Governor Mills Announces Federal Approval of Bonus Payments for Direct Support Workers

Mills Administration’s plan provides an estimated $126 million for new-hire and retention bonuses for home- and community-based employees

Governor Janet Mills announced Nov. 23rd that the Federal government has approved Maine’s plan to allocate an estimated $126 million in MaineCare funds available through the American Rescue Plan (ARP) for bonuses for new and existing home- and

community-based services (HCBS) direct support workers and shared living providers. These payments represent a major component of the Maine Department of Health and Human Services’ (DHHS) plan to improve access to high-quality services for Maine people of all ages living with disabilities and behavioral health challenges.

DHHS received approval of the plan today from the U.S. Centers for Medicare and Medicaid Services (CMS). CMS is now reviewing previously submitted amendments to the MaineCare State Plan that will authorize Federal matching funds for the plan.

The bonus payment component of the plan aims to address COVID-related, short-term health care worker shortages. It is also closely aligned with the health care workforce priorities included in Governor Janet Mills’ Maine Jobs and Recovery Plan.

“Direct support workers, like all health care providers, have been the backbone of our response to COVID-19. They’ve shown up on the frontlines for more than a year and half to provide vital care for Maine people, despite the risks to their own health. Their work is meaningful beyond words,” said Governor Mills. “This Federal funding will allow us to recruit and retain more direct support workers, help them build life-long careers here in Maine, and strengthen our system of care and services for older adults and those with disabilities and mental health challenges.”

“This funding will support the services older adults and Mainers living with disabilities and behavioral health challenges need to stay healthy and fulfil their goals,” said Jeanne Lambrew, Commissioner of the Maine Department of Health and Human Services. “We look forward to getting bonuses into the hands of Maine’s dedicated direct support workers, who remain on the front lines of our pandemic response.”

“Every day, thousands of older Mainers and people with disabilities who need home care services rely upon a very skilled and dedicated home care workforce,” said Brenda Gallant, Maine’s Long-Term Care Ombudsman. “These workers deserve to be recognized and we are very pleased that the Mills Administration has dedicated this funding to attract and retain this critical workforce.”

“These bonuses are welcomed and honor the hard work and commitment of direct care workers who have stayed the course over these long months of the pandemic,” said Laura Cordes, Executive Director of the Maine Association for Community Service Providers. “Direct care workers deliver amazing care to Maine children and adults with intellectual disabilities and autism. At a time when many provider agencies and programs are walking the fine line of collapse due to the critical staffing shortage, these bonuses can help stem the loss of direct care workers across the state.”

“This funding for recruitment and retention bonuses is welcome relief -- particularly during this workforce shortage,” said Laurie Belden, Executive Director of the Home Care and Hospice Alliance of Maine. “These incentives, as well as other initiatives being developed by the Mills Administration, are critical to ensure care in the home remains a viable choice for Maine's older adults and those with disabilities.”

"This effort on the part of DHHS was a great example of collaboration with the provider community to ensure timely access to services,” said Malory Shaughnessy, Executive Director of the Alliance for Addiction and Mental Health Services. “The fact that this enhanced HCBS funding can be applied to behavioral health services for the first time is also critical to recognizing the importance of the behavioral health workforce, and supporting Mainers with mental health and substance use disorders to remain in their home communities. The Alliance applauds the Mills Administration and its plan to allocate the single largest portion of funding to retention and attraction bonuses for direct support workers and their supervisors."

Eligible HCBS providers must register with the Department in order to receive payments. Registration will occur through an online portal beginning November 29 and continuing for 10 business days.

DHHS will distribute the funds to qualified provider agencies in two phases, beginning in January, based on their HCBS MaineCare revenue. Provider agencies will pay bonuses directly to workers, shared living providers, and supervisors. Individual bonus amounts will be determined by the provider agency in accordance with a bonus policy that the agency will adopt and share with its employees. DHHS developed this system in consultation with provider agencies to reduce the administrative burden, give agencies more certainty about available funding and allow agencies to create specific bonus policies that make sense for their employees. All provider agencies that receive funds for bonuses are required to pay at least 80 percent of funds in direct payments to staff, not including agency leadership. Agencies will be subject to both Federal and State audit.

The $126 million allocated for bonus payments is part of DHHS’s broader plan to invest approximately $229 million in Federal Medicaid matching funds for Maine’s HCBS system improvement plan, which was developed in consultation with stakeholders, including providers and families. The plan reflects the consensus that the most immediate challenge facing Maine’s HCBS system is attracting and retaining direct support workers. As part of the HCBS system improvement plan, the Department is also creating a direct support worker council, developing career ladders, making worker certification more portable and pursuing other longer-term initiatives.

Governor Mills’ Maine Jobs and Recovery Plan includes a slate of initiatives to encourage people to pursue health care jobs in Maine and strengthen the state’s health care workforce. This includes $4 million to provide scholarships and student loan relief to enable more people to become behavioral health specialists, long term support workers and other health professionals. An additional $8 million supports a program to help people who work in the health care field gain skills and advance with their employer. The Jobs and Recovery Plan also includes a $1.5 million recruitment effort, with $500,000 dedicated specifically to promoting direct support worker jobs, such as aides for older Mainers or individuals with disabilities.

The Mills Administration has taken a number of actions to support HCBS providers during the pandemic. Group home providers received a significant increase in their MaineCare base rates on July 1 and will be included in the first wave of agencies to receive rate adjustments in January to support an average wage for direct support workers of at least 125% of the State minimum wage.

As provided in the biennial budget, the Administration recently announced $146 million primarily for workforce recruitment and retention support: $123 million for nursing facilities, residential care facilities (Private Non Medical Institution (PNMI) Cs), and adult family care homes and $23 million for hospitals. This is in addition to the award of $25 million in Coronavirus Relief Funds to health care organizations to help them recover from the COVID-19 pandemic.

This month, Substance Use Treatment facilities (PNMI Appendix B providers) are receiving MaineCare rate increases for a variety of services. Children’s Residential Care Facilities (PNMI D providers) also received rate increases, effective November 1, 2021 to help providers meet new requirements associated with the federal Family First Prevention Services Act.

Additionally, earlier in the pandemic, Maine DHHS adopted emergency provisions in MaineCare to give agencies more flexibility with staffing, which remain ongoing. The Department has also connected providers to potential sources of staff, including the state’s ASPIRE program, vocational rehabilitation services, college job boards and the Department of Labor’s Maine JobLink. These and other resources are available in a Recruitment and Retention Tool Kit.