The Mills administration is asking federal regulators for authorization to boost pay rates for thousands of workers who provide home- and community-based services to Mainers with autism or intellectual disabilities.

But an organization that represents social services agencies said the additional funding and flexibility, while appreciated, is inadequate and “will only continue to undercut a fragile service network that was already in crisis” before the coronavirus pandemic.

Direct care workers were not included in an emergency funding package the Legislature passed in March that increased MaineCare reimbursement rates for other workers who help care for home-bound senior citizens. As a result, agencies that care for individuals with intellectual disabilities have been struggling to support or retain the often lower-paid workers whose services have become even more critical – and challenging – during the coronavirus pandemic.

The Maine Department of Health and Human Services is requesting a waiver from the federal government that would allow the agency to increase reimbursement rates for direct care workers by 10 percent. The reimbursement rate request, which would cost $13 million in state and federal funds, would be retroactive to March 1 and extend through May.

“Adults with disabilities and older Mainers continue to rely on these vital services and the direct support professionals who provide them in the face of this pandemic,” DHHS Commissioner Jeanne Lambrew said in a written statement. “We join the majority of states in seeking this flexibility and support from the federal government to ensure that more than 5,600 Maine people continue to be supported in their homes and communities throughout the state during this public health emergency.”

Some service providers have been critical of DHHS for not doing more to support the agencies and staff that help care for individuals with intellectual disabilities, brain injuries, autism or other disabilities. Many direct care workers earn minimum wage or slightly more, despite the emotional and physical demands of the jobs.


Those challenges have only increased during the COVID-19 crisis as staff continue to care for clients, whether in their homes or in group homes. Agencies also report shortages of the personal protective equipment, such as masks and gloves, needed to reduce the risks of transmission of the COVID-19 disease.

Laura Cordes, executive director of the Maine Association for Community Service Providers, said the Mills administration’s request “falls woefully short” of the needs of the workers putting themselves and their families at risk while providing critical care to their clients.

Cordes said agencies have depleted their cash reserves and lines of credit to provide overtime and hazard pay to staff, buy food for clients, obtain protective gear and disinfection supplies, and buy new technology to allow remote work, when possible. She added that “many providers are on the verge of collapse” and may have to close or scale back operations without additional support.

“While we appreciate the flexibility that the plan affords for service delivery, it simply doesn’t demonstrate the type of commitment we need from the state to survive this moment,” Cordes said. “A 10 percent increase falls short of what is needed to increase wages and cover the emergency expenses incurred to keep safely providing critical care and support during this pandemic.”

The agencies that provide home-based care to thousands of older Mainers or residents with intellectual disabilities have been facing a workforce crisis for years. The financial crunch has been exacerbated by the fact that MaineCare reimbursement rates have not kept pace with the 60 percent increase in Maine’s minimum wage in four years and other mandates that drove up provider costs.

The Legislature approved a reimbursement rate for other home-care and personal support specialists in the spring as part of an emergency package of coronavirus bills. Mills then bumped up the timeline for the pay increases by three months in order to help workers and their employers during the pandemic.


But DHHS has said that federal guidelines require a comprehensive rate analysis before the department could enact a similar reimbursement rate increase for direct-care workers who serve individuals with intellectual disabilities.

The waiver request filed this week with the U.S. Centers for Medicare and Medicaid Services will provide DHHS with the flexibility to provide the temporary rate increase, which could be used to provide hazard pay to workers.

Neal Meltzer, executive director of the Sanford-based nonprofit Waban that provides services to roughly 1,000 clients in southern Maine, welcomed the anticipated release of additional funding but agreed it does not go far enough.

Waban, which has roughly 450 staff members, has dipped into its reserves to offer a $2-an-hour pay increase, dubbed a “hero reinvestment incentive,” to direct care workers. Additionally, Waban is supplying all meals to staff who work at group homes so they can avoid risk of exposure at the grocery store and is continuing to provide health insurance to several dozen furloughed staff.

Meltzer had said last week that those coronavirus-response initiatives, among others, are costing Waban about $180,000 a month. The 10 percent reimbursement rate increase that DHHS has proposed, he said, is “helpful” but it doesn’t even cover the additional $2-per-hour “hero” pay he and other agencies are providing.

He also raised concerns that the flexibility and enhanced funding are currently slated to expire on May 31, although DHHS officials signaled that could be extended. The governor’s phased economic reopening plan appears to envision many of the medically vulnerable people remaining sequestered until September.

“It’s a good attempt. It’s not perfect,” Meltzer said. “I think more needs to be done. But I am hopeful that more will be done and that it will be done in a more prospective way.”

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