MAINE COALITION FOR HOUSING & QUALITY SERVICES
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September 14, 2026
Minutes
Attendees via Zoom: Cullen Ryan, Bridget McCabe, Margaret Cardoza, Catherine Thibedeau, Robin Levesque, Rob Moran, Mary Chris Semrow, Julianne Zaharis, Dr. J.C. