Last year, as the Legislature faced a state shutdown, legislative leaders got together to hammer out a bipartisan budget deal that would increase Medicaid reimbursements to provide wage increases for the state’s 26,000 direct care workers who care for the elderly and people with disabilities. Those reimbursements were necessary because the state’s Medicaid-dependent nursing homes, community support providers and home care agencies need to give raises to their low-wage employees in order to comply with the new minimum wage law and to retain workers who can find better paid and easier work in retail and other service jobs. According to the Maine Council on Aging, the average wage of a direct care worker is between $10 and $12 per hour and about 53 percent of them rely on public assistance because most of them work part-time with no benefits. If the Legislature does not renew the funding by June 30, providers worry they’ll either have to decrease wages for direct care workers or even close down.

In a March 1 op-ed, both House Majority Leader Erin Herbig and Assistant House Minority Leader Ellie Espling (R-New Gloucester) agreed that it was necessary to pass at least two bills, LD 967 and LD 643, which would help maintain those wage increases.

“Home- and community-based services help Mainers age safely and independently in place,” Herbig and Espling wrote in the Portland Press Herald. “People with intellectual and developmental disabilities and autism rely on direct support professionals to provide the services they need every day to live safely in their communities. This includes helping people do everything from shopping and cooking a meal to using the bathroom and properly maintaining feeding tubes. Before LD 967 was partially funded last year, intellectual and developmental disabilities and autism services, provided in sections 21 and 29 of MaineCare, had been slashed by more than 30 percent since 2007.”

LD 967 would provide nearly $23 million to boost wages of people working with individuals with intellectual disabilities or autism. Both Democrats and Republicans have also expressed support for LD 323, which provide about $5.2 million to gradually move 300 people with disabilities off waiting lists and into community-based programs so they can move out of their parents’ homes.

Maine Coalition for Housing Quality Service Director Cullen Ryan, who is the father of an adult son with intellectual disabilities, is hoping that the Legislature will return to pass those bills even though he said the wage increases will only keep up with what the cost of living was in 2007. He also noted that there were still over 1,600 Mainers with severe disabilities on the waiting list for round-the-clock care as of last August. So while funding 300 slots will help, the state is far from meeting its obligation to support people with disabilities because the list continues to grow.

“If you don’t provide adequate supports for this population, it not only means that they don’t get to be included in the community and be able to actually build on the skills that they developed in special education growing up because those skills tend to atrophy,” said Ryan. “But on top of that it means that a parent or both parents need to quit their jobs and stay home with them if they don’t have services.”

In 2014, families of adults with the most severe and persistent intellectual disabilities and autism won a class action lawsuit against the state, which required it to fund services for those individuals requiring round-the-clock care. But other families still struggle to balance their need to earn a living with caring for their adult children with disabilities once they graduate from high school.

Last year, a group of families from the midcoast testified to the Legislature on behalf of their adult children with disabilities on the waiting the list. Among them was Hillary Stenau of Camden, whose son Alex Jurek was entering his fifth year of high school because there were not any providers that could give him the care he needed. Reached by phone last week, Stenau said that while her son could technically graduate this year, she and her husband, Mirek Jurek, decided to keep him at Camden Hills Regional High School for another year because they still haven’t found a group home for him. Still, she said the wage increases for direct care workers will likely help attract and retain staff for other services he is eligible for but can’t receive because of employee vacancies at service providers.

“It’s hard because even for after-school programs, we haven’t even been able to get help … because the agencies can’t find any staff,” said Stenau. “Alex gets home and he gets off the bus and says, ‘What are we doing today? Can someone take me to the library or can we go and have coffee?’ In order for these opportunities to be there for Alex, the agencies that have the staff people to take these folks out into the community need to be paid. I’ve called a lot of agencies locally and they all say, ‘We just can’t get staff in the area.’ I think [LD 967] will make the difference between a lot of day programs staying afloat or not.”

Increasing Wages for Home Care Workers

Advocates for elderly and disabled Mainers are working hard to make sure the Legislature honors its promise to increase wages for workers who provide home care for elderly Mainers. LD 643, sponsored by Rep. Ellie Espling (R-New Gloucester), would provide nearly $3.7 million to maintain the higher MaineCare reimbursements that allow home care providers to maintain higher wages. Testifying in support of the bill in March of last year, Mollie Baldwin, executive director of the provider Home Care for Maine, noted that 90 percent of her agency’s revenue comes from MaineCare, which pays 475 direct care workers who care for 800 elderly and disabled adults across the state. She said that the organization was able to increase the hourly wage of its employees from $10.10 to $10.91 as a result of a previous reimbursement increase, but half of its workforce turns over every year as workers leave for full-time jobs with benefits.

