June 14, 2021
Minutes
Minutes
Attendees via Zoom: Emily Mello, Rory Robb, Brenda Smith, Ali Vercoe, Debbie Dionne, Beth Morse, Amanda Hodgkins, Carol Snyder, Mark Kemmerle, Maggie Hoffman, Robin Levesque, Joyce Daggett, Staci Converse, Margaret Cardoza, Lily Lin, Betsy Hopkins, Samantha Leuschner, Helen Hemminger, Julie Brennan, Bonnie Robinson, Rachel Dyer, Trena Jackson, Dawn Cedrone, Ed & Suellen Doggett, J Richardson Collins, Mary Chris Semrow, Lillian C, Jodi Benvie, Janet Hamel, David Cowing, Vickey Rand, Cullen Ryan, and a few people who joined the meeting in progress and/or left prior to its conclusion.
Click here for a link to a recording of this meeting
Cullen Ryan introduced himself and welcomed the group. Participants names were read by Cullen to save time. Minutes from the last meeting were accepted.
Featured Speaker: Mark Kemmerle, Executive Director, Maine Developmental Services Oversight and Advisory Board (MDSOAB). mainedsoab.org Topic: MDSOAB Annual Forum – feedback for DHHS, including feedback on the availability, accessibility, and quality of services for persons with intellectual disabilities or autism and their families.
Cullen: Each year the MDSOAB holds community forum(s) to pull people familiar with and/or receiving services together to provide input on how services are working well, how they could be improved, and provide general feedback. Today we have Mark Kemmerle, Executive Director of the MDSOAB. I want to welcome you and thank you for being here. This forum is designed to start a dialogue. This year will very similar the past few years’ MDSOAB annual forums, with a handful of identified questions/prompts on which the group will focus and comment. We want you all have Mark’s contact information ([email protected]) so that you can continue to provide feedback after the meeting as well.
Mark Kemmerle: We’ve been holding annual forums here for about four or five years. Two years ago, we were able to have listening sessions in person in Bangor and Lewiston, which were very well received. We couldn’t do that last year due to COVID. I’m hoping by fall, when people are more comfortable gathering in person, we can get back out and go to the families and the people receiving services and listen and receive feedback about the services they receive. When you look at the feedback received about issues, it’s very similar year-to-year. It’s been a tough year for OADS (the Office of Aging and Disability Services) and for the service providers. OADS has been under a lot of pressure to deal with stopping the spread of the coronavirus and getting thousands of residents and staff vaccinated. And, OADS and the providers have also had much work to do to come into compliance with the new federal Home and Community Based Services (HCBS) Settings Rule. All these efforts required a great deal of work from OADS staff and from all the state’s providers. In light of these challenges, many issues may have gone unaddressed because there just was not capacity to address them given everything else requiring immediate attention. Please respond to the following prompts concerning the performance of both the provider community and DHHS/OADS in the past year and of goals and priorities for the future. The more specific people can be with their feedback and suggestions, the better.
Forum Discussion: The following includes a numbered/bulleted list of initiatives and questions for consideration. The direct feedback generated from attendees follows each prompt, and is italicized, with any responses to questions/comments indented and identified by the speaker, as relevant.
1. What things have gone particularly well and deserve our acknowledgment and thanks? – Provider agencies and OADS did a fine job keeping people safe during the pandemic. It was incredibly difficult for agencies to keep their doors open and continue with business as usual during the pandemic, and they were commended for doing so. The additional funding to increase DSP wages during the pandemic was very helpful. Providers and OADS showed a lot of creativity, flexibility, and innovation extremely quickly. The weekly OADS calls have been extremely helpful for information sharing and transparency, and hopefully they continue even after the pandemic.
2. Have any new issues arisen that have gone unaddressed due to the unusual demands on the system in this past year? – So much time was spent doing damage control that opportunities were lost to help people stay connected, have meaningful relationships, and things to do. Pandemic management mode and keeping people safe and what people couldn’t do hindered focusing on what people could do even amid the pandemic. Life kept going, and opportunities to enrich relationships were put on the back burner at first. Person centered planning (PCP) wasn’t particularly rich due to the pandemic, and it took longer to focus on the possibilities versus just what could not be done. As mental health services are administered through a different MaineCare silo, many people supported through OADS’ disability services social isolation triggered huge mental health challenges. It would have been helpful to have virtual support for folks with a dual diagnosis (ID/DD and mental health). There was a large learning curve for people who were not tech savvy. Having DSPs be more involved in helping the people they support to learn and use the technology would be advantageous. DSPs may not have the expectation that our loved ones can do more than what they think they can – people ought to be encouraged to participate more in the technology aspect. The DSP workforce crisis was heightened during the pandemic, and it was a huge loss. DSPs who stayed in the field deserve a large reward for their tireless efforts and dedication.
Opening the lines of communication with DSPs would be helpful. There are communication barriers for some DSPs, English is the second language of many DSPs – there’s a cultural and a communication gap. A parent stated that she read an article recently about DSPs becoming unionized to provide collective empowerment and protection.
3. Some issues come up year after year at these listening sessions:
The old transition council structure, that mostly went by the wayside except for SMACT (Southern Maine Advisory Council on Transition) was very advantageous. It’s disheartening to realize that twenty years later that parents are still struggling with transition. Virtual information sessions or ways for families to learn how to support someone with ID/DD and mental health challenges, and for direct care workers to learn how to support people with ID/DD and mental health challenges. Everything is very siloed and people with ID/DD and mental health issues suffered during the pandemic because of this. Coping strategies and supports would be helpful. Better exploring the intersectionality of emotions and ID/DD services so the system can support people better would be very advantageous. In general, in terms of mental health the system does not do a good job of really supporting people with complex mental health needs because staff are trained on ID/DD. There’s little information out there about the intersection with the mental health world. A provider stated that they used an online training called Open Future Learning which has a number of modules on mental health topics. This provider also trained some families and paid them under the K waiver. Lack of summer programming and services is problematic, and often requires parents to take the summer off to provide care for their children. The need for staff supervision doubled during the pandemic. The youngest children and their families often go overlooked, but it’s a real problem especially for the youngest age group 0-3 years old.
4. Do you have a specific plan or proposal that - if implemented – would dramatically improve an area of service? – Cross-training staff on mental health. A richer person-centered planning (PCP) process that better connects people with unpaid supports in the community. The HCBS Settings Rule will assist with this, but we need more training and expertise in the system. There is a lack of independent living options for adults with ID/DD. Shared living is a great model that works for many people, but a housing arrangement where someone can live independently with peers in the community would benefit many. The Department ought to establish a full-time permanent HCBS Housing Specialist position so there’s someone looking at housing innovations being done elsewhere and helping to build relationships with affordable housing agencies and other partners throughout the state so these unmet needs for affordable and supportive housing can be addressed. To honor the intent of the HCBS Settings Rule, there needs to be a larger continuum of supportive housing options. We don’t need to cut the menu of current models, but we can increase the options available. There’s a possibility of looking at others in the community as supports. There may be people who want to live with people with ID/DD – college students, interns, etc. This would expand social awareness and knowledge of the needs of people with ID/DD as well as help to defer cost of living for these people in exchange for natural support services.
5. I believe almost everyone would agree that the biggest issue in service delivery in the past year has been the shortage of qualified direct care workers. Any specific suggestions on recruitment and retention of direct support professionals would be appreciated. – Develop additional strategies to build being a DSP as a profession – helping to repay student loans, paying for ongoing education, etc. to motivate people to get into the field and to stay and grow as professionals. Supporting education in the various ways possible is a long-term investment in professionalizing and increasing the respect for this line of work. Robust self-directed services would improve workforce capacity in a creative way. DSPs sharing interests with waiver participants, neighbors who have strong relationships with waiver participants, etc., there may be a non-traditional member of the workforce that would be perfectly matched for waiver participants. Self-directed services really allow us to grow the workforce and grow options for more meaningful lives. With robust self-directed services, you wouldn’t have to recruit for staff online where people often don’t read the job descriptions – that often include those very specific things that members like to do such as knitting etc., which then affects the quality of services. You could recruit for DSPs at the local churches, knitting circles, book clubs, etc., the places and activities in the community in which members want to actively participate. Natural supports are hard to come by and they are very unique – so having the Department and the system rely upon them is challenging. The idea of self-directed services, for individuals to go out and seek people to specifically provide the services for which they’re looking is a creative one. Natural supports can happen, but they change the job of a DSP with which we haven’t done very well. Such as DSPs needing to work an evening shift or two to adapt to the activities in which people want to participate. How do I help them participate in events that are outside of regular business hours and cultivate relationships with people there and slowly back off? This is what’s required of a DSP when building natural supports. It’s doable, but it can be difficult, and it must be purposeful. HCBS Settings Rule requires this type of service delivery. However, with the current workforce crisis agencies don’t have the capacity to do so. Addressing the workforce crisis is paramount, as well as addressing the lack of affordable housing options. We need the structures in place to truly make this happen for everyone.
Cullen: We will be sure that all of feedback provided today is incorporated into the minutes and given to Mark for the MDSOAB. If people have additional feedback on how things are working and how things could be improved please email Mark ([email protected]). Thank you, Mark, for being here today!
