January 19, 2023
Governor Janet Mills’ biennial budget proposes $84 million to support access and innovation in services for individuals with intellectual and developmental disabilities (IDD) and brain injury. The proposed funding addresses access by adding individuals to Maine’s IDD programs and keeping pace with inflation through additional cost-of-living rate adjustments. The budget promotes innovation with a new Lifespan program that simplifies and centers the program on the people it serves and their changing needs and plans. Initiatives include:
$34 million to enroll an additional 900 people in the Section 29 IDD waiver program during the first 18 months of the biennium (July 1, 2023, through December 31, 2024). This will enable the Department to eliminate the Section 29 wait list and keep up with new applicants. As the workforce shortage persists, Section 29 offers flexible options to individuals and families who may choose services delivered through traditional provider agencies or self-directed supports that allow individual to identify supports outside the normal provider network.
$3 million to continue enrolling people served on an emergency basis under Section 21. These funds will sustain the 50 reserved enrollments authorized in last year’s supplemental budget.
$42 million for future cost-of-living adjustments for Sections 18, 20, 21, and 29, Intermediate Care Facilities for Individuals with IDD (ICFs/IID), and PNMI Fs. This funding anticipates the need for additional cost-of-living adjustments over the biennium.
$5 million to launch a new Lifespan program, which will enroll 50 adults and 40 children per month beginning in January 2025 for a total of 540 enrollees in the biennium.
Lifespan: A Program for a Lifetime
Lifespan is one of three system improvement prongs that the Office of Aging and Disability Services (OADS) is implementing under A Path for ME, an initiative to improve and transform how services are delivered to people with IDD.
The second prong is a robust identification of needs using the Supports Intensity Scale, a nationally validated and reliable tool used in several other states. Individuals enrolling in Lifespan will have an assessment and the person-centered planning team will use information from the assessment to develop an individualized service plan.
The third prong is innovation. Lifespan recognizes that individuals with disabilities each have their own paths, and services must be flexible and responsive in order to support those paths. To that end, OADS is using one-time federal funding to stimulate innovation through a grant-making initiative.
The first round of grants, issued this month, includes projects that expand the use of technology and remote support; promote employment and financial independence; enhance supports for individuals with exceptional medical or behavioral needs, and offer alternative residential options. Grantees will receive technical support from the National Disability Institute (NDI), and projects will be assessed for effectiveness in real time, with the most promising innovations to be folded into Lifespan.
Currently, individuals with IDD can experience abrupt and confusing transitions as they move from children’s services to adult services. Typically, they begin receiving adult supports through Section 29, Maine’s supportive services waiver, and place their names on the Section 21 wait list in anticipation of needing the more intensive services offered by Section 21 in the future.
Lifespan will enroll individuals earlier (at age 14), enabling the development of a life plan and making the transition to adulthood smoother. If needs become more intensive, different services can be accessed without changing programs. Lifespan would:
Simplify the system by having just one waiver for people with IDD;
Provide greater certainty as the program supports people for their lifetime, with different services based on a person’s age and needs;
Ease transitions since it enrolls people with IDD as young as age 14 to help them as they change from children’s services to adult services;
Help people to plan for the future (not just one year at a time);
Provide supports to individuals in their home settings to help prevent a crisis, rather than giving support only after a crisis has happened;
Support the strengths of each person with IDD, but also the strengths of each person’s family and local community;
Offer more opportunities and support for people with IDD to find and keep a community job they like and do well; and
Offer more opportunities and support for people with IDD to self-direct their waiver services, giving people the chance to hire their own workers.
OADS began planning for Lifespan in September 2022 with the first of five stakeholder feedback sessions. Stakeholders expressed strong support for Lifespan and for participation in an advisory committee that includes individuals with disabilities, family members, advocates, and providers. OADS is leading the work, collaborating closely with the Office of Child and Family Services (OCFS). Lifespan will be created as a Medicaid (MaineCare) waiver program, making the Office of MaineCare Services (OMS) a key partner as well. DHHS will also be working closely with the Department of Labor’s Bureau of Rehabilitation Services (BRS) and the Department of Education.
Broader Improvements to Home- and Community-Based Services
The Mills Administration has made historic investments to improve home- and community-based services (HCBS) for older Mainers and people with IDD through the budget as well as new federal funds. The biennial budget for fiscal years 2022 and 2023 invested $90.6 million to increase MaineCare rates for HCBS waiver services for older adults and people with disabilities and brain injury. The supplemental budget added another $68.5 million, for a combined investment of $159.1 million. The HCBS cost-of-living rate increases that took effect January 1, 2023, included an additional $19 million to keep up with higher than projected inflation, bringing the total for the current biennium to $178.1 million.
In addition to these ongoing investments, the Department is implementing its HCBS Improvement Plan with over $240 million in one-time federal funding made available specifically for this purpose through the American Rescue Plan Act. As of December 2022, $132 million has been invested from the plan, with most of the funds supporting bonuses to direct support workers. In addition to the bonuses, in September 2022, group home providers received a one-time payment of $6 million to address continuing COVID-related staffing challenges, and providers subject to the federal HCBS settings rule received $5 million in remediation grants to help bring their programs into compliance.
In addition to supporting payment improvements, the Mills Administration has worked with the Legislature to expand access to HCBS waiver services with an expansion of the number of individuals added to these services. Each year since 2019, the Governor has supported increased funding to provide greater access to waiver services.
New preliminary data shows that as a result, the number of adults with IDD receiving support for residential services through MaineCare jumped 46 percent between State Fiscal Year 2017 and July 1, 2022. This was possible through an expansion of shared living, a family-style living situation that affords opportunities for individuals with IDD to become a member of the household, a family, and their local communities. Staffing challenges caused group homes to decline slightly in the same period, underscoring how important it is to offer a range of options to ensure resiliency of the service system in emergencies.