September 13, 2021
Minutes
Minutes
Attendees via Zoom: Alexandria Twombly, Andy Taranko, Beth Morse, Betsy Hopkins, Bonnie Robinson, Carol Snyder, Craig Patterson, Heidi Mansir, Jamie Whitehouse, LyAnn Grogan, Laura Cordes, Lorraine DeFreitas, Julie Brennan, Maria Cameron, Mary Chris Semrow, Megan Salvin, Robin Levesque, Todd Goodwin, Trena Jackson, Helen Hemminger, Brenda Smith, Amy Moller, Jen Jello, Tammy Pike, Amanda Hodgkins, Andrew Cassidy, Libby Stone-Sterling, Mark Kemmerle, Beth Mylroie, Chris, Kim Humphrey, Rachel Dyer, Stacy Lamontagne, Joyce Dagget, Annmarie Mayberry, 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. Minutes from the last meeting were accepted. Participants introduced themselves.
Featured Speaker: Laura Cordes, Executive Director, Maine Association for Community Service Providers (MACSP). meacsp.org Topic: Results of the First Session of Maine’s 130th Legislature.
Cullen: Today we have Laura Cordes, Executive Director of MACSP (Maine Association for Community Service Providers) giving a presentation on the results of the First Session of Maine’s 130th Legislature. It was an intense legislative session to say the least, and Laura was in the thick of it. There was a large group of legislators that really wanted to do something significant about changing the status quo, specifically around housing and services. It was quite busy with a lot of folks wanting to make positive changes. That left us sorting things out from various directions. Laura worked determinedly throughout the legislative session advocating for the resources needed to optimize Maine’s system of care for people with ID/DD in Maine. Thank you, Laura, for all you’ve done, and for being here today!
Laura Cordes: The session was intense for many reasons, but it was also really remarkable. A year ago, at this time we didn’t have high COVID rates, but as we got into the fall and into the Legislative Session, we are seeing COVID rates increase. With everything going on at the Federal level and the presidential election, there were many question marks for the future. There were concerns about resources coming into the state, a weakened economy, that there wouldn’t be help on the way, etc. It’s remarkable to think back to where we were at the start of the Legislative Session. We had a heightened sense of all the problems and crises we’d all been challenged with for years, made more visible by the pandemic. We also had the unique opportunity, with the federal resources and legislators willing to think creatively, to do something about it.
Begin presentation (Click here for the presentation):
Laura reviewed three budgets that passed the Legislature and became Public Law. Please see the presentation for more information.
Laura reviewed bills that passed the Legislature and became Public Law. Please see the presentation for more information, including bill titles. These bills include:
Cullen: A bill that become Public Law that we briefly covered in last month’s meeting is LD 1733 – An Act to Provide Allocations for the Distribution of State Fiscal recovery Funds. This is the bill that addressed the federal recovery funding that Maine is receiving through the American Rescue Plan Act (ARPA). Some of the bills that were sitting on the Special Appropriations Table awaiting funding were essentially supported with funding as part of this bill. It did not receive 2/3’s vote so it will become effective 90 days after adjournment sine die, which is Monday, 10/18/21. The final bill can be found here and includes:
Laura: It’s really remarkable what we were able to achieve in the last session. Now it’s time to gear up for the next session, which per Statute begins the first Wednesday after the first Tuesday of January (1/12/22) and concludes the third Wednesday in April (4/20/22). Cloture is very early this year, perhaps because they have such a long list of carry-over bills. Cloture occurs very early this year, on 9/24. This is when legislators must have bill titles submitted for leadership to consider for the legislative session. legislative leadership will go through a process this fall by which they decide which of the proposed bills can move forward for consideration. There are a number of bills that have been carried over that will require our advocacy. Reaching out to members of the HHS (Health and Human Services) Committee or the AFA (Appropriations and Financial Affairs) Committee cannot happen soon enough, as time will go by quickly and much work remains.
Discussion:
-A parent asked if there are any bills that address rates for MaineCare nursing. She stated that her daughter has been approved to have a nurse come into the home to assist with medication management. This funding has been approved for two years, but her daughter’s case manager has not been able to find a nurse due to the low MaineCare rates for this service.
Laura: There is a staff shortage across all services and sectors, and that includes nursing as well. If you knew the particular service, I might be able to comment in more detail. I don’t know of a particular MaineCare nursing rate, but I do know of it under particular services. I’m happy to follow up with you after the meeting.
-A provider stated that if you’re working with EIM (Elder Independence of Maine) it’s likely Section 19. Nursing also falls under Section 96, which can work concurrently with Sections 21 and 29. There are some pretty specific agencies that provide Section 19 services, and it’s a little different from the Section 21, 29, 28, and 65 services. A provider stated that they have someone looking for this service as well who has also not had luck finding anything. Some agencies are also having difficulty with the health home model, but the lack of available nurses also affects the ability to provide that service. It was stated that the critical case units might have data on this need.
