January 11, 2024
MaineCare continues progress toward ensuring equitable, accessible, and sustainable health coverage for low-income people, through its nationally recognized transformation of Maine’s rate-setting system. Most recently, the Department increased reimbursement rates for certain MaineCare services through cost of living adjustments as directed by the rate reform law.
P.L. Ch. 639 (PDF) requires that, for all services with base rates determined through a rate study, the Department will provide an annual COLA effective on a consistent date for services that have not received a rate adjustment within the 12 months prior to the effective date of the COLA. Additionally, this unanimously passed law calls for annual updates to track Medicare rate changes for services benchmarked to Medicare.
The COLA is effective as of January 1, 2024, and is equal to an increase of 2.54 percent above the currently established rate(s). This increase is equal to the increase in the state minimum wage from January 1, 2023, to January 1, 2024, as determined by the Maine Department of Labor.
January 1, 2024, COLA Rate Adjustments
| Section 2* | Adult Family Care Services |
| Section 12 | Consumer Directed Attendant |
| Section 13* | Targeted Case Management Services |
| Section 17* | Community Support Services |
| Section 18 | Home and Community Based Services (HCBS) for Adults with Brain Injury |
| Section 19 | HCBS for the Elderly and Adults with Disabilities |
| Section 20 | HCBS for Adults with Other Related Conditions |
| Section 21 | HCBS for Members with Intellectual Disabilities or Autism Spectrum Disorder |
| Section 26* | Day Health Services |
| Section 28* | Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations |
| Section 29 | Support Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder |
| Section 65* | Behavioral Health Services |
| Section 92* | Behavioral Health Home Services |
| Section 96 | Private Duty Nursing and Personal Care Services |
*Pending federal approval and legislative appropriations.
Effective January 1, 2024, MaineCare additionally increased reimbursement rates for Nursing Facilities (NFs) and Residential Care Facilities (RCFs) in accordance with Part AAAA of P.L. 2021 Ch. 398 (PDF). Both COLA and the NF/RCF increases ensure that the labor components of rates for these services continue to equal at least 125 percent of Maine minimum wage and are funded by the FY24-25 current-services budget.
These increases are part of the Department’s rate reform efforts that, as of late 2023, have affected 34 sections of MaineCare policy, representing 75 percent of MaineCare's claims-based spending. For example, in the summer of 2023, the Department rebased rates for Federally Qualified Health Centers (FQHCs), with an average rate increase of 45 percent. The Department announced the upcoming calendar year 2024 rate determination schedule on December 8th. All previous and in-progress rate determination efforts can be found on the Rate System Reform webpage.
For more information on MaineCare’s Comprehensive Rate System Evaluation and to stay updated on Rate System Reform, visit www.maine.gov/dhhs/oms/about-us/projects-initiatives/mainecare-rate-system-reform.