PITTSFIELD — When the dust settles and the political rhetoric fades, Maine’s nursing homes will get an additional $25.8 million for Medicaid reimbursements this year.

In the wake of recent vetoes, overrides and invective, the Democrat-led Legislature can take credit for about half of the money, and Republican Gov. Paul LePage can take credit for the other half. Both sides say they weren’t playing politics and simply wanted to do the right thing.

But the cash infusion comes too late for Mary Ford, owner of Pittsfield Rehab & Nursing.

Her 57-bed nursing home on Leighton Street is set to close by Sept. 5, after being underfunded by MaineCare, the state’s form of Medicaid, for about a decade. It’s the only nursing home in town and one of two rural independent nursing homes in Maine that is closing this summer for a variety of reasons.

By Friday, all but one of 47 residents of Ford’s nursing home had moved. The rooms and hallways were nearly empty. Few of her 66 staff members remained.

“The bottom line is this is not a viable business,” Ford said. “We’ve been outcompeted. The industry’s consolidating and Medicaid is underfunding. If there had been any other choice, I would have done it.”

Lately, Ford said, the daily Medicaid reimbursement rate for her business, which averages about $178 per resident across the state, fell about $15 short of her costs. And she had only a handful of self-pay residents and no Medicare-funded, skilled-nursing rehabilitation patients to help make up the difference.

Nursing home operators and advocates say the additional $25.8 million in fiscal year 2015 is a positive step toward fully funding a critical sector of long-term care in which MaineCare losses have climbed to $30 million annually, according the Maine Health Care Association.

MaineCare reimbursement rates are being adjusted for the first time since 2008 – when they were based on 2005 expenditures. The new rates will reflect actual nursing home expenditures in 2011, the most recent audited data available. But what about fiscal 2016 and 2017?

The Legislature has increased MaineCare funding for nursing home reimbursements by $13 million for the next two fiscal years, including federal matching money. But that falls about $17 million short of actual annual costs, and it doesn’t address many other challenges facing Maine’s long-term care providers, including underpaid home care workers and assisted-living residences in dire need of renovations.

Ford said Maine’s government leaders must move past political wrangling and work together to solve serious long-term care funding problems that promise to become more acute as Maine’s senior population grows. Maine’s median age — 43.5 years — is the highest in the United States, in part because the state also has a dwindling younger population, according to the U.S. Census. The state’s proportion of people age 65 and older — 17 percent — is second only to Florida’s 18.2 percent.

“There needs to be stable funding for nursing homes and it needs to not be politicized,” Ford said. She understands that it’s a gubernatorial election year, she said, but she’s not impressed by political maneuvering.

“The governor should not get points for his efforts,” Ford said. “This problem (with MaineCare reimbursements) has been going on for a long time.”

Orie Gadway, who owns 39-bed Coastal Manor in Yarmouth, views the governor’s efforts in a more positive light. The average MaineCare reimbursement rate runs about $17 below the average daily cost at his business. An attached six-bed, private-pay, assisted-care residence allows him to make ends meet.

“To me, (LePage is) doing what’s right, whether it’s political or not, though I don’t think politics should become involved,” Gadway said. “It’s a Band-Aid trying to catch up, but it’s gonna help.”


The politics of nursing home funding ramped up in the final days of the last legislative session. In mid-April, LePage vetoed a bipartisan supplemental budget, L.D. 1858, that would increase nursing home reimbursements by $13 million in fiscal 2016 and 2017. It also would provide $1.1 million when the funding mechanism started in June 2015, the last month of fiscal 2015.

The Legislature easily overrode LePage’s budget veto and passed another bill, L.D. 1776, that included an initial $11.6 million to increase reimbursements in fiscal 2015, which started July 1. The bill also would provide slightly higher payments to nursing homes with more than 70 percent MaineCare residents and would require the state to adjust reimbursement rates every two years to more closely reflect actual costs.

LePage let L.D. 1776 become law without his signature, but he didn’t let the Legislature’s efforts go unchallenged.

“It wasn’t enough,” said Adrienne Bennett, LePage’s spokeswoman. The governor was concerned that some nursing homes would lose funding under the Legislature’s plan and he would violate his legal obligation to “do no harm” if he went along with it, she said.