-After the meeting, the following information was shared that might be helpful: While she is awaiting services, if the individual she is supporting has some type of acute medical need, such as a wound, pressure sore or infection, she may qualify for short-term visiting nurses. In order to obtain this, she could get a referral from the primary care doctor. There are a number of companies, depending on where she resides, like Northern Light, that could more quickly provide temporary relief if there are acute medical needs. Many family caregivers are not aware of this service, and it could make a difference to those that are struggling during the staffing shortage or who are awaiting care.
Cullen: The workforce crisis seems to be paramount, and it’s affecting every single sector from nursing to direct care. Agencies are having difficulty attracting employees throughout the entire service sector. This workforce crisis is acute in Maine due to its aging population, and the pandemic has notably worsened the crisis. The ability to pay a professional wage has hindered this as well. My son would like to have the support to go out into the community, but the agency he works with hasn’t been able to hire staff.
Betsy Hopkins – DHHS/OADS: Most of the folks here don’t oversee Section 19 services, but I can certainly put that question to DHHS staff to provide more information for you. You can also email me: [email protected].
-It was stated that there is also a staff shortage for the younger population. It was asked who determines what that hourly rate is for staffing, and whether or not it ties directly to state allocated funds that are distributed to agencies. She added that providing an income that’s sustainable for direct service providers (DSPs) is paramount.
Laura: Maine is very similar to other states. Before the pandemic we faced a workforce crisis across the board. It has only worsened amid the pandemic. Advocates secured a 10% FMAP increase (the federal reimbursement rate) for adult HCBS through the American Rescue Plan Act (ARPA). This will provide a significant increase to the funding that Maine receives for its adult HCBS. The State sets the rates, which are fixed and have many different components. To its credit, the Department has realized that historically the rates have been set inconsistently. And the state is going through a rate system evaluation reform plan. Having the FMAP dollars is significant in the state, as is the rate increase to 125% of minimum wage. There is an effort at the federal level to have $400 million towards HCBS for the next three years. The House and the Senate’s proposals are not in sync, and neither match the $400 million that’s needed. Advocating for this funding is something that we all could do to better the system. More information to follow on this and be on the lookout for an Action Alert from MACSP on how you contact Maine’s Delegation to advocate for this critical funding.
Betsy: There is a rate study that’s completed on all of the services. The State contracts with an outside entity to complete the study. Part of that study will be based on feedback received from providers. I’m not sure when these studies are disseminated. We can’t do rate studies all at once as it’s too large of a task, so the work is being done in parts. The rates that are being increased in January will be 125% of minimum wage.
Laura: And the minimum wage goes up every January. Currently we’re at $12.15 for minimum wage; 125% of that the wage component would be about $15.19.
-It was stated that in order to have conversations with legislators or Maine’s Delegation it would be advantageous to have more information about the exact dollar figures.
Cullen: It’s important to reach out to your representatives, with information as well as your stories – how the workforce crisis is affecting you and your family and the person you care about. This helps them understand the emergency you’re facing and the pathway to correcting the problems. This is the best time of the year to connect with members of the Legislature. They will be putting in bill titles between now and 9/24, so it’s an ideal time to talk to them about that. But it’s also the perfect time to reach out to your representatives, tell your story, and detail what is needed to address your family’s needs.
Cullen: Thank you very much for this presentation, Laura, it was extremely informative. Well done! And I want to thank all of you for your tireless advocacy throughout the Legislative Session. Thank you all!
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: The main thing I wanted to mention is that we’ve gone to monthly stakeholder meetings. The September meeting is tomorrow, 9/14 from 3:00-4:30pm (it has been extended by a half an hour). The focus of this next stakeholder meeting will be to exchange ideas and to provide information and resources that may support staff recruitment and retention efforts. (Click here to join the OADS Stakeholders Zoom Meeting, Meeting ID: 955 532 303 Password: a1234567).
The FMAP spending plan in on the OADS website (click here for the plan). About $125 million of those dollars are going to workforce stabilization issues. We submitted our plan to CMS in July and have not heard back yet. We’ve also followed up with CMS, because we want to get this underway and this funding out as soon as possible due to the staffing crisis, but we still have not heard back, unfortunately.
As long as they can keep members safe, we have allowed agencies to keep their staffing ratio at 70% during the pandemic versus the required 92.5%. This staffing ratio allowance change was due to end at the end of this month and will be allowed to continue through December 2021.
We’ll be sharing more information at tomorrow’s stakeholder meeting as well.
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
Cullen: Teresa Barrows could not attend today’s meeting, but provided the following update via email:
Cullen: Amanda Hodgkins is here and might be able to add to this or answer questions.
Amanda Hodgkins: We continue our work on the Resource Directory that we have mentioned at previous meetings. We have expanded that to include resources/information from the Department of Labor (DOL) and the Department of Education (DOE). The directory has grown to about 38 pages or so. Our next steps include determining how best to get the information out there.
Cullen: Thank you for being here, Amanda!
DOL – Division of Vocational Rehabilitation - www.maine.gov/rehab/dvr
Cullen: Libby reached out and offered to provide updates at each of our meetings and we are really excited about that!
