Maine Department of Health and Human Services Supplemental Budget Summary

April 23, 2024

The supplemental budget passed by the Legislature and signed by Governor Mills on Monday invests in a range of Maine Department of Health and Human Services programs and initiatives. This includes mental health and substance use disorder prevention and response, violence prevention and recovery, child health and welfare, MaineCare payment reform, and maintaining core services.

Funding described below is for “all funds” meaning federal matching funds and grants, state general fund, and other special revenue. Totals are for the biennium including State Fiscal Year (FY) 2024 and 2025.

Mental Health and Substance Use Disorder Prevention and Response:

  • Supporting Mobile Crisis Teams: $5.3 million for FY25, supplemented by enhanced federal matching funds, to strengthen mobile crisis response through a comprehensive MaineCare (Medicaid) payment model. This model will support teams comprised of specially trained behavioral health responders including peers providing services 24 hours a day, 7 days a week who de-escalate mental health and substance use crises, assess needs, and provide an appropriate level of care in the least restrictive setting, in addition to providing community debriefing and critical incident response services. These teams, which are dispatched to the location of a person in crisis through 988 – Maine’s 24/7 centralized crisis lifeline – are a critical safety-net service that the Mills Administration has effectively worked with providers and national experts for the past two years to improve.
  • Building More Crisis Receiving Centers: $4.4 million in funding to establish crisis receiving centers in Lewiston, Penobscot County, and Aroostook County. Crisis receiving centers are a proven model of behavioral crisis intervention, allowing any person experiencing a mental health or substance use crisis to get immediate, appropriate, and no-cost crisis support. This budget builds on the successful Portland center and directs the Department to develop a plan to create a statewide network of crisis receiving centers that provide greater access to behavioral health services for people across the state. The budget also adds $550,000 to increase the start-up funding for the substance use disorder treatment center in Kennebec County included in the biennial budget passed last year as well as allows greater flexibility in the type of services offered by the center.
  • Implementing Comprehensive Behavioral Health Centers: $2 million for startup and implementation costs for all organizations participating in the certified community behavioral health clinic (CCHBC) program. A CCBHC is a specially designated clinic that provides a comprehensive range of clinical evidence-based mental health and substance use services – that includes but is not limited to crisis services. CCBHCs are required to serve anyone who requests care for mental health or substance use, regardless of their ability to pay, place of residence, or age. This includes developmentally appropriate care for children and youth. Maine plans to seek federal approval for Medicaid reimbursement for CCBHCs at an enhanced matching rate after piloting this program.
  • Strengthening the Behavioral Health Workforce: $2.5 million in ongoing funding for providers of medication management to increase recruitment and retention of skilled workers and clinicians.
  • Adjusting Payments to Behavioral Health Providers for Inflation: $19.8 million to ensure payments to behavioral health providers keep pace with costs affected by inflation.

Violence Prevention and Recovery:

  • Establishing an Office of Violence Prevention at the Maine CDC: $3.2 million to establish an Office of Violence Prevention at the Maine Center for Disease Control and Prevention (CDC). It will coordinate and promote effective efforts to reduce violence and promote research regarding causes of and evidence-based responses to violence. The Office will create a data hub to inform efforts, provide grants for community-based programs, and increase awareness and education about laws and resources relating to violence prevention, including gun violence.
  • Funding Victims’ Services: $6 million in one-time funding to address a federal funding shortfall from the Victims of Crime Act (VOCA). This funding will support community-based domestic violence and sexual assault services, civil legal representation for victims, victim witness advocates, and housing and supportive services for elder abuse victims.
  • Enhancing Funding for Extreme Risk Protection Order Assessments: $422,400 to support the surge in mental health assessments under the extreme risk protection order law since the tragedy in Lewiston. The law has been used over 15 times more often in the nearly six months since the shooting in Lewiston than for the three previous years it was in effect.
  • Bolstering Behavioral Health Response to the Lewiston Tragedy: $8.5 million for St. Mary’s to sustain and expand acute behavioral health services in Lewiston and $248,000 for one-time post-traumatic wellness assistance for first responders, peer support counseling and other incidental costs associated with the Lewiston tragedy. The budget also includes $1.9 million for the Department of Economic and Community Development for a one-time grant to a licensed provider to prevent a significant disruption in a range of behavioral health services for victims of the Lewiston tragedy.