End Presentation (round of applause would have occurred were it not for everyone being muted and on Zoom)
DHHS – Office of Aging and Disability Services (OADS) - www.maine.gov/dhhs/oads
Betsy Hopkins – Associate Director, DHHS-OADS Disability Services: DHHS has entered into a final Settlement Agreement as a result of a 2018 complaint filed with the Department of Justice and the resulting investigation under Title II of the Americans with Disabilities Act (ADA). In February 2020, a findings letter was issued to the Department concluding that the Department was violating Title II of the ADA. Per the agreement, the Department has agreed to seek approval from CMS (Centers for Medicare and Medicaid Services) to amend the Section 21 Waiver to establish an exceptions process authorizing Section 21 Members, and people applying for Section 21, to seek, and the Department to authorize, services in excess of otherwise-applicable Section 21 Waiver monetary and/or unit caps where necessary to ensure members receive adequate and appropriate services and supports in the most integrated setting appropriate to their needs. The Department has 270 days from the date of the Agreement to submit the Waiver Amendment application to CMS, and 270 days after CMS approval to adopt rules establishing the exceptions process. The agreement also states that the Department will adopt a rule to require that the services members receive under Section 21, and the settings in which they are received/delivered, will be determined by the member’s needs, to be identified through an assessment of functional need and preferences verse through provider preference. The Department has one year from the date of the Agreement to make the modifications necessary to implement this aspect. Further details can be found in the Agreement itself (Click here for the Settlement Agreement). I will be able to share more information at the next meeting.
We’ve held some listening sessions soliciting feedback about the additional federal funding coming into Maine with the increase in FMAP (Federal Medicaid Assistance Percentage for federal Medicaid match funds). We’ve tried to include as many suggestions as possible. A blog about the Department’s initial plans for FMAP funds is on our website (click here). There will be a listening session on Tuesday, 6/15 from 12-1:00pm for which anyone can sign up to learn more about this. To RSVP and receive the link for the event, please email [email protected].
In order to do some of the work we want to do moving ahead, we need to have a standardized needs assessment, to help us understand everyone’s individual needs, so we can have services and supports that match. OADS is holding a Needs Assessment Project “Kick-Off” Meeting for Stakeholders on Thursday, 6/17 from 1-2:00pm via Zoom. We are formally beginning the “Standardized Needs Assessment Implementation Project” – an important initiative for all ID/DD HCBS waiver members, their families, advocates, and service providers. Come learn more about our plan for this work, and how we will be soliciting and using ongoing stakeholder input (click here for more information including the Zoom meeting link). The meeting will be recorded, and materials posted on our website. We’ve already received feedback regarding this and have looked at the similar processes undertaken in the past to avoid the same pitfalls that were experienced previously.
-It was asked if the deadline was extended for the state FMAP plans.
Betsy: Yes, it was extended by a month, but we’re trying to get the plan in sooner rather than later. Initial proposals will be submitted to CMS. Then, we’ll have an opportunity each quarter to implement new projects. We’re trying to get the high-level, most pressing needs addressed in the initial proposal. We hope to have the initial plan submitted within the next week or so.
Cullen: The increase in FMAP funds is a big deal, as Maine’s money goes much further in terms of helping people. How long will this increased match last?
Betsy: We have until March 2024 to expend all of the funds. That’s really exciting, that we can do some meaningful, thought-out projects using these funds rather than rushing everything to get the funds used.
Cullen: Thank you very much, Betsy, for all of this information and for being here!
DHHS – Office of Child and Family Services (OCFS) - www.maine.gov/dhhs/ocfs
Teresa Barrows: As far as transition to adulthood, we have engaged in the beginning of an internal process with Betsy and her team to develop a protocol to better streamline the transition of services between OCFS and OADS. We’re very excited about this and that’s where our focus will be for the next few months. We continue to see a lot of children and families struggling, including emergency department usage. We’re still seeing a lot of staffing shortages and residential programs close. We also are working with the rest of the Department regarding the FMAP funds to better our system, considering the feedback of stakeholders.
Cullen: I’m glad OCFS is looking at the Blueprint for Effective Transition and using it as it’s blueprint for its Transition Age Youth Roadmap. I hope that people carefully review the Blueprint and think through each of the areas, as there is a lot of really great information.
Cullen: Thank you for being here today, Teresa and Amanda!
Special Education – No update
SMACT (Southern Maine Advisory Council on Transition)
Nancy Peavy was unable to attend today’s meeting. The SMACT website and the Coalition website are cross-linked for convenience and information-sharing. As a reminder, if you want to be on the email list feel free to email Nancy ([email protected]). The next meeting is in the fall on 10/1.