Libby Stone-Sterling: It’s great to be here! Many of you know that Voc Rehab (VR) assists people to prepare for, find, and maintain employment. We served and are continuing to serve people throughout the pandemic. Currently there is a waitlist for Categories 3 and 4, this includes individuals with fewer barriers to employment. Though the waitlist is not very long. Anyone who is qualifying for case management or waiver services would be in categories 1 or 2 and would be able to be served at this time. Like many places, we’re experiencing turnover, but we’re able to serve people and we’re looking for applications. Feel free to reach out to me via email: [email protected]
We are also doing some reorganization, including incorporating some of the lessons we’ve learned throughout the pandemic, such as virtual trainings etc. Having virtual opportunities also helps with transportation and staffing issues. We worked with SUFU earlier this year to look at some of our online modules to ensure they are accessible and meet people’s need.
Over the coming year my big ask is to think about ways we can increase consumer and family involvement and solicit continuous feedback. We have a State Rehabilitation Council, which is looking for consumers to join. We’re also looking for more opportunities for more ongoing feedback. We want to make sure as we move forward that we’re really hearing from the people using our services.
The other piece of work we’re doing is around transition. The Workforce Innovation and Opportunity Act (WIOA) put a strong focus on ensuring that young people with disabilities are prepared for employment and we’re taking that very seriously. We’re working closely with DOE to determine how VR can be a player in helping to meet people’s needs in those early years of high school and setting high expectations for employment earlier. We’re working closely with OADS and OCFS as well.
We’re wrapping up a 5-year grant around transition, and we have some very interesting findings that will be coming out in the near future. I’m looking forward to sharing that information with you, including some great best practices.
We’ve very committed to ensuring that all individuals have access to paid work opportunities prior to leaving high school. We also have a very successful summer work program. We continue to work closely with our community services partners.
-A special educator stated that the graduation age has been extended to age 22. She asked if they are looking at how that will affect VR in terms of paid work experiences through those additional years, and what that will look like.
Libby: We’re having those conversations with OCFS, OADS, and DOE. There’s a huge focus on it being community-based, and to use that time to maximize opportunities for young people and set them on a good course towards employment.
-The educator asked how someone would provide feedback or participate in those discussions.
-It was stated the [email protected] would be a good person to contact regarding this.
Cullen: Thank you, Libby, this is a lot of great information! It’s wonderful to have regular updates from VR at these meetings. Thank you for being here!
Special Education
Beth Mylroie: It’s great to be back full-time with students in the classroom. It’s exciting to hear the excitement on the part of the parents as well as the students!
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]). SMACT meetings occur the first Friday of each month throughout the school year. The next meeting is on 10/1 at 1:00pm via Zoom. Betsy Morrison, Transitional Services Manager at PSL/STRIVE in South Portland will share information about the TOPS (Transition Outcomes Program for Students) Anne Ryan, STRIVE Online Program Director, will share information about STRIVE Worldwide.
Items(s) of focus/Concern:
1. Discussion regarding how vaccination is affecting the DSP workforce crisis:
-A provider from John F Murphy Homes stated that they have been fully supportive of vaccination efforts and have incentivized staff getting vaccinated (other paid time off to do so, etc.). However, they’re reached a plateau. As of Friday, the agency has 102 people who do not want to be vaccinated. Due to this John F Murphy Homes has unfortunately started to plan for how to approach program closures. He stated that things may change, but they have to plan for the worst and hope for the best. This will be devastating for our sector.
Laura: Other providers are facing the same challenges and are expressing the same concerns. MACSP joined with the Maine Council on Aging and other state associations in calling on the State to extend the 10/1 vaccination deadline. We are not opposing the vaccination mandate, but we want to ensure there are contingency plans so providers can work through these challenges. The results of a survey found that more than half of providers of 2- to 3-person group homes were anticipating having to terminate services for people they support if they were to lose only one to two more staff members. We were happy to see the Governor extend the deadline by 30 days. It remains to be seen how this will help, but every little bit helps.
-A parent stated that two or three staff are planning to leave her son’s house. She stated that staff have worked there for years and love the work. They would be willing to take tests regularly, but do not want to get vaccinated.
2. Discussion regarding Modivcare & transportation concerns:
Cullen: I’ve heard from parents that there have been issues with transportation, especially recently, so I wanted to provide an opportunity for the group to discuss this. My son ran into an issue where it took weeks for the transportation agency to identify his address, despite it not changing for more than 5 years. This affected his access to services.
-A parent stated that her daughter has been having a lot of transportation issues. The transportation was so unreliable that her daughter’s day program started picking her up and dropping her off. Today, the transportation provider got her daughter to work an hour late. Her daughter has worked there for years so her job was understanding, but not many employers would be, given that scenario. This also causes a lot of stress for all involved. She stated that she requested that Ubers or Taxis not be used, which seemed to help slightly. Disability Rights Maine has suggested filing complaints with MaineCare directly, which can be done via phone 1-800-977-6740, or email [email protected].
-A parent stated that there are not enough options for transportation available to match people’s needs. It was asked if there’s MaineCare funding for an agency to provide transportation to and from a day program.
-A provider stated that’s it’s possible for an agency to become a contracted transportation provider, but the paperwork to do so is very lengthy. However, even for agencies that do provide transportation the workforce crisis has affected their ability to provide that as a service.
-It was stated that there is not a MaineCare reimbursement option for parents to make these transportation arrangements themselves. There’s a need for more flexibility and more options for transportation for people with disabilities.