“Our employees are some of the most dedicated people I know,” wrote Baldwin. “They travel long distances, often venturing all alone into the homes of strangers, to do the basic, but no less essential tasks that keep our elder adults in their homes ... Our workers deserve better pay that reflects the value of the work they do and the importance we place in taking care of our most vulnerable population.”

Maine’s Long-Term Care Ombudsman Brenda Gallant noted that home care agencies across the state are experiencing enormous staffing shortages, which is resulting in preventable health complications, emergency room visits, family members getting burned out from caring for their relatives, and placements in nursing homes at a much higher cost than home care. For instance, she said one 74-year-/ old woman with end-stage COPD lives alone and is eligible for MaineCare funded home care, but hasn’t received it in almost a year due to staffing shortages.

“She has had to pay her neighbors to pick up groceries and prepare her meals,” wrote Gallant. “This is very difficult to manage on her income. She has had multiple ED visits and increased health problems.”

She also mentioned the case of an 88-year-old man with dementia who lives with his wife, who is also in poor health.

“He requires an RN visit every week for skin check, medication preparation and blood draw,” she said. “An agency RN could not be found. As a result, the family has been private paying an RN. This has put a financial strain on the family.”

Funding for Nursing Home & Assisted Living Workers

Republicans and Democrats also previously agreed to support LD 1466, which would provide about $11.1 million to give wage increases to direct care workers in nursing homes. Jess Mauer, co-chair of the Maine Council on Aging, testified last year that about 6,000 hours of approved MaineCare services were going unmet due to staffing shortages, and waiting lists at nursing homes have been growing.

“As we all know, Maine has the oldest population in the country. With folks living at home long into their 80s and 90s with little or no care, there can be little doubt that this crisis will grow if we do not take immediate action to lift this workforce up across the long-term care continuum,” said Mauer. “In fact, there are more than 60,000 Mainers who are 80 years or older living in Maine. As these Mainers begin to have more significant care needs, the unmet hours and unfilled beds will grow if we do nothing.”

The Legislature is also considering LD 1188, which would provide over $1 million to provide cost-of-living increases for workers at assisted living facilities known as PNMIs. Testifying on behalf of the residential care industry last April, Maine Health Care Association President Rick Erb argued that PNMIs are less costly than nursing homes and have helped to reduce the number of people going into nursing homes by a third since the 1990s.

“A cost-of-living adjustment is critical to absorb the increasing costs of staffing and operating these facilities,” he wrote.

Jackman Community Health Center Funding

Both Democrats and Republicans also agreed to support a bill to provide $150,000 to help the Jackman Community Health Center cover a $250,000 shortfall to continue to provide emergency on-call services. Back in February, Sarah Dubay of Penobscot Community Health Care said that since 2014 her organization had provided primary care services and 24/7 acute care at the Jackman facility, which it shared with a nursing home operated by Maine General Health. However, after Maine General decided to close the nursing home, it laid off staff that it shared with the health center to provide emergency care. As a result, the center now only provides primary care services on weekdays and has someone on-call to provide 24/7 emergency medical attention. The stop-gap measure will be used until the health center finds a long-term solution to its financial woes.

“Access to quality health care, especially 24/7 acute care, is critical for the town of Jackman,” wrote Dubay. “The nearest emergency rooms are 55 miles away in Greenville or 75 miles away in Skowhegan, down roads that are poorly maintained in the wintertime and also heavily traveled by deer, moose, and other wildlife any time of year. Simply put, if you are someone suffering from a heart attack or snowmobile accident, then Jackman might as well be on an island. Any life-threatening illnesses or injuries must be stabilized in Jackman to allow for the local ambulance to have enough time to transport the patient to Greenville or Skowhegan.”

Cognitive & Behavioral Services for Children

Earlier in April Republicans and Democrats both agreed to support LD 1820, which would allocate over $2.8 million to increase Medicaid reimbursement rates for support services for children with cognitive impairment and functional limitations. Maine Association for Community Service Providers Executive Director Lydia Dawson testified back in March that the services provided under LD 1820 include activities to help the children develop skills to manage their behavioral health treatment needs and social skills necessary to live with other people and build relationships. However, she said state reimbursement rates for the services have been so low that providers have not been able to attract and retain behavioral health practitioners. As a result, she said children have ended up languishing on waitlists for those services, which has caused strain and stress to their families.

“The reality of the current state of these services in Maine is abysmal,” wrote Dawson. “The rate for these services is so low that providers are closing the services all over the state. There is a waitlist for services that lists approximately 300 children waiting for service. These are not children who are waiting to be authorized for services; these are children who have been determined eligible for the service and cannot find a single provider in the entire state available to help them.”