Child Welfare, Children’s Behavioral Health Services, and Child Care:

  • Adding Targeted Positions to Support Child Protective Caseworkers: $1.3 million for targeted positions – such as legal aides and trainers – to expand teams for caseworkers so they can focus their time and energy on engagement with children and families, follow-up for services, investigations, and making sound decisions to protect children in need.
  • Funding a Reclassification of Child Welfare Positions: $4 million to support a reclassification of child welfare caseworkers and supervisors to ensure that the compensation properly reflects the difficulty and complexity of the work.
  • Supporting Children in State Care: $1.5 million to support services for children in state custody, including funding for room and board, clothing, activities, and respite, and a new comprehensive foster child assessment service that provides timely, comprehensive evaluations for youth entering foster care. The budget also enhances staff to support high-fidelity wrap-around services that facilitate services for children with intense needs to keep them in their communities and out of state custody.
  • Catalyzing New Children’s Behavioral Health Services: $2 million to capitalize a Psychiatric Residential Treatment Facility to provide therapeutic treatment to children and youth with complicated behavioral health needs and reduce unnecessary emergency department stays; $1 million for training in the Adolescent Community Reinforcement Approach, a model providing youth experiencing substance use disorder skills such as effective problem solving, communication and recreation; and $500,000 to promote additional mental health services for children in rural Maine.
  • Supporting Maine’s Child Care Sector: Authorizes full and effective investment of all of the $12.9 million in General Funds previously appropriated for early care that could not otherwise be spent in FY24 due to the delayed implementation of the biennial budget and other reasons. Specifically, the budget authorizes one-time child care provider stability grants, Head Start costs, technology changes necessary to implement recent state and federal policy changes, and support for families. The budget also authorizes the use of appropriated funds in FY25 for a child care staff scholarship program to inform recommendations on how to design an effective and efficient permanent program.

MaineCare Payment Reform:

  • Improving Nursing Facility Access and Quality: The budget modifies appropriations enacted in last year’s biennial budget and newly appropriates funding that, in addition to $15.4 million to support higher than expected inflation, provides nursing facilities with $125 million in federal and state funds.
    • Short-Term Support for Continuing Access. The budget authorizes the Department to make a $30 million one-time supplemental payment to Maine’s nursing homes in 2024 to maintain access for residents in advance of payment reform. This follows about $19 million in additional payments that were made in December 2023.
    • Improving Value for Residents and Families through Payment Reform. The budget authorizes $82 million for a new way of paying nursing facilities starting in January 2025. This includes funding and $58 million from a Transition Fund to help facilities succeed in implementation over a three-year period. The new rate approach emphasizes sufficiency and stability of direct care staff. It builds into the rates wages for nurses, CNAs, and others that are in the top 25 percent of wages paid for those professions in Maine. It gives facilities greater operational flexibility and predictability of revenue, while also providing incentives for cost efficiency and reductions in the use of temporary agency staff. For the first time, the nursing facility payment approach will include mechanisms that reward quality and value for residents.
    • Supporting our Veterans. The budget includes $13.3 million (state and federal) in one-time funding to ensure continuing access to nursing and residential care facilities for our veterans. The supplemental payment to Maine Veterans Homes (MVH) will help offset the cost of MaineCare residents. The budget also ensures that a one-time appropriation from last year, which was narrowly targeted to nursing facilities only, can also support MVH’s residential care facilities.
  • Improving Hospital Reimbursements: $96.4 million in federal, state, and new hospital revenue to reform hospital reimbursement rates to improve the health of Maine people. With support from the budget, hospitals will see improved reimbursement because the payments will better align with Medicare – a more consistent and fair approach to paying for outlier costs that relate to patient need – and improved outpatient rates to encourage more community-based care when possible. It will also improve transparency and uniformity for similar hospitals across the reimbursement system as a whole. The agreement maximizes the available funding under federal payment limits and provides additional support for MaineCare in the future. 
  • Expanding Access to Medications for Maine People: The budget provides $787,000 for family planning rate reform that includes increased support for long-acting reversible contraception and $4 million in one-time grants to federally-qualified health centers to expand their pharmacy services for MaineCare members and others.

Maintaining Core Health and Human Services:

  • Funding Unexpected MaineCare Pharmacy Costs: Adds $20.7 million in one-time funding for the unexpected additional and one-time pharmacy costs due to the cybersecurity attack on United Health’s Change Healthcare. The Office of MaineCare Services took temporary action to help MaineCare members access needed medication following the disruption of its pharmacy claims system that started on February 21, 2024. This funding would support MaineCare’s response to the disruption.
  • Sustaining Support for Basic Needs: Adds $10 million for General Assistance that is connected to reforms to make the program more sustainable in the long-term. Also adds $5.4 million for the state Supplemental Nutrition Assistance Program (SNAP) given increased demand.
  • Ensuring Sufficient Eligibility Workers: Adds 20 eligibility specialists plus support staff to ensure customer service for Maine’s growing population and increased demand for MaineCare and SNAP.
  • Complying with Federal Medicaid Changes: Provides $34.5 million necessary to compensate for federal formula funding changes for Medicaid related to higher income and drug costs resulting in a larger mandatory drug “clawback” payment.
  • Replenishing the MaineCare Stabilization Fund: Directly provides $23.5 million and potentially provides another $6.5 million to this special fund to be used to prevent eligibility or benefit cuts and continue implementation of rate reform.