Maine House Speaker Ryan Fecteau is lobbying for an upcoming bill that would boost the pay of direct care health workers — and make a number of other reforms — in the latest attempt to try to ease the workforce crisis in the field.

The pay increase was not included in Gov. Janet Mills’ two-year budget proposal that was unveiled last week, but the topic is a priority for Fecteau.

Speaker of the House Ryan Fecteau, D-Biddeford, speaks during the first day of the 2025 legislative session last week. Joe Phelan/Kennebec Journal

“It is no secret that there is a care gap in Maine that is keeping people from accessing direct care support. It’s increasingly challenging to find folks who are willing to step up to join the direct care workforce, given the physically and emotionally demanding work and low wages. That means people who need and should be able to access these services, can’t,” Fecteau, the bill’s primary sponsor, said in a statement. “We need to do everything we can to increase access to this type of care across the state.

The bill has not yet been formally introduced, but draft language was sent to the Legislature’s Revisor’s office last week, and the bill is expected to be released in the coming weeks.

The direct care shortage is at the heart of many shortcomings in health care services, including having children languish in emergency departments waiting to be discharged to long-term care facilities. In one recent example, 13-year-old Abby Bedard stayed at Redington-Fairview General Hospital in Skowhegan for 304 days before being discharged to an Orono facility that could care for her mental and physical challenges.

Direct care workers are the front-line employees who provide services for people who need assistance. They are the workers who care for people in their homes when they’re physically disabled, and work in rehabilitation centers, nursing homes, group homes for people with intellectual disabilities, and in the behavioral health field.

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“There’s a lot of hope in this bill,” said Jess Maurer, executive director of the Maine Council on Aging. “To solve this workforce crisis, we need to be competitive on wages. Employers of all kinds are paying more for labor.”

These workers are mostly employed by nonprofits, and their pay is tied to MaineCare reimbursement rates.

While reimbursement rates have improved in recent years, advocates and nonprofit leaders say that the rates are still too low to be competitive in the tight labor market. Currently, MaineCare rates reimburse at levels that allow pay to be up to 125% of the state minimum wage.

Fecteau’s proposal would mandate an increase for rates so that employers could pay up to 140% of the state minimum wage. The state’s minimum wage is currently $14.65 per hour, so 140% would be $20.51. Workers who make 125% of the state minimum wage earn $18.31 per hour.

Lindsay Hammes, a spokesperson for the Maine Department of Health and Human Services, which administers the MaineCare program, said she couldn’t answer questions about the new proposal on Monday. Previously, DHHS has pointed to reimbursement rate improvements, bonuses to attract and retain workers and other investments in health care services as ways that the Mills administration has responded.

Mills has said generally that the budget is going to be tight over the next two years.

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But advocates say what Mills has done is not enough, and some programs, like the Morrison Center in Scarborough, have closed or curtailed programs.

A June 2024 analysis by the Maine Center for Economic Policy think tank said that Maine needs to hire an additional 2,300 full-time direct care workers — there are currently about 24,000 such workers in Maine — to meet existing needs. With Maine’s aging demographics, demand for direct care workers is expected to soar over the next decade.

Similar entry-level jobs, such as for customer service workers, administrative assistants, short-order cooks and janitors, currently pay on average $1.92 more per hour than direct care workers earn, according to the analysis.

Arthur Phillips, an analyst for the Maine Center for Economic Policy and author of the 2024 report, said that the workforce shortage “reduces our economic output by as much as $1 billion per year.”

Without help, patients get sicker and are less likely to rejoin the workforce, and their caregivers may have to scale back their work hours or leave the workforce.

“There are really significant economic costs to the status quo,” Phillips said. “If we made these improvements, it would have reverberating impacts across the state.”

Maurer, of the Maine Council on Aging, said the bill will make other improvements and reduce inefficiencies in the system, such as making sure clients are home when the workers arrive, and allowing credentialed workers to work in similar fields. Currently, someone working as a direct care worker in a group home for adults with intellectual disabilities would need to get a completely separate credential to work in behavioral health, even though the jobs are nearly the same, she said.

“We need to better manage what’s happening on the ground,” Maurer said.

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