Disability Rights Maine (DRM) Update:
Staci Converse: I wanted to highlight some of the case work we’ve been doing lately. We’ve talked a lot in these meetings about supported decision-making (SDM) and we’ve been working on the ground to see this actualized for people. In the past few weeks, we have transitioned full guardianship to SDM for three people. Related to the Settlement Agreement Betsy mentioned, I wanted to highlight that DHHS already has a process through which people can request additional services based on their situation – the reasonable modification process. We have had a number of successes with this that have just been finalized in the past few weeks. We had a number of cases where people had been getting a lot of nursing services as child, only to have their nursing services reduced when transitioning to adult services because of the cap. For these cases we filed the reasonable modification requests and were successful in getting additional services for these individuals.
Cullen: Thank you for this information, Staci!
Federal & Housing Updates:
Cullen:
State Legislature Update:
Cullen:
Update from Laura Cordes - MACSP (Maine Association for Community Service Providers):
Status updates on bills of interest:
Announcements:
The next meeting will be on Monday, August 9, 2021, 12-2pm, via Zoom.
Please note there will not be a meeting in July.
Featured Speaker: Helen Hemminger, Research and KIDS COUNT Associate, Maine Children’s Alliance.
Topic: 2021 Maine KIDS COUNT Data Book.
Unless changed, Coalition meetings are on the 2nd Monday of the month from 12-2pm.
(in 2021 the October meeting will be the 3rd Monday due to the holiday)
The Maine Coalition for Housing and Quality Services provides equal opportunity for meeting participation. If you wish to attend but require an interpreter or other accommodation, please forward your request two weeks prior to the monthly meeting to [email protected].
Click here for a link to a recording of this meeting
Cullen Ryan introduced himself and welcomed the group. Participants names were read by Cullen to save time. Minutes from the last meeting were accepted.
Featured Speaker: Mark Kemmerle, Executive Director, Maine Developmental Services Oversight and Advisory Board (MDSOAB). mainedsoab.org Topic: MDSOAB Annual Forum – feedback for DHHS, including feedback on the availability, accessibility, and quality of services for persons with intellectual disabilities or autism and their families.
Cullen: Each year the MDSOAB holds community forum(s) to pull people familiar with and/or receiving services together to provide input on how services are working well, how they could be improved, and provide general feedback. Today we have Mark Kemmerle, Executive Director of the MDSOAB. I want to welcome you and thank you for being here. This forum is designed to start a dialogue. This year will very similar the past few years’ MDSOAB annual forums, with a handful of identified questions/prompts on which the group will focus and comment. We want you all have Mark’s contact information ([email protected]) so that you can continue to provide feedback after the meeting as well.
Mark Kemmerle: We’ve been holding annual forums here for about four or five years. Two years ago, we were able to have listening sessions in person in Bangor and Lewiston, which were very well received. We couldn’t do that last year due to COVID. I’m hoping by fall, when people are more comfortable gathering in person, we can get back out and go to the families and the people receiving services and listen and receive feedback about the services they receive. When you look at the feedback received about issues, it’s very similar year-to-year. It’s been a tough year for OADS (the Office of Aging and Disability Services) and for the service providers. OADS has been under a lot of pressure to deal with stopping the spread of the coronavirus and getting thousands of residents and staff vaccinated. And, OADS and the providers have also had much work to do to come into compliance with the new federal Home and Community Based Services (HCBS) Settings Rule. All these efforts required a great deal of work from OADS staff and from all the state’s providers. In light of these challenges, many issues may have gone unaddressed because there just was not capacity to address them given everything else requiring immediate attention. Please respond to the following prompts concerning the performance of both the provider community and DHHS/OADS in the past year and of goals and priorities for the future. The more specific people can be with their feedback and suggestions, the better.
Forum Discussion: The following includes a numbered/bulleted list of initiatives and questions for consideration. The direct feedback generated from attendees follows each prompt, and is italicized, with any responses to questions/comments indented and identified by the speaker, as relevant.
1. What things have gone particularly well and deserve our acknowledgment and thanks? – Provider agencies and OADS did a fine job keeping people safe during the pandemic. It was incredibly difficult for agencies to keep their doors open and continue with business as usual during the pandemic, and they were commended for doing so. The additional funding to increase DSP wages during the pandemic was very helpful. Providers and OADS showed a lot of creativity, flexibility, and innovation extremely quickly. The weekly OADS calls have been extremely helpful for information sharing and transparency, and hopefully they continue even after the pandemic.
2. Have any new issues arisen that have gone unaddressed due to the unusual demands on the system in this past year? – So much time was spent doing damage control that opportunities were lost to help people stay connected, have meaningful relationships, and things to do. Pandemic management mode and keeping people safe and what people couldn’t do hindered focusing on what people could do even amid the pandemic. Life kept going, and opportunities to enrich relationships were put on the back burner at first. Person centered planning (PCP) wasn’t particularly rich due to the pandemic, and it took longer to focus on the possibilities versus just what could not be done. As mental health services are administered through a different MaineCare silo, many people supported through OADS’ disability services social isolation triggered huge mental health challenges. It would have been helpful to have virtual support for folks with a dual diagnosis (ID/DD and mental health). There was a large learning curve for people who were not tech savvy. Having DSPs be more involved in helping the people they support to learn and use the technology would be advantageous. DSPs may not have the expectation that our loved ones can do more than what they think they can – people ought to be encouraged to participate more in the technology aspect. The DSP workforce crisis was heightened during the pandemic, and it was a huge loss. DSPs who stayed in the field deserve a large reward for their tireless efforts and dedication.