Laura: I believe the Department was doing some transportation work right before the pandemic, and I’m not sure where that stands. It would be interesting to see if they plan to continue that work.
Betsy: There were a series of listening sessions on transportation that were held prior to the pandemic. Then an outside evaluator was hired, and I believe that evaluation report is close to being finalized. There will be a series of opportunities to share the results of that evaluation. I’ll look into this and bring back more information to the group.
3. Information about how you can participate in a Public Comment Period for the Proposed HCBS Settings Rule that will affect services:
Cullen: The Department has revised its original notice of rulemaking for its Global Home and Community-Based (HCBS) Waiver Person-Centered Planning and Settings Rule to include a remote public hearing (the Department’s Notice has been posted to the Coalition's website for your convenience). This is the Rule that will implement changes to the system. This Rule likely affects you and/or someone within your circle. (The Proposed Rule itself can be found by clicking here).
More information will be sent out with the minutes from today’s meeting, including an Action Alert. Information from people who have carefully reviewed these rule changes and have found some potential issues that might resonate for you as well. This will be included with the Action Alert as well. This is an opportunity for people to weigh in through a public process. I believe the Department is trying to get this right, so let’s work together to help them do so.
Betsy: It’s a Federal Rule, and this Proposed Rule implements changes in Maine in accordance with the Federal Rule.
-It was stated that there’s not a lot of detail included in the Rule, so it’s hard to assess the affect it will have – such as the section on the PCP and the needs assessment. It’s hard to determine what it will all mean once implemented.
Cullen: I hope people will provide feedback on what they like and what they think could be improved.
Betsy: Thank you for mentioning that Cullen. Feedback is helpful, whether you agree with what’s included or have suggestions to improve it. The feedback is very helpful.
Disability Rights Maine (DRM) Update:
Megan Salvin: Currently, we’re helping clients with issues around vaccination, specifically clients under guardianship who want to receive the vaccine, but their guardians are withholding consent. We’ve been working on filing grievances against guardians if that’s what the client wishes, with the hope of a court ruling that will allow people to get vaccinated without their guardian’s consent. This is a great example of decision making and guardianship issues. Next week we’re teaming up with SUFU (Speaking Up For Us) for its annual statewide conference, being held on 9/21 and 9/22. DRM will be helping to present along with some self-advocates for 7 presentations.
Federal & Housing Updates:
Cullen:
State Legislature Update: No additional Updates
Updates/Other Business:
Helen Hemminger – Maine Children’s Alliance: Maine Children’s Alliance received three grants to focus on Head Start, Prenatal Care, and CDS. We will be putting together focus groups for each of these topics. We’re interested in hearing people’s stories. We’ve hired a half-time parent advocate who will be reaching out to form these focus groups.
The next meeting will be on Monday, October 18, 2021, 12-2pm, via Zoom*.
Please note this is the third Monday of the month due to the holiday.
Featured Speaker: Paul Saucier, Director, DHHS-OADS.
Topic: What’s going on at OADS – an overview of OADS initiatives, goals and objectives, and its vision for the future.
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. Minutes from the last meeting were accepted. Participants introduced themselves.
Featured Speaker: Laura Cordes, Executive Director, Maine Association for Community Service Providers (MACSP). meacsp.org Topic: Results of the First Session of Maine’s 130th Legislature.
Cullen: Today we have Laura Cordes, Executive Director of MACSP (Maine Association for Community Service Providers) giving a presentation on the results of the First Session of Maine’s 130th Legislature. It was an intense legislative session to say the least, and Laura was in the thick of it. There was a large group of legislators that really wanted to do something significant about changing the status quo, specifically around housing and services. It was quite busy with a lot of folks wanting to make positive changes. That left us sorting things out from various directions. Laura worked determinedly throughout the legislative session advocating for the resources needed to optimize Maine’s system of care for people with ID/DD in Maine. Thank you, Laura, for all you’ve done, and for being here today!
Laura Cordes: The session was intense for many reasons, but it was also really remarkable. A year ago, at this time we didn’t have high COVID rates, but as we got into the fall and into the Legislative Session, we are seeing COVID rates increase. With everything going on at the Federal level and the presidential election, there were many question marks for the future. There were concerns about resources coming into the state, a weakened economy, that there wouldn’t be help on the way, etc. It’s remarkable to think back to where we were at the start of the Legislative Session. We had a heightened sense of all the problems and crises we’d all been challenged with for years, made more visible by the pandemic. We also had the unique opportunity, with the federal resources and legislators willing to think creatively, to do something about it.
Begin presentation (Click here for the presentation):
Laura reviewed three budgets that passed the Legislature and became Public Law. Please see the presentation for more information.
- The Supplemental Budget: There’s usually an opportunity for legislators to adjust the current fiscal year budget – the Supplemental Budget did that. Retainer payments for community support programs were included in the Supplemental Budget.
- The Back-to-Basics Budget – With the federal dollars coming, lawmakers wanted to make sure there was a budget in place prior to 7/1. So, early in the Session they passed the Back-to-Basics Budget to have something in place for the start of the fiscal year. The Administration provided in its budget request funding to bring adult residential services rates up to minimum wage, as well as funding for the new tiered rate for community supports.