Party leaders also initially agreed to support LD 1517, which would provide about $6 million in increased Medicaid reimbursement rates for behavioral health services, support services for children with cognitive impairments and residential service centers. Testifying in support of the bill last year, Lori K. Gramlich, executive director of the Maine Chapter of the National Association of Social Workers, pointed out that MaineCare reimbursement rates for behavioral therapies paid $55 per hour while private insurers like Anthem reimburses at $99 per hour.

 


“The increasing epidemic of substance use, opiate addiction and more complex behavioral health issues have compounded our ability to be responsive to those most in need,” wrote Gramlich. “We cannot afford to have rates that do not support the services needed by our most vulnerable folks. We cannot afford to limit access of services to people who desperately need them not only for themselves, but for their families as well.... It is a challenge for LCSW private practitioners to provide MaineCare mental health services due to inadequate reimbursement.”

Democratic and Republican leaders also earlier expressed support for LD 1868, which would provide an additional $262,000 for multisystemic therapy for children with behavioral disorders and their families. Back in March, Michael Abbatiello, senior vice president of Operations and Finance at Maine Behavioral Healthcare (MBH), testified that multisystemic therapy (MST) is an evidence-based program to treat youth with substance abuse problems and at risk of incarceration with the focus on improving the child’s home life. He said the program has been proven to reduce the number of arrests and out-of-home placements. However, he said MST loses the most money for Maine Behavioral Healthcare because state Medicaid reimbursements haven’t been adjusted since 2011. He said that MBH has had to reduce its MST teams over the past four years from three to one and half teams.

“Passage of LD l868 will allow us to grow our MST teams back to the levels we had several years ago in a manner that will lead to reducing overall healthcare costs, provide for highly effective outcomes today and in the future, and do so in a way that will financially sustain this [evidence-based program],” wrote Abbatiello.

New Drug Treatment Program

Legislative leaders tentatively agreed to support LD 1430, which would provide nearly $6.7 million to create a statewide referral center for people with drug addictions to go for help. “Hub and spoke,” which is based on a program pioneered in Vermont, would include addiction treatment centers (the “hub”) that prescribe opioid replacement drugs with the “spokes” that connect patients with therapy, counseling and other resources once they are stabilized.

“The goal is for Mainers to know who to call; where to go if you, or somebody you know, is suffering from addiction, or worse overdosing,” wrote the bill’s sponsor, Rep. Karen Vachon (R-Scarborough), in testimony. “Care doesn’t discriminate. It is available here in Maine for the insured and the uninsured. Care is provided by qualified people, in the right place, with a compassionate focus on recovery that leads to a job; a purposeful life restored.”

Creating Another Drug Court

The two parties also agreed to support LD 1885, which would provide $160,000 in additional funding for a new drug court with the capacity to accommodate up to 30 participants. Drug courts help coordinate groups of stakeholders — including judges, social workers, law enforcement and others — to help rehabilitate drug offenders through supervision and drug treatment services, which includes sanctions and incentives. But no drug courts currently exist in Waldo, Knox or Lincoln counties, as state funding for the programs have been limited. Alliance for Addiction and Mental Health Services Executive Director Malory Shaughnessy, who represents substance abuse treatment providers, argued in testimony that drug courts can save money and reduce redicivism

“The most recent evaluation of the adult drug treatment courts and the co-occurring disorders and veterans court concluded that the recidivism rate (defined as a criminal MaineGeneral Behavioral Health conviction within 18 months post-admission) for graduates was only 16%,” wrote Shaughnessy. “Individuals with similar criminal histories but only on probation had recidivism rates between 39.6% and 47.1%. These programs work — they save lives, as well as state dollars.”

However, the ACLU of Maine expressed concern about the proposal and argued that drug courts make the system more punitive toward people with drug addictions. ACLU lobbyist Oami Amarasingham noted that although defendants can have the charges against them removed from their record if they’re able to stay clean and sober, they are put under intense and often intrusive supervision. She pointed out that in 2016, 52 Mainers graduated from the program, but 62 failed. And failing the progran often leads to longer mandated sentences than those who do not enter the program because the defendent lost the opportunity to negotiate the terms of plea agreements.

“In addition to making the criminal justice system more punitive towards substance use disorders, drug courts also raise serious constitutional concerns related to due process and privacy,” wrote Amarasingham. “As mentioned above, in Maine in order to be referred to the drug court program by the prosecutor, the defendant must enter a guilty plea. This puts the defendant in the position of choosing between receiving treatment and exercising their constitutional right to a trial and due process, greatly increasing the power of the prosecutor to compel a plea agreement.”

