Maine is in the midst of an urgent and ongoing crisis in its essential care and support workforce. From staffing shortages in community behavioral health to residential and community-based services for adults with intellectual and developmental disabilities, autism or brain injuries to in-home and nursing care for our aging residents, thousands of Mainers who are approved for MaineCare services struggle to access the care they need. Thousands more remain on waitlists — waiting for the services they deserve.
At the heart of this crisis has been the issue of stagnant MaineCare reimbursement rates. For years, providers relied on outdated rates with no consistent, reliable process for review or adjustment. In some cases, rates had gone unchanged for decades, leaving providers unable to keep up with rising costs or offer competitive wages to attract and retain staff.
In 2022, Maine made meaningful progress. A new rate reform system — developed under the current administration, supported by stakeholders and codified by the Legislature — established a nationally recognized and structured approach to rate setting. It created clear expectations and a reliable five-year schedule for comprehensive rate determinations.
Critically, the system also introduced annual cost-of-living adjustments (COLAs) to be applied in the years between rate reviews. These annual COLAs have helped address inflation, narrow long-standing funding gaps and support essential wage increases for direct care and support workers — the frontline professionals who deliver vital services across Maine.
In a state with a chronic workforce shortage and a year over year steadily rising minimum wage, these COLAs are not a luxury — they are a necessity. They are key to maintaining service access and retaining the workforce thousands of Mainers rely on each day.
Yet despite two years of successful COLA implementation, the Department of Health and Human Services did not apply the Jan. 1, 2025 COLA as required by law. This decision has intensified an already strained system and leaves it to the Legislature to restore the funding.
Additionally, the administration’s November 2024 settlement agreement with the U.S. Department of Justice — addressing long-standing deficiencies in Maine’s children’s behavioral health system — explicitly requires COLA implementation for behavioral health providers as outlined in Maine statute. Failing to apply the COLA not only violates state law — it contradicts a federal commitment.
The administration has also proposed suspending COLAs for the next two years, a move that would undermine providers’ ability to retain staff and manage rising program costs. Annual COLAs were beginning to work. Some services were stabilizing. Providers were seeing modest progress in workforce recruitment and retention. At a moment when momentum is building, Maine cannot afford to retreat from its commitment to adequately fund these critical services.
MaineCare services are required under Maine law and to apply an annual cost-of-living adjustment and to ensure that wage and benefit components of direct care service rates are adjusted to support 125% of minimum wage. Essential care and support employers — joined by associations, advocates and research institutions through the Essential Care and Support Workforce Partnership — are calling on the Legislature to uphold its obligation and restore the full COLAs over the biennium, including this year’s 3.5%.
Without it, behavioral health, IDD and direct care providers will fall further behind, threatening access to care for some of the state’s most vulnerable populations. Bipartisan support for upholding the annual COLAs is strong. The Health and Human Services Committee voted unanimously to restore the COLA in its report to the Appropriations Committee, and recently House Speaker Ryan Fecteau, D-Biddeford, and Rep. Jennifer Poirier, R-Skowhegan, stood with direct care workers and advocates at the State House, calling for the full restoration of COLAs, reaffirming the state’s responsibility to fund essential services and support the workforce behind them.
Support for our state’s essential care and support workforce, and a commitment to the thousands of Mainers they serve, cannot wait. The state must honor its promises, follow its laws and continue the progress made through rate reform. The health and well-being of Maine communities depend on it.
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