- Mark: In speaking with Paul Saucier and Betsy Hopkins, they’re very interested in reaching out to DSPs and determine why people make it a career choice. What is the appeal? OADS would like to understand the profile of someone who would consider a career as a direct care worker.
Opening the lines of communication with DSPs would be helpful. There are communication barriers for some DSPs, English is the second language of many DSPs – there’s a cultural and a communication gap. A parent stated that she read an article recently about DSPs becoming unionized to provide collective empowerment and protection.
3. Some issues come up year after year at these listening sessions:
- Stabilizing the work force
- Transportation
- Crisis services
- Transition from child services to adult services
- Communication
- Navigating the system
- Which of these areas of concern should be addressed IMMEDIATELY as the Department has breathing room? Where would you allocate resources? – For Maine Parent Federation, transition is their number one priority. Parents don’t know where to get information on transition, as well as guardianship and supported decision-making. They also receive a lot of calls and questions about the waiver waitlists. More information dissemination regarding transition would be advantageous.
The old transition council structure, that mostly went by the wayside except for SMACT (Southern Maine Advisory Council on Transition) was very advantageous. It’s disheartening to realize that twenty years later that parents are still struggling with transition. Virtual information sessions or ways for families to learn how to support someone with ID/DD and mental health challenges, and for direct care workers to learn how to support people with ID/DD and mental health challenges. Everything is very siloed and people with ID/DD and mental health issues suffered during the pandemic because of this. Coping strategies and supports would be helpful. Better exploring the intersectionality of emotions and ID/DD services so the system can support people better would be very advantageous. In general, in terms of mental health the system does not do a good job of really supporting people with complex mental health needs because staff are trained on ID/DD. There’s little information out there about the intersection with the mental health world. A provider stated that they used an online training called Open Future Learning which has a number of modules on mental health topics. This provider also trained some families and paid them under the K waiver. Lack of summer programming and services is problematic, and often requires parents to take the summer off to provide care for their children. The need for staff supervision doubled during the pandemic. The youngest children and their families often go overlooked, but it’s a real problem especially for the youngest age group 0-3 years old.
4. Do you have a specific plan or proposal that - if implemented – would dramatically improve an area of service? – Cross-training staff on mental health. A richer person-centered planning (PCP) process that better connects people with unpaid supports in the community. The HCBS Settings Rule will assist with this, but we need more training and expertise in the system. There is a lack of independent living options for adults with ID/DD. Shared living is a great model that works for many people, but a housing arrangement where someone can live independently with peers in the community would benefit many. The Department ought to establish a full-time permanent HCBS Housing Specialist position so there’s someone looking at housing innovations being done elsewhere and helping to build relationships with affordable housing agencies and other partners throughout the state so these unmet needs for affordable and supportive housing can be addressed. To honor the intent of the HCBS Settings Rule, there needs to be a larger continuum of supportive housing options. We don’t need to cut the menu of current models, but we can increase the options available. There’s a possibility of looking at others in the community as supports. There may be people who want to live with people with ID/DD – college students, interns, etc. This would expand social awareness and knowledge of the needs of people with ID/DD as well as help to defer cost of living for these people in exchange for natural support services.
5. I believe almost everyone would agree that the biggest issue in service delivery in the past year has been the shortage of qualified direct care workers. Any specific suggestions on recruitment and retention of direct support professionals would be appreciated. – Develop additional strategies to build being a DSP as a profession – helping to repay student loans, paying for ongoing education, etc. to motivate people to get into the field and to stay and grow as professionals. Supporting education in the various ways possible is a long-term investment in professionalizing and increasing the respect for this line of work. Robust self-directed services would improve workforce capacity in a creative way. DSPs sharing interests with waiver participants, neighbors who have strong relationships with waiver participants, etc., there may be a non-traditional member of the workforce that would be perfectly matched for waiver participants. Self-directed services really allow us to grow the workforce and grow options for more meaningful lives. With robust self-directed services, you wouldn’t have to recruit for staff online where people often don’t read the job descriptions – that often include those very specific things that members like to do such as knitting etc., which then affects the quality of services. You could recruit for DSPs at the local churches, knitting circles, book clubs, etc., the places and activities in the community in which members want to actively participate. Natural supports are hard to come by and they are very unique – so having the Department and the system rely upon them is challenging. The idea of self-directed services, for individuals to go out and seek people to specifically provide the services for which they’re looking is a creative one. Natural supports can happen, but they change the job of a DSP with which we haven’t done very well. Such as DSPs needing to work an evening shift or two to adapt to the activities in which people want to participate. How do I help them participate in events that are outside of regular business hours and cultivate relationships with people there and slowly back off? This is what’s required of a DSP when building natural supports. It’s doable, but it can be difficult, and it must be purposeful. HCBS Settings Rule requires this type of service delivery. However, with the current workforce crisis agencies don’t have the capacity to do so. Addressing the workforce crisis is paramount, as well as addressing the lack of affordable housing options. We need the structures in place to truly make this happen for everyone.
