On January 1, 2025, Maine implemented a comprehensive reform of nursing facility reimbursement rates through MaineCare to stabilize a sector under strain, strengthen the direct care workforce, improve quality, and ensure continued access to care for Maine’s older adults.
One year in, the results are encouraging, and the State is moving forward with confidence into 2026.
A necessary response to long-standing challenges
Maine’s nursing facilities have faced sustained financial pressure from inflation, rising operating costs, and a historic shortage of direct care workers, threatening both access to care and workforce stability.
In response, the Mills Administration made a substantial investment in nursing facilities through rate reform, which was implemented with a progressive rollout that started in January 2025. Unlike prior short-term adjustments, the reform was designed as a long-term structural change to better align reimbursement to compensate for and reward the provision of high-value care.
The reformed rates:
- Support workforce stability and quality improvement;
- Incentivize permanent staffing and competitive wages;
- Reward reduced reliance on temporary staffing; and
- Promote better health outcomes and resident well-being.
Investing in the direct care workforce
The reform prioritizes nurses, certified nursing assistants, and other frontline staff who provide daily care.
The rate model discourages long term use of temporary staffing and promotes permanent employment and salary growth, building on:
- A law supporting at least 125 percent of minimum wage for direct care workers;
- Expanded training and workforce development; and
- Broader supports across residential and home and community-based settings.
These efforts have helped place Maine among the top states nationally for direct care workforce policy.
Supporting facilities through transition
To support implementation, including transition to the achievement of a consistent and fair reimbursement approach across facilities, the Legislature and Administration established the Nursing Facility Reform Transition Fund.
The three-year fund totals $72.8 million; uses for the first year include:
- A $15 million supplemental payment to nursing facilities
- An $8.1 million quality bonus pool payment
- A temporary add-on amount to reimbursement rates to support up to 20% contract staffing
- Holding harmless facilities with rates higher than the new standard rate in Year 1 of reform; while allowing a maximum 20% increase to rates in Year 1 versus the originally planned 10% limit.
This spending reflects a deliberate strategy to stabilize now and strengthen for the future.
Advancing quality through value-based payments
Rate reform also advances quality by directly linking payment to participation in quality improvement activities and performance on quality-of-care measures.
In early 2025, the Department launched QuEST (Quality, Excellence, Staffing, Teamwork), a value-based payment and technical assistance initiative that promotes continuous improvement while encouraging changes in workplace culture as a strategy to empower staff, reduce turnover, improve quality of resident care, and decrease reliance on temporary agency staffing.
In 2025, nursing facility leaders at all levels engaged in monthly learning sessions and discussions led by national experts on topics like culture change in nursing homes to drive stability in staffing, reducing antipsychotic medication use in nursing home residents, and measurement and improvement in resident and family satisfaction. Participation in these learning sessions, along with other quality activities, determined each nursing facility’s eligibility for a portion of an $8.1 million quality bonus pool, to be paid out upon U.S. Centers for Medicare & Medicaid Services (CMS) approval of Maine’s related State Plan Amendment. In 2026, technical support through QuEST will continue, and quality payments will increasingly be awarded based on measured performance and outcomes.
QuEST and the accompanying quality bonus pool represent the first-time nursing facilities have had a direct financial incentive tied to improving quality for Maine’s long-term care residents.
Initial measures focus on:
- Staff turnover for nurses and CNAs;
- Use of antipsychotic medications; and
- Resident and family satisfaction through the CoreQ survey.
QuEST is delivered in partnership with the Maine Health Care Association, the Long-Term Care Ombudsman Program, and quality improvement experts.
Looking ahead to 2026
Nursing facility rate reform is a long-term commitment. Early results show that Maine’s approach is working. Over 97% of nursing facilities completed the quality improvement initiatives in 2025, and all facilities began receiving score cards on available performance measures. Reports show that statewide average contract staffing rates have been falling substantially.
As Maine moves into 2026, the State will continue to monitor outcomes and partner with providers, residents, families, and advocates to ensure a stable, high quality, and responsive system.
This work reflects a shared commitment to support caregivers and ensure that every Mainer can age with dignity and access the care they deserve.