improve coordination and to accelerate action. The Governor’s Office of Policy, Innovation, and the Future this week hired Elizabeth Gattine, an expert on aging policy from the University of Southern Maine, to coordinate the work of the Cabinet on Aging.