Solutions remain elusive as group home crisis looms

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Advocates for adults with intellectual disabilities worried about group home closures peppered a top state official with questions Monday, but no definitive steps were taken to alleviate a potential crisis that could begin this summer.

Ricker Hamilton, commissioner of the Maine Department of Health and Human Services, met with the Maine Coalition for Housing and Supportive Services in downtown Portland. Hamilton promised to listen to their concerns.

Group homes have been a hot topic with the coalition, which meets monthly. Parents and advocates are worried that low reimbursement rates to pay employees who work in the group homes, coupled with a rising minimum wage, will result in many group home closures this summer. About 4,000 adults with intellectual disabilities receive Medicaid services for group home living, day programs and other supportive services, or a combination of services.

Medicaid is a blended program funded by state and federal dollars, but states have wide latitude to operate the programs, including setting reimbursement rates.

When asked what should be done about low reimbursement rates for group homes, Hamilton said that’s the purview of the Legislature.

“Ask the legislators to finish their job,” he said.

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Lawmakers adjourned May 2 without addressing funding for numerous issues, including education, the opioid crisis and reimbursement rates for direct care workers. It’s uncertain whether lawmakers will return for a special session before 2019.

As a result of the Legislature’s inaction, rates are due to revert to 2017 levels on July 1, which means nonprofit agencies that operate the group homes would be reimbursed for employees to earn $9.17 per hour. As of January, the minimum wage increased to $10 per hour, as required by a voter-approved referendum.

So the nonprofit agencies, already financially strapped, would have to make up the difference, said Lydia Dawson, executive director of the Maine Association for Community Service Providers. The jobs are challenging and Maine is facing a workforce shortage, so paying minimum wage means that it’s extremely difficult to fill the jobs, advocates have said.

Hamilton said the minimum wage increase is having the “unintended consequence” of harming these services.

Dawson has said she expects many group homes will close if the reimbursement rate isn’t fixed.

A bill that attracted bipartisan support would raise rates to the equivalent of $11 per hour and index the rates to inflation, but while lawmakers approved that bill, they also separately need to agree to fund the $26 million it would take to increase the reimbursement rates.

In February, Hamilton’s agency argued against the bill, saying a comprehensive rate study needs to be completed before DHHS could support rate increases.

Lawmakers approved a temporary measure last year that increased the reimbursement rate to $10 per hour, but that rate is due to expire June 30. Meanwhile, about 1,700 adults with intellectual disabilities are on a waiting list to get into a group home, a tenfold increase in the waiting list compared to a decade ago.

Hamilton said Monday that “time and again” Maine DHHS has been a “lone voice” advocating for funding to reduce the wait list.

“People should not be waiting for a single service,” Hamilton said.

But Dawson said both the waiting list and the reimbursement rates need to be addressed. If the rates aren’t improved, funding the waiting list is ineffective because nonprofit agencies still won’t be able to hire workers.

“Increasing the rates stops the bleeding and stabilizes the system,” Dawson said. She said Hamilton’s appearance Monday is a “hopeful” sign that a solution can be found.

Debbie Dionne, 66, of Topsham has a 38-year-old daughter with intellectual disabilities who lives in a group home, and she fears the home will close this summer. Dionne said she “wants to be optimistic” that a solution is at hand, but the rates must be set to make it possible for nonprofits to attract and retain workers.

“Agencies have to be able to stay in business. The math has to work for them,” Dionne said.

A group of artists and a mentor are hard at work at Spindleworks, an art studio for people with intellectual disabilities. The studio is an example of a service whose funding has suffered from the Legislature’s adjournment that left important business unfinished. Clockwise from left: Grace McKenna, artist mentor Julianne Carle, Lidia Woofenden, McKensy Brown and Barbara Welborn. (Ben McCanna/Portland Press Herald)

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