Cullen: We will be sure that all of feedback provided today is incorporated into the minutes and given to Mark for the MDSOAB. If people have additional feedback on how things are working and how things could be improved please email Mark ([email protected]). Thank you, Mark, for being here today!
End Presentation (round of applause would have occurred were it not for everyone being muted and on Zoom)
DHHS – Office of Aging and Disability Services (OADS) - www.maine.gov/dhhs/oads
Betsy Hopkins – Associate Director, DHHS-OADS Disability Services: DHHS has entered into a final Settlement Agreement as a result of a 2018 complaint filed with the Department of Justice and the resulting investigation under Title II of the Americans with Disabilities Act (ADA). In February 2020, a findings letter was issued to the Department concluding that the Department was violating Title II of the ADA. Per the agreement, the Department has agreed to seek approval from CMS (Centers for Medicare and Medicaid Services) to amend the Section 21 Waiver to establish an exceptions process authorizing Section 21 Members, and people applying for Section 21, to seek, and the Department to authorize, services in excess of otherwise-applicable Section 21 Waiver monetary and/or unit caps where necessary to ensure members receive adequate and appropriate services and supports in the most integrated setting appropriate to their needs. The Department has 270 days from the date of the Agreement to submit the Waiver Amendment application to CMS, and 270 days after CMS approval to adopt rules establishing the exceptions process. The agreement also states that the Department will adopt a rule to require that the services members receive under Section 21, and the settings in which they are received/delivered, will be determined by the member’s needs, to be identified through an assessment of functional need and preferences verse through provider preference. The Department has one year from the date of the Agreement to make the modifications necessary to implement this aspect. Further details can be found in the Agreement itself (Click here for the Settlement Agreement). I will be able to share more information at the next meeting.
We’ve held some listening sessions soliciting feedback about the additional federal funding coming into Maine with the increase in FMAP (Federal Medicaid Assistance Percentage for federal Medicaid match funds). We’ve tried to include as many suggestions as possible. A blog about the Department’s initial plans for FMAP funds is on our website (click here). There will be a listening session on Tuesday, 6/15 from 12-1:00pm for which anyone can sign up to learn more about this. To RSVP and receive the link for the event, please email [email protected].
In order to do some of the work we want to do moving ahead, we need to have a standardized needs assessment, to help us understand everyone’s individual needs, so we can have services and supports that match. OADS is holding a Needs Assessment Project “Kick-Off” Meeting for Stakeholders on Thursday, 6/17 from 1-2:00pm via Zoom. We are formally beginning the “Standardized Needs Assessment Implementation Project” – an important initiative for all ID/DD HCBS waiver members, their families, advocates, and service providers. Come learn more about our plan for this work, and how we will be soliciting and using ongoing stakeholder input (click here for more information including the Zoom meeting link). The meeting will be recorded, and materials posted on our website. We’ve already received feedback regarding this and have looked at the similar processes undertaken in the past to avoid the same pitfalls that were experienced previously.
-It was asked if the deadline was extended for the state FMAP plans.
Betsy: Yes, it was extended by a month, but we’re trying to get the plan in sooner rather than later. Initial proposals will be submitted to CMS. Then, we’ll have an opportunity each quarter to implement new projects. We’re trying to get the high-level, most pressing needs addressed in the initial proposal. We hope to have the initial plan submitted within the next week or so.
Cullen: The increase in FMAP funds is a big deal, as Maine’s money goes much further in terms of helping people. How long will this increased match last?
Betsy: We have until March 2024 to expend all of the funds. That’s really exciting, that we can do some meaningful, thought-out projects using these funds rather than rushing everything to get the funds used.
Cullen: Thank you very much, Betsy, for all of this information and for being here!
DHHS – Office of Child and Family Services (OCFS) - www.maine.gov/dhhs/ocfs
Teresa Barrows: As far as transition to adulthood, we have engaged in the beginning of an internal process with Betsy and her team to develop a protocol to better streamline the transition of services between OCFS and OADS. We’re very excited about this and that’s where our focus will be for the next few months. We continue to see a lot of children and families struggling, including emergency department usage. We’re still seeing a lot of staffing shortages and residential programs close. We also are working with the rest of the Department regarding the FMAP funds to better our system, considering the feedback of stakeholders.
