Direct-care agencies urge Maine lawmakers to raise reimbursement rates

Scott Thistle, Portland Press Herald, Maine
·5 min read

Apr. 21—Direct-care agency leaders called on lawmakers Tuesday to raise MaineCare reimbursement rates to help them retain workers and reduce long waiting lists for services for thousands of adults and children with intellectual and developmental disabilities.

Managers said they continue to struggle to find, and keep, workers as many leave the field for less stressful and better paying jobs with other employers including fast-food restaurants or such retailers as Walmart.

Ellis Baum, regional director of Residential Resources in Westbrook, said his workers, who provide a range of supports to individuals in private and group homes, are maxed out, working 70, 80 and even 100 hours a week, either because they need the overtime pay or because there is simply nobody else available to do the critical work.

Baum said his agency struggles to meet the needs of its 50 clients throughout southern Maine and regularly faces a service gap of more than 700 hours per week, despite the long hours being logged by his 100 workers.

Baum, who has worked in the field for 21 years, said he started as a direct-care provider, and the theme of his testimony Tuesday was fatigue.

"I know firsthand what it feels like to string together 70-hour workweeks while providing care to people with significant needs and challenging behavior. I know what it's like to be tired," Baum said. He said it breaks his heart to see those working for him string together even longer work weeks now.

"The sad fact is they are working these hours because they cannot pay their bills working 40 hours per week," Baum said. And even with many working grueling schedules, his agency weekly still has hundreds of hours of care that need to be covered. "Through 14 locations, I currently have 714 open hours per week that must be filled," he said.

Baum said turnover rates for workers are as high as 40 percent, which has a financial cost and, equally important, a serious impact on clients.

"Imagine when you rely on people to take care of you, to assist you with some of the most intimate things, that all of us have to go through as part of our daily routine, and then not have a full level of trust with those people doing that type of work," Baum said. He said an increase in the frequency and duration of challenging behaviors from clients stems from high turnover rates with staff.

At least four bills before a legislative committee seek to increase Medicaid reimbursement rates for workers to ensure they are being paid more than the state's $12.15 per hour minimum wage, including one that requires they be paid at least $2 more an hour. The bills, if approved, could boost the wages for as many as 33,576 workers, according to a report by a state commission that studied labor shortages at the agencies last year. The commission's report also recommends direct-care workers be paid at least 125 percent of the state's minimum wage — or at least $15.19 an hour.

Another bill also would allow parents who provide care to their disabled children to be reimbursed if they are licensed as a certified nursing assistant. Another measure would provide direct-care workers with retroactive hazardous-duty pay for their work from Jan. 1 through April 30 of this year. And a third bill would peg reimbursement rate increases to the Consumer Price Index, just like the state's minimum wage. The bills are being sponsored by both Republicans and Democrats and appear to have broad bipartisan support.

In February 2020 the committee also heard and approved similar legislation that would have increased reimbursement rates by requiring direct-care workers to be paid at least 125 percent of the current minimum wage.

The price tag on that bill, which also included a minimum $2 per hour rate increase, was $69 million a year, with $26 million of that paid for with state funds and $43 million with federal funds. But the bill was among dozens that were left unfinished as the Legislature adjourned abruptly at the onset of the COVID-19 pandemic in March.

Meanwhile, the shortage of workers has left many group homes leaving beds unfilled, while waiting lists for those who need care or in-home services continue to grow.

The committee on Wednesday will take testimony on another batch of bills seeking to address the waiting lists of thousands of people, including 600 children. The average wait time for children is six months, said Malory Shaughnessy, with the Alliance for Addiction and Mental Health Services.

The pandemic has only exacerbated the longstanding reimbursement problem, leaving workers, agencies and those they care for in crisis, Shaughnessy said. The pandemic also has added to the numbers needing services, as restrictions put in place to slow the spread of the virus have increased the demand for behavioral health services.

Shaughnessy noted that some have said there are just not enough eligible workers in Maine to fill all the available direct-care jobs. "But that isn't really the case," Shaughnessy said. "The reality is, these providers cannot compete with other businesses that have increased wages beyond the reach of the current reimbursement rates."

Shaughnessy also urged the Legislature to act quickly. "We need something now," Shaughnessy said. "Not in a year. Now is when we need it."