Amarasingham added that drug addiction is a public health crisis that should be handled by the health care system and not the criminal justice system.

Clean Elections Funding to Run Out on July 1

Clean elections supporters are concerned that the Legislature still has not fixed a drafting error in the biennial budget that would prevent the Maine Ethics Commission from dispersing any money into the Clean Elections fund after July 1. According to the group Maine Citizens for Clean Elections (MCCE), funding for the Clean Elections was included in the budget passed last year, but a drafting error prevents the Ethics Commission from disbursing the public campaign funds to candidates after the current fiscal year ends on June 30. The Legislature did pass a bill (LD 1894) to fix the error, but failed to garner the 2/3 votes necessary to pass it as an emergency measure due to opposition from a number of House Republicans. The Legislature would need to return for a special session to pass the bill in order for roughly 240 candidates who qualified for public financing under the Maine Clean Elections Act.

“Voters have twice spoken loud and clear that they want a strong and fully funded Clean Election law to keep our lawmakers accountable to us, everyday voters, not wealthy campaign donors,” said MCCE Executive Director Anna Kellar in a statement. “Candidates for the legislature and governor — including Republicans, Democrats and independents — have already signed up to use Clean Elections and worked hard to qualify for Clean Elections funding. Thousands of Mainers have given qualifying contributions. By refusing to fix what everyone agrees was a mistake by legislative staff, House Republicans are changing the rules in the middle of the game.”

School Funding Still in Limbo

The Legislature still has not passed LD 1869, which would authorize more than $1 billion in General Purpose Aid to fund schools for the next fiscal year. On May 3, the Maine School Management Association, which represents superintendents, sent out an alert to its members urging them to pressure lawmakers to pass the bill out of concern that if the bill doesn’t pass, the power to disburse the money would be put in the hands of Gov. LePage.

“If the Legislature fails to return and pass the bill, the Department of Education has determined there is an administrative solution to get the money out. The concern is the precedent it would set to have the Legislature cede authority for authorizing school funding to the executive branch,” wrote MSMA Executive Director Steve Bailey. “School Board members and superintendents are urged to contact their legislators and ask them to convene a special session to pass this bill. Funding for public education should be in the hands of legislators who represent the taxpayers, parents, teachers and students in their districts. GPA should not be an executive branch decision.”

Other Bills Democrats & Republicans Supported

Democrats have also released a list of about $68 million in spending initiatives that they say all sides agreed on until negotiations broke down in mid-April. The list includes all of the aforementioned bills both parties agreed to support, as well as the $3.8 million Medicaid funding bill and legislation to provide funding for mental health and substance use disorder treatment in jails and prisons, training to allow forest rangers to carry firearms and a pilot project to establish an early childhood consultation program. The list also includes the restoration of funding for school-based health centers, funding to make trafficking of fentanyl a Class A crime, punishable by up to 30 years in prison, and funding for the Child Development Services System, which supports screening for and identifying disabilities in young children.

House Republicans say they also support LD 1736, which would assist Maine National Guard members in paying tuition to private colleges. The state already helps them cover the costs of attending public secondary educational institutions. The measure would also provide more funding for emergency assistance for veterans.

Bill to Support Cooperatives Still Tabled

The Legislature has yet to take action on LD 1338, which would incentivize employee ownership by exempting the sale of business assets to cooperatives and other employee-owned enterprises. The measure, which the Legislature passed unanimously in April, would also provide a tax break on interest income earned from financing the sale of a business to employees. The exemption would apply to businesses that create employee stock ownership plans (ESOPs), worker-owned cooperatives, consumer cooperatives and affordable housing cooperatives. However, it is currently tabled in the Appropriations Committee awaiting funding.

Testifying in support of the bill, Northport resident Rob Brown, the director of Business Ownership Solutions at the Cooperative Development Institute, said incentivizing employee ownership will help preserve businesses and farms as the baby boomer owners retire.

“l’m sure many of you have seen news stories recently acknowledging the strong uptick in the number of Maine businesses converting to employee and cooperative ownership, operating in sectors such as agriculture and food production, manufacturing, retail, food service, fishing, marketing, housing, construction, engineering, banking and insurance,” wrote Brown. “However, the transformative nature of cooperative and employee owned businesses is yet to be realized in Maine, as this growth represents a drop in the bucket compared to the magnitude of the challenge. LD 1338 would be an effective effort to capitalize on the potential. It will help raise awareness of and incentivize this highly beneficial succession planning option, and will help close unnecessary capital gaps.”

It’s estimated that there are about 12,790 Maine businesses employing 108,000 people that are owned by baby boomers facing retirement. The Democracy at Work Institute (DWI) estimates that 85 percent of all business owners do not have a succession plan for when they retire.