Cullen: I’m glad OCFS is looking at the Blueprint for Effective Transition and using it as it’s blueprint for its Transition Age Youth Roadmap. I hope that people carefully review the Blueprint and think through each of the areas, as there is a lot of really great information.
Cullen: Thank you for being here today, Teresa and Amanda!
Special Education – No update
SMACT (Southern Maine Advisory Council on Transition)
Nancy Peavy was unable to attend today’s meeting. The SMACT website and the Coalition website are cross-linked for convenience and information-sharing. As a reminder, if you want to be on the email list feel free to email Nancy ([email protected]). The next meeting is in the fall on 10/1.
Disability Rights Maine (DRM) Update:
Staci Converse: I wanted to highlight some of the case work we’ve been doing lately. We’ve talked a lot in these meetings about supported decision-making (SDM) and we’ve been working on the ground to see this actualized for people. In the past few weeks, we have transitioned full guardianship to SDM for three people. Related to the Settlement Agreement Betsy mentioned, I wanted to highlight that DHHS already has a process through which people can request additional services based on their situation – the reasonable modification process. We have had a number of successes with this that have just been finalized in the past few weeks. We had a number of cases where people had been getting a lot of nursing services as child, only to have their nursing services reduced when transitioning to adult services because of the cap. For these cases we filed the reasonable modification requests and were successful in getting additional services for these individuals.
Cullen: Thank you for this information, Staci!
Federal & Housing Updates:
Cullen:
- On 5/28 President Biden released his $6 trillion budget request for FY 22 budget Per the NLIHC: The $6 trillion budget proposes $9 billion in additional funding for HUD, a 15% increase over FY21. The funds would provide substantial federal investment in affordable homes and increase the availability of housing assistance to families with the greatest need. Overall, the budget request calls for expanding rental assistance through the Tenant Based Rental Assistance program to 200,000 additional households, focusing on those experiencing homelessness and survivors escaping domestic violence, dating violence, sexual assault, stalking, or human trafficking. If enacted, this provision would be the single largest expansion of vouchers in the program’s history. The FY22 budget is the first annual spending bill in a decade that is not limited by the low spending caps required by the Budget Control Act that have prevented Congress from investing in affordable housing at the scale necessary.
- On 3/31, President Biden released details on his “American Jobs Plan,” an approximately $2 trillion infrastructure and recovery package. This package includes $213 billion to produce, preserve, and retrofit more than two million affordable and sustainable places to live, through grants, formula funding, targeted tax credits, and project-based rental assistance. It is very evident that the Administration is very dedicated to increasing the supply of affordable housing, which as many of you know is sorely lacking in Maine and across the country. Though the Administration has shown its dedication to housing as infrastructure, much work remains to convince others in Congress of this.
- Negotiations on an infrastructure package between the President and Senator Shelley Moore Capito ended on 6/8 with both agreeing that, despite weeks of good-faith effort, the two sides were too far apart to find a compromise. Now, bipartisan groups of senators and representatives have stepped in to reach an alternative deal. On 6/10, a bipartisan group of ten senators released an outline of a $1.2 trillion proposal that includes $579 billion in new spending. None of the new proposals under consideration include the major investments in affordable, accessible housing needed for millions of households with the lowest incomes.
- President Biden released details on his “American Families Plan,” a $1.8 trillion companion bill to the $2.5 trillion American Jobs Plan. The American Families Plan would invest in education, childcare, and paid leave, among other priorities. The proposal calls for making community college free, expanding Pell grants for students, investing in universal preschool, expanding nutrition assistance for children, providing paid family and medical leave, permanently extending enhancements to the childcare tax credit, earned income tax credit, and Affordable Care Act, and keeping the expanded child tax credit though 2025.
- There are various efforts in Congress to increase the National Housing Trust Fund, which funds the development of housing for people with very low incomes and is the primary funding mechanism for permanent supportive housing in Maine.
State Legislature Update:
Cullen:
- An Act To Provide Allocations for the Distribution of State Fiscal Recovery Funds – The Governor’s proposal includes one-time funding to expand housing options that are affordable to workers and their families to own or rent, through existing financing programs through MaineHousing, as well as new incentives in partnership with DECD, and utilizing input from stakeholders, municipalities, and community providers. These funds may also be used to provide planning and technical assistance for communities, developers, and builders to encourage construction or production of affordable, energy efficient housing units close to services and employment centers to support individuals, families, and state workforce needs. Proposed funding for housing development: SFY 22: $10 million; SFY 23: $40 million)
- Governor’s Change Package – FY 22 & FY 23 Supplemental Budget –The Governor released her Part Two Budget Proposal on 5/12. The proposal is being considered as a “change package” that builds on the Governor’s original proposal for the FY 2022-2023 biennium. The Legislature is currently working through public hearings and work sessions on the budget. If approved, it would become the supplemental budget for FY 2022-2023. Taken in combination with the current services budget enacted earlier this year, the Governor’s proposals for FY 2022-2023 would result in a $8.77 billion budget for the biennium. The “Part 2” budget complements the Governor’s Maine Jobs & Recovery Plan, her Administration’s proposal for the use of American Rescue Plan Act funding, and her recently released bond proposal.