So LePage vetoed a unanimous bipartisan bill, L.D. 1719, that would spend about $5 million in federal tobacco settlement money from the Fund for a Healthy Maine on a variety of health awareness and service programs such as smoking cessation and children’s dental care. It included $330,000 for adult day care services and $275,000 to provide Medicare counseling for seniors.

On May 1, in the final hours of the session, LePage submitted an emergency bill, L.D. 1864, that would use about $5 million from the fund to increase nursing home reimbursements. Both bills died and the money remains in the fund, unspent.

Then, a little over a week ago, the governor announced that he’d found a new revenue source to increase nursing home reimbursements without the Legislature.

The Department of Health and Human Services anticipates a $10 million surplus in MaineCare programs in fiscal 2014, which ended June 30. The programs were $100 million in the hole earlier this year.

LePage said he plans to spend $4.6 million of the surplus to increase nursing home reimbursements in fiscal 2015. With federal matching funds factored in, LePage’s action will add a total $13.1 million to nursing home reimbursements this year.

“We re-prioritized to put the nursing homes at the top of the list,” Bennett said.


House Speaker Mark Eves, D-North Berwick, said the Legislature is taking a broader approach to funding challenges related to Maine’s rapidly aging population.

Eves hosted a series of round-table talks and a statewide summit on aging in January, when MaineCare underfunding for most long-term care services was highlighted as a significant problem.

“This is not a partisan issue and I’ve been fighting really hard to keep it from becoming one,” Eves said. “We did the best we could with the money we knew we had.”

Moving forward, Eves said, he hopes to build a broad, bipartisan coalition that will develop a plan to address the growing need for home-based support services for seniors while preserving assisted-living residences and nursing homes for people who need them.

While both Eves and LePage say they’re concerned about the impact of closing nursing homes, Marion Mosher understands the impact all too well.

A few years ago, Mosher’s mother, Julia Ward, spent four months at Pittsfield Rehab & Nursing before she died. She was 97.

“She was very comfortable there,” Mosher said of the nursing home. “It was very nice for her. She fit in. She had friends there, and her other friends could visit her. The closing is a big loss for the community, both for the loss of jobs and for the loss of a place that’s close to family members and friends.”

Rick Erb, executive director of the Maine Health Care Association, believes there’s hope because Maine’s political leaders finally agree that the remaining 105 nursing homes in the state should be reimbursed for their actual costs.

“What they couldn’t agree on is how,” said Erb, whose organization represents the nursing homes and about 100 assisted-living residences across the state.

“This is a big step,” Erb said. “It’s the largest increase we’ve ever seen. But I don’t believe it should be a political issue, and I don’t think the voters want it to be.”


Operating a nursing home has grown more difficult in recent years, especially in rural areas that have a higher percentage of residents who are dependent on MaineCare, Erb and others said.

Many nursing homes cover the MaineCare funding gap with higher rates paid by self-pay residents and short-term Medicare rehab clients.

Staying in the black is tougher for independent, family-owned, small-group nursing homes that aren’t part of larger chains or closely affiliated with local hospitals, so they don’t have the benefit of shared costs and administration or a steady stream of Medicare clients.

Many nursing homes also compete with hospitals that have so-called “swing beds,” which are licensed to be used for Medicare-funded rehab stays. Some hospitals and doctors also direct patients to nearby, affiliated nursing homes, to the dismay of rural operators like Nathan Brown in Lubec.

Next month, Brown will close his family’s nursing home which overlooks a channel of Passamaquoddy Bay.

Once a top-rated residence by U.S. News & World Report, Oceanview Nursing Home had a tough time keeping its 39 beds filled in recent years. Brown figures he needed to fill at least 34 beds to break even, and his highest occupancy last year was 32 residents, he said.

“If you’re not affiliated, you’re out of the loop,” Brown said. “We’re a smaller, older facility that’s not as flashy as some of the other nursing homes. It looks like home, but the service is the same.”

Brown said he questions whether increasing MaineCare reimbursements will fix all that ails Maine’s nursing homes. He believes it may make things worse.

“You’re guaranteeing that costs will go up for everyone rather than looking at the challenges that are making it difficult for some nursing homes today,” Brown said.

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