AUGUSTA — Lawmakers are proposing emergency legislation to increase state reimbursement rates for workers who provide home-based care to the elderly and disabled in response to the planned closure of one of Maine’s largest service agencies.

The proposal calls for tapping $8.5 million of the state’s anticipated revenue surplus this year to increase reimbursement rates by up to 53 percent for some home-based care providers. Supporters contend an immediate rate adjustment is necessary to prevent additional agencies from closing before the state can complete a longer-term analysis of how rates are set in Maine.

Shenna Bellows, D-Manchester Joe Phelan/Kennebec Journal

“The closure of Home Care for Maine must be a wake-up call for all of us here in Augusta,” Sen. Shenna Bellows, D-Manchester, said during a State House news conference unveiling her bill. “Agencies cannot continue to provide these vital services at a loss. It is time to fix a decade of under-funding of vital services for our most vulnerable communities.”

Home Care for Maine, based in Farmingdale, said this month that low MaineCare reimbursement rates were a key factor in the decision to close in April. The nonprofit provides home-based services to nearly 600 low-income senior citizens and adults with disabilities around the state.

The state currently pays $20.52 per hour for the “personal support services” workers who help individuals with everyday needs such as hygiene, bathing, dressing, cooking, housekeeping or grocery shopping. After accounting for benefits, taxes, administrative costs and other expenses, that typically translates into a base wage for the worker of less than Maine’s minimum wage of $12 an hour.

Newell Augur, an attorney for Home Care for Maine, said he was encouraged by the bipartisan support for the reimbursement bill. Augur noted that the $8.5 million in state money would draw an estimated $15 million to $16 million in federal matching funds.

“It won’t repair or put Home Care for Maine back together, but it will hopefully shore up our home-based care services in the state for the short-term,” Augur said.

Care providers have been warning for years that Maine’s reimbursement rates were failing to keep up with rising costs, creating a worker shortage in a state with the nation’s oldest population. Maine’s minimum wage has risen 60 percent – from $7.50 to $12 an hour – since 2016, and service agencies say other state or federal mandates have added to their costs.

“I feel like we have been raising the flag for help in our industry for years,” said Laurie Beldin, executive director of the Home Care and Hospice Alliance of Maine.

Beldin said many providers are “beyond crisis,” as evidenced by the Farmingdale agency’s imminent closure. As Maine’s population ages, demand for home-based services is growing, and Beldin said she is encouraged by the attention the issue has received in recent months from a special commission and lawmakers.

“Without reimbursement rates being more in line with actual costs of delivering care, our agencies are unable to pay competitive wages, attract and recruit quality, compassionate caregivers and, frankly, to keep their doors open,” Beldin said.

Bellows’ bill, co-sponsored by Rep. Thom Harnett, D-Gardiner, has bipartisan support, although Senate Republicans accused Democrats of being slow to join the call for higher reimbursement rates.

“The closure of Home Care for Maine is not a problem that is ‘a decade in the making,’ as Senator Bellows claims,” the Senate Republican caucus said in a statement. “It is specifically tied to the 60 percent increase in the state’s minimum wage over the last three years and the resistance by Democrats to providing proper funding to match the mandated increase in labor costs.”

Republicans had criticized Democratic Gov. Janet Mills last year for holding up a bill to increase reimbursement rates for nursing homes over concerns about jeopardizing federal Medicaid funding. Democrats, meanwhile, have criticized Republicans for opposing budgets that increased rates.

The request for $8.5 million for reimbursement rates will also have to compete with a long list of other interests vying for a share of the additional $126 million available for lawmakers to divvy up this legislative session.

“There are a significant number of competing priorities in this budget, but one of the points we made today is the state has been penny-wise and pound-foolish,” Bellows said. “People have the best quality of life if they can stay at home, and it saves the state money” over institutionalized care.

Mills’ supplemental budget proposal, released earlier this month, does not contain any additional money for reimbursement rate increases. But the Legislature holds the purse strings in Maine, and lawmakers began the process of reviewing those funding requests this week.

“The administration is reviewing the bill,” said Jackie Farwell, spokeswoman for the Maine Department of Health and Human Services. “We share the concern of lawmakers and want to find a long-term solution to this issue. That includes comprehensively evaluating MaineCare’s rate-setting system to create a streamlined and coherent system that ensures access to high-quality care.”

The bill by Bellows and Harnett is one of several measures that lawmakers will consider before the 2020 legislative session wraps up in April.

A special commission on the worker shortage in Maine’s long-term care system recently recommended paying direct care workers at least 125 percent of the state’s minimum wage as a way to draw more people to those jobs.

The commission’s recommendations also include: creating a rate-setting commission independent of DHHS, requiring the department to account for minimum wage increases and paid time off while setting rates, and making direct care workers eligible for student loan repayment programs.

Jillian Jolicoeur, chief operating officer at the Assistance Plus agency that provides home-based and behavioral care to clients, called the rate-setting review process “long overdue.” Jolicoeur added, however, that “emergency action” is needed to address the reimbursement rate issue and worker shortage.

“If we continue to do nothing about this current home-care reimbursement rate, the infrastructure we have now will not exist by the time DHHS has completed their rate research,” Jolicoeur said.


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