- The Biennial Budget for FY 22 & FY 23 – This budget: Includes rate increases, bringing the rates up to 125% of minimum wage effective 1/1/22; funds an additional 30 Section 29 slots per month; and establishes and funds an Aging and Disability Mortality Review Panel.
Laura reviewed bills that passed the Legislature and became Public Law. Please see the presentation for more information, including bill titles. These bills include:
- Planning for early intervention services from birth to age three; transitioning services for kids ages four to six from CDS (Child Development Services) to the schools; restricting the use of seclusion and restraint in schools; and implementing other education-related measures to ensure access to continued school-based services.
- Addressing rural nonmedical transportation; establishing a tax credit for family caregivers; addressing rates not addressed in bills that passed such as Section 13, which would be prioritized as part of the rate study; strengthening the IEP process; allowing for reimbursement to parents providing in-home personal care services to their children with ID/DD; eliminating the waitlists for certain MaineCare services including Sections 21 and 29; and establishing a reimbursement rate accounting for high behavioral needs.
Cullen: A bill that become Public Law that we briefly covered in last month’s meeting is LD 1733 – An Act to Provide Allocations for the Distribution of State Fiscal recovery Funds. This is the bill that addressed the federal recovery funding that Maine is receiving through the American Rescue Plan Act (ARPA). Some of the bills that were sitting on the Special Appropriations Table awaiting funding were essentially supported with funding as part of this bill. It did not receive 2/3’s vote so it will become effective 90 days after adjournment sine die, which is Monday, 10/18/21. The final bill can be found here and includes:
- Nearly $6M to backstop increased pay for behavioral health workers under Secs. 17, 26, 28, and 65 passed in the budget
- $50M for affordable workforce housing with a Maine State Housing Authority and Department of Economic and Community Development partnership, $20M of which is subject to a pilot program using Project Labor Agreements.
- $1.5M for housing navigators in the Maine State Housing Authority – 2-year pilot program within the Maine State Housing Authority. The authority shall hire individuals referred to as "housing navigators" affiliated with local housing authorities, general assistance programs or nonprofit organizations to assist tenants with locating housing and the rental application process and to provide supportive services to promote successful landlord-tenant relationships.
Laura: It’s really remarkable what we were able to achieve in the last session. Now it’s time to gear up for the next session, which per Statute begins the first Wednesday after the first Tuesday of January (1/12/22) and concludes the third Wednesday in April (4/20/22). Cloture is very early this year, perhaps because they have such a long list of carry-over bills. Cloture occurs very early this year, on 9/24. This is when legislators must have bill titles submitted for leadership to consider for the legislative session. legislative leadership will go through a process this fall by which they decide which of the proposed bills can move forward for consideration. There are a number of bills that have been carried over that will require our advocacy. Reaching out to members of the HHS (Health and Human Services) Committee or the AFA (Appropriations and Financial Affairs) Committee cannot happen soon enough, as time will go by quickly and much work remains.
Discussion:
-A parent asked if there are any bills that address rates for MaineCare nursing. She stated that her daughter has been approved to have a nurse come into the home to assist with medication management. This funding has been approved for two years, but her daughter’s case manager has not been able to find a nurse due to the low MaineCare rates for this service.
Laura: There is a staff shortage across all services and sectors, and that includes nursing as well. If you knew the particular service, I might be able to comment in more detail. I don’t know of a particular MaineCare nursing rate, but I do know of it under particular services. I’m happy to follow up with you after the meeting.
-A provider stated that if you’re working with EIM (Elder Independence of Maine) it’s likely Section 19. Nursing also falls under Section 96, which can work concurrently with Sections 21 and 29. There are some pretty specific agencies that provide Section 19 services, and it’s a little different from the Section 21, 29, 28, and 65 services. A provider stated that they have someone looking for this service as well who has also not had luck finding anything. Some agencies are also having difficulty with the health home model, but the lack of available nurses also affects the ability to provide that service. It was stated that the critical case units might have data on this need.
-After the meeting, the following information was shared that might be helpful: While she is awaiting services, if the individual she is supporting has some type of acute medical need, such as a wound, pressure sore or infection, she may qualify for short-term visiting nurses. In order to obtain this, she could get a referral from the primary care doctor. There are a number of companies, depending on where she resides, like Northern Light, that could more quickly provide temporary relief if there are acute medical needs. Many family caregivers are not aware of this service, and it could make a difference to those that are struggling during the staffing shortage or who are awaiting care.
Cullen: The workforce crisis seems to be paramount, and it’s affecting every single sector from nursing to direct care. Agencies are having difficulty attracting employees throughout the entire service sector. This workforce crisis is acute in Maine due to its aging population, and the pandemic has notably worsened the crisis. The ability to pay a professional wage has hindered this as well. My son would like to have the support to go out into the community, but the agency he works with hasn’t been able to hire staff.
Betsy Hopkins – DHHS/OADS: Most of the folks here don’t oversee Section 19 services, but I can certainly put that question to DHHS staff to provide more information for you. You can also email me: [email protected].