Update from Laura Cordes - MACSP (Maine Association for Community Service Providers):
- The Legislature may adjourn at the end of the day Wednesday, 6/16, and reconvene to complete the budget at the end of the month.
- We are deeply appreciative of the Department and their announcement to use ARPA funds for essential support worker bonuses but feel strongly that we need rates above minimum wage to support individuals and their families and that LD1573 is still critically needed to stabilize the workforce and services.
Status updates on bills of interest:
- LD 1573 – This bill was amended and became an omnibus rate bill. The Health & Human Services Committee (HHS) Committee members took all of the rate bills and put them into one. The details aren’t out yet, but it passed unanimously in Committee and provides an across the board rate increase to 125% of minimum wage. This looks comprehensively at the workforce issues in Maine, to get the workforce up and beyond minimum wage. However, the Committee decided not to support an oversight committee to work with DHHS and DOL to take the bipartisan Long-Term Care Workforce Commission recommendations and work on them long-term. The compromise is that the Department will report to the Legislature each year. Current status: Committee voted Ought to Pass As Amended (OTP-AM)
- LD 1204 – This bill allows for the reimbursement of a parent providing in-home personal care services to the parent's child by allowing the parent to register as a personal care agency if the parent has made reasonable efforts to obtain regular in-home personal care services and has passed a background check. The bill was amended to make it an emergency bill, and a fiscal note: Funding from the General Fund of $55,612 in FY 22, and $111,224 in FY 23 (and funding from the Federal Expenditures Fund of $99,122 in FY 22, and $198,243 in FY 23). Current status: Passed to be enacted in the House and Senate, and on the Special Appropriations Table pending Passage to be Enacted.
- LD 1360 – Similar to what happened with LD 1573, this bill was amended and became an omnibus waitlist bill. Current status: Passed to be enacted in the House and Senate, and on the Special Appropriations Table pending Passage to be Enacted.
- LD 415 – This is the bill that increases the rates for Targeted Case Management. The bill passed unanimously out of Committee. Those rates haven’t been touched in well more than a decade, so this is welcome news. Current status: Passed to be enacted in the House and Senate, and on the Special Appropriations Table pending Passage to be Enacted.
- LD 854 – This is the bill that would carve out preschool-aged children with ID/DD pertaining to the Department promulgating rules related to school-based services Section 28 and 65). You may remember that the Department had release, then pull the Section 106 rule. They are looking at the rule and looking to reintroduce it, combining Section 65 and Section 28. This bill would ensure that any changes to services for 3-5-year-olds would be considered major substantive, meaning it would go before the Legislature and have a public hearing. The bill also requires the Department to create a workgroup to participate in this rulemaking. Current status: Passed to be enacted in the House and Senate with the 2/3’s required for an emergency bill. The bill now goes for the Governor’s signature.
- LD 1373 – This is the bill that would restrict seclusion and restraint in schools. The entire bill was amended and replaced by the sponsor. The amendment says that any kind of seclusion in schools is prohibited. The bill would not prohibit all restraint, just more severe restraint. Maine is out of step with other states regarding seclusion, and hopefully will be remedied with this bill. Current status: Divided report out of Committee OTP-AM/ONTP.
- LD 1574 – This is the bill which asks the Department to consider in the rates people with high behavioral needs. Current status: Carry Over Requested by Committee and approved.
Announcements:
- Maine Children's Alliance is seeking a project coordinator and two stipended Parent Leaders for two related new grant funded projects. Click here for more information.
- Click here for information on Specialized Housing Inc.’s Virtual Info Session on the Houses on E Street
The next meeting will be on Monday, August 9, 2021, 12-2pm, via Zoom.
Please note there will not be a meeting in July.
Featured Speaker: Helen Hemminger, Research and KIDS COUNT Associate, Maine Children’s Alliance.
Topic: 2021 Maine KIDS COUNT Data Book.
Unless changed, Coalition meetings are on the 2nd Monday of the month from 12-2pm.
(in 2021 the October meeting will be the 3rd Monday due to the holiday)
The Maine Coalition for Housing and Quality Services provides equal opportunity for meeting participation. If you wish to attend but require an interpreter or other accommodation, please forward your request two weeks prior to the monthly meeting to [email protected].