The state has slashed the money it pays to assisted living facilities to hold beds for residents who are in the hospital or away getting rehab. And when residents leave for reasons that aren’t medical – say to visit family for a week – the state won’t pay to hold their bed at all.

Facility officials say they’ll soon have to make some hard decisions. The choice: Make a living or keep residents’ beds reserved for them while they’re away.

“How many days can you go without getting paid?” asked Cindy Quinlan, administrator for Clover Health Care, which runs a 135-bed assisted living facility in Auburn.

The state says it had to balance the budget somehow and simply can’t afford to keep paying for beds that aren’t being used.

Geoff Green, Department of Health and Human Services deputy commissioner, sees at least one solution for assisted living facilities: Give away the residents’ beds and then put them at the top of the waiting list before their release from the hospital or rehab.

“It’s a change, but we think it’s a change that can be managed,” Green said.

The funding change was approved by the Legislature last session in order to help fill what was projected to be a $190 million budget gap. The state spends more than $105 million a year on assisted living residents and expects to save about $1.4 million with the cuts.

The state had been paying approximately $100 a day per person to hold beds, according to Richard Erb, president of the Maine Health Care Association, which represents long-term care, rehabilitation and nursing care providers. The state will now pay $15 or $20 a day, with a 30-day limit.

If residents are away for a nonmedical reason, the state won’t pay at all to hold their bed.

The time clock starts as soon as residents are gone for a full day.

To help offset the change, the state increased facilities’ daily payments by $1.52 per person. That’s about a 2 percent increase.

While that increase was nice, Erb said, facilities hadn’t seen a raise at all over the past two years, and so the skyrocketing cost-of-living will eat that $1.52. And area facilities say one or two absent residents won’t be enough to trim their spending on staff, heat or food to compensate for the funding loss.

“How does one person make a difference?” said Marie Beaucage, administrator at the Sarah Frye Home in Auburn, which serves 36 people.

She worries about residents like the husband and wife who were recently separated when the wife fell and required weeks of rehab in another facility.

“There was a concern we’d have to discharge her after 30 days and here her poor husband would sit on this end,” Beaucage said.

The facility has decided to bring the wife back and get her physical therapy in-house. It’s a workaround the home was willing and able to make this time, but “I don’t think you’re going to find a lot of homes to do that,” Beaucage said.

The state believes assisted living facilities can deal with the change, in part, by doing exactly what the Sarah Frye Home did – collaborate with the rehab facility and create a solution.

Green, at DHHS, believes facilities can manage short-term absences since they’re now getting more money per day. Long-term absences may force more creative solutions.

“What might work better is for the facility to work with the nursing facility so that when the person is ready to come back, they get put to the top of the waiting list if there is one, or that planning is done so those transitions can happen without the state having to pay essentially for two beds at the same time for a long period of time,” Green said.

The change took effect Aug. 1 and affects about 4,000 residents in 120 assisted living facilities. It will also affect facilities that deal with adult mental health and children’s behavioral health issues.

DHHS will monitor the change and report to the Legislature in January.