-It was stated that there is also a staff shortage for the younger population. It was asked who determines what that hourly rate is for staffing, and whether or not it ties directly to state allocated funds that are distributed to agencies. She added that providing an income that’s sustainable for direct service providers (DSPs) is paramount.
Laura: Maine is very similar to other states. Before the pandemic we faced a workforce crisis across the board. It has only worsened amid the pandemic. Advocates secured a 10% FMAP increase (the federal reimbursement rate) for adult HCBS through the American Rescue Plan Act (ARPA). This will provide a significant increase to the funding that Maine receives for its adult HCBS. The State sets the rates, which are fixed and have many different components. To its credit, the Department has realized that historically the rates have been set inconsistently. And the state is going through a rate system evaluation reform plan. Having the FMAP dollars is significant in the state, as is the rate increase to 125% of minimum wage. There is an effort at the federal level to have $400 million towards HCBS for the next three years. The House and the Senate’s proposals are not in sync, and neither match the $400 million that’s needed. Advocating for this funding is something that we all could do to better the system. More information to follow on this and be on the lookout for an Action Alert from MACSP on how you contact Maine’s Delegation to advocate for this critical funding.
Betsy: There is a rate study that’s completed on all of the services. The State contracts with an outside entity to complete the study. Part of that study will be based on feedback received from providers. I’m not sure when these studies are disseminated. We can’t do rate studies all at once as it’s too large of a task, so the work is being done in parts. The rates that are being increased in January will be 125% of minimum wage.
Laura: And the minimum wage goes up every January. Currently we’re at $12.15 for minimum wage; 125% of that the wage component would be about $15.19.
-It was stated that in order to have conversations with legislators or Maine’s Delegation it would be advantageous to have more information about the exact dollar figures.
Cullen: It’s important to reach out to your representatives, with information as well as your stories – how the workforce crisis is affecting you and your family and the person you care about. This helps them understand the emergency you’re facing and the pathway to correcting the problems. This is the best time of the year to connect with members of the Legislature. They will be putting in bill titles between now and 9/24, so it’s an ideal time to talk to them about that. But it’s also the perfect time to reach out to your representatives, tell your story, and detail what is needed to address your family’s needs.
Cullen: Thank you very much for this presentation, Laura, it was extremely informative. Well done! And I want to thank all of you for your tireless advocacy throughout the Legislative Session. Thank you all!
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: The main thing I wanted to mention is that we’ve gone to monthly stakeholder meetings. The September meeting is tomorrow, 9/14 from 3:00-4:30pm (it has been extended by a half an hour). The focus of this next stakeholder meeting will be to exchange ideas and to provide information and resources that may support staff recruitment and retention efforts. (Click here to join the OADS Stakeholders Zoom Meeting, Meeting ID: 955 532 303 Password: a1234567).
The FMAP spending plan in on the OADS website (click here for the plan). About $125 million of those dollars are going to workforce stabilization issues. We submitted our plan to CMS in July and have not heard back yet. We’ve also followed up with CMS, because we want to get this underway and this funding out as soon as possible due to the staffing crisis, but we still have not heard back, unfortunately.
As long as they can keep members safe, we have allowed agencies to keep their staffing ratio at 70% during the pandemic versus the required 92.5%. This staffing ratio allowance change was due to end at the end of this month and will be allowed to continue through December 2021.
We’ll be sharing more information at tomorrow’s stakeholder meeting as well.
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
Cullen: Teresa Barrows could not attend today’s meeting, but provided the following update via email:
- We continue to work closely with Betsy and her team at OADS to create a clear transition process for youth transitioning to OADs and creating an implementation plan.
- We continue to experience a lack of timely resources due to work force shortages and the impact of the pandemic; however, we continue to work on finding solutions.
Cullen: Amanda Hodgkins is here and might be able to add to this or answer questions.
Amanda Hodgkins: We continue our work on the Resource Directory that we have mentioned at previous meetings. We have expanded that to include resources/information from the Department of Labor (DOL) and the Department of Education (DOE). The directory has grown to about 38 pages or so. Our next steps include determining how best to get the information out there.
Cullen: Thank you for being here, Amanda!
DOL – Division of Vocational Rehabilitation - www.maine.gov/rehab/dvr
Cullen: Libby reached out and offered to provide updates at each of our meetings and we are really excited about that!
Libby Stone-Sterling: It’s great to be here! Many of you know that Voc Rehab (VR) assists people to prepare for, find, and maintain employment. We served and are continuing to serve people throughout the pandemic. Currently there is a waitlist for Categories 3 and 4, this includes individuals with fewer barriers to employment. Though the waitlist is not very long. Anyone who is qualifying for case management or waiver services would be in categories 1 or 2 and would be able to be served at this time. Like many places, we’re experiencing turnover, but we’re able to serve people and we’re looking for applications. Feel free to reach out to me via email: [email protected]
We are also doing some reorganization, including incorporating some of the lessons we’ve learned throughout the pandemic, such as virtual trainings etc. Having virtual opportunities also helps with transportation and staffing issues. We worked with SUFU earlier this year to look at some of our online modules to ensure they are accessible and meet people’s need.
Over the coming year my big ask is to think about ways we can increase consumer and family involvement and solicit continuous feedback. We have a State Rehabilitation Council, which is looking for consumers to join. We’re also looking for more opportunities for more ongoing feedback. We want to make sure as we move forward that we’re really hearing from the people using our services.
The other piece of work we’re doing is around transition. The Workforce Innovation and Opportunity Act (WIOA) put a strong focus on ensuring that young people with disabilities are prepared for employment and we’re taking that very seriously. We’re working closely with DOE to determine how VR can be a player in helping to meet people’s needs in those early years of high school and setting high expectations for employment earlier. We’re working closely with OADS and OCFS as well.
We’re wrapping up a 5-year grant around transition, and we have some very interesting findings that will be coming out in the near future. I’m looking forward to sharing that information with you, including some great best practices.
We’ve very committed to ensuring that all individuals have access to paid work opportunities prior to leaving high school. We also have a very successful summer work program. We continue to work closely with our community services partners.
-A special educator stated that the graduation age has been extended to age 22. She asked if they are looking at how that will affect VR in terms of paid work experiences through those additional years, and what that will look like.
Libby: We’re having those conversations with OCFS, OADS, and DOE. There’s a huge focus on it being community-based, and to use that time to maximize opportunities for young people and set them on a good course towards employment.
-The educator asked how someone would provide feedback or participate in those discussions.
-It was stated the [email protected] would be a good person to contact regarding this.
Cullen: Thank you, Libby, this is a lot of great information! It’s wonderful to have regular updates from VR at these meetings. Thank you for being here!
Special Education
Beth Mylroie: It’s great to be back full-time with students in the classroom. It’s exciting to hear the excitement on the part of the parents as well as the students!
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]). SMACT meetings occur the first Friday of each month throughout the school year. The next meeting is on 10/1 at 1:00pm via Zoom. Betsy Morrison, Transitional Services Manager at PSL/STRIVE in South Portland will share information about the TOPS (Transition Outcomes Program for Students) Anne Ryan, STRIVE Online Program Director, will share information about STRIVE Worldwide.
Items(s) of focus/Concern:
1. Discussion regarding how vaccination is affecting the DSP workforce crisis:
-A provider from John F Murphy Homes stated that they have been fully supportive of vaccination efforts and have incentivized staff getting vaccinated (other paid time off to do so, etc.). However, they’re reached a plateau. As of Friday, the agency has 102 people who do not want to be vaccinated. Due to this John F Murphy Homes has unfortunately started to plan for how to approach program closures. He stated that things may change, but they have to plan for the worst and hope for the best. This will be devastating for our sector.
Laura: Other providers are facing the same challenges and are expressing the same concerns. MACSP joined with the Maine Council on Aging and other state associations in calling on the State to extend the 10/1 vaccination deadline. We are not opposing the vaccination mandate, but we want to ensure there are contingency plans so providers can work through these challenges. The results of a survey found that more than half of providers of 2- to 3-person group homes were anticipating having to terminate services for people they support if they were to lose only one to two more staff members. We were happy to see the Governor extend the deadline by 30 days. It remains to be seen how this will help, but every little bit helps.
-A parent stated that two or three staff are planning to leave her son’s house. She stated that staff have worked there for years and love the work. They would be willing to take tests regularly, but do not want to get vaccinated.
2. Discussion regarding Modivcare & transportation concerns:
Cullen: I’ve heard from parents that there have been issues with transportation, especially recently, so I wanted to provide an opportunity for the group to discuss this. My son ran into an issue where it took weeks for the transportation agency to identify his address, despite it not changing for more than 5 years. This affected his access to services.
-A parent stated that her daughter has been having a lot of transportation issues. The transportation was so unreliable that her daughter’s day program started picking her up and dropping her off. Today, the transportation provider got her daughter to work an hour late. Her daughter has worked there for years so her job was understanding, but not many employers would be, given that scenario. This also causes a lot of stress for all involved. She stated that she requested that Ubers or Taxis not be used, which seemed to help slightly. Disability Rights Maine has suggested filing complaints with MaineCare directly, which can be done via phone 1-800-977-6740, or email [email protected].
-A parent stated that there are not enough options for transportation available to match people’s needs. It was asked if there’s MaineCare funding for an agency to provide transportation to and from a day program.
-A provider stated that’s it’s possible for an agency to become a contracted transportation provider, but the paperwork to do so is very lengthy. However, even for agencies that do provide transportation the workforce crisis has affected their ability to provide that as a service.
-It was stated that there is not a MaineCare reimbursement option for parents to make these transportation arrangements themselves. There’s a need for more flexibility and more options for transportation for people with disabilities.
Laura: I believe the Department was doing some transportation work right before the pandemic, and I’m not sure where that stands. It would be interesting to see if they plan to continue that work.
Betsy: There were a series of listening sessions on transportation that were held prior to the pandemic. Then an outside evaluator was hired, and I believe that evaluation report is close to being finalized. There will be a series of opportunities to share the results of that evaluation. I’ll look into this and bring back more information to the group.
3. Information about how you can participate in a Public Comment Period for the Proposed HCBS Settings Rule that will affect services:
Cullen: The Department has revised its original notice of rulemaking for its Global Home and Community-Based (HCBS) Waiver Person-Centered Planning and Settings Rule to include a remote public hearing (the Department’s Notice has been posted to the Coalition's website for your convenience). This is the Rule that will implement changes to the system. This Rule likely affects you and/or someone within your circle. (The Proposed Rule itself can be found by clicking here).
- Public Hearing: Comments on this Rule can be made at a Public Hearing, scheduled for Tuesday, 9/28 at 11 am via Zoom (Zoom Meeting link: https://mainestate.zoom.us/j/89675358898 Meeting ID: 896 7535 8898).
- Submitted Written Comments: You can also submit written comments through 10/8 at 11:59 pm. Comments can be submitted online by filling out the form or pasting your comments in the text field.
- Emailed Written Comments: Comments may also be emailed directly to [email protected].
More information will be sent out with the minutes from today’s meeting, including an Action Alert. Information from people who have carefully reviewed these rule changes and have found some potential issues that might resonate for you as well. This will be included with the Action Alert as well. This is an opportunity for people to weigh in through a public process. I believe the Department is trying to get this right, so let’s work together to help them do so.
Betsy: It’s a Federal Rule, and this Proposed Rule implements changes in Maine in accordance with the Federal Rule.
-It was stated that there’s not a lot of detail included in the Rule, so it’s hard to assess the affect it will have – such as the section on the PCP and the needs assessment. It’s hard to determine what it will all mean once implemented.
Cullen: I hope people will provide feedback on what they like and what they think could be improved.
Betsy: Thank you for mentioning that Cullen. Feedback is helpful, whether you agree with what’s included or have suggestions to improve it. The feedback is very helpful.
Disability Rights Maine (DRM) Update:
Megan Salvin: Currently, we’re helping clients with issues around vaccination, specifically clients under guardianship who want to receive the vaccine, but their guardians are withholding consent. We’ve been working on filing grievances against guardians if that’s what the client wishes, with the hope of a court ruling that will allow people to get vaccinated without their guardian’s consent. This is a great example of decision making and guardianship issues. Next week we’re teaming up with SUFU (Speaking Up For Us) for its annual statewide conference, being held on 9/21 and 9/22. DRM will be helping to present along with some self-advocates for 7 presentations.
Federal & Housing Updates:
Cullen:
- Federal Budget: Advocates are working to ensure that the FY 22 budget, which begins 10/1, includes the highest possible funding for HUD programs, including Section 8.
- On 7/12, House Appropriations Subcommittee overseeing HUD spending passed a bill to fund critical housing programs for FY 22. The bill includes $56.5 billion for HUD programs, a $6.8 billion increase (14%) above FY 21 enacted levels and $314 million below the President’s FY 22 request. The Senate has yet to release its HUD budget.
- Congress’ Budget Resolution & Infrastructure Reconciliation Package: On 9/9 The House Financial Services Committee released legislation to invest more than $330 billion in affordable housing through a $3.5 trillion infrastructure and economic recovery reconciliation bill, which could pass in the Senate with a simple majority rather than the 60 votes required for other legislation. A few items of note from the bill include:
- $90 billion for rental assistance, including $75 billion for Housing Choice Vouchers (Section 8) and $15 billion for Project-Based Rental Assistance.
- $37 billion for the national Housing Trust Fund (as a set-aside within the HOME Investment Partnership Program).
- $1 billion for Section 811 Housing for Persons with Disabilities.
- The Decent, Affordable, Safe Housing for All (DASH) Act: On 8/18 Senate Finance Committee Chair Ron Wyden (D-Ore.) announced the DASH Act, legislation to make a generational investment to which would tackle the housing affordability crisis, among various other important measures. Pertinent to this group, the legislation increases funding for low- and middle-income housing development and provides $10 billion in the Housing Trust Fund (HTF) for the next ten years to states to acquire, develop, or rehabilitate deeply affordable housing. In Maine, resources from the HTF are the primary funding mechanism for supportive housing development.
- The Coalition unanimously approved sending letters of thanks to Maine’s Delegation for their support of the DASH Act.
State Legislature Update: No additional Updates
Updates/Other Business:
Helen Hemminger – Maine Children’s Alliance: Maine Children’s Alliance received three grants to focus on Head Start, Prenatal Care, and CDS. We will be putting together focus groups for each of these topics. We’re interested in hearing people’s stories. We’ve hired a half-time parent advocate who will be reaching out to form these focus groups.
- A parent stated that there are concerns about crisis standards of care nationally, especially for people with disabilities as COVID rates and hospitalizations go up. She stated that people with disabilities including people with ID/DD who have been hospitalized with COVID have been more likely to be removed from ventilators and have received a much lower level of care overall. She asked if Maine is looking at having a crisis standard of care that could be enforced throughout the medical community. More information to follow on this at next month’s meeting, if it’s available.
The next meeting will be on Monday, October 18, 2021, 12-2pm, via Zoom*.
Please note this is the third Monday of the month due to the holiday.
Featured Speaker: Paul Saucier, Director, DHHS-OADS.
Topic: What’s going on at OADS – an overview of OADS initiatives, goals and objectives, and its vision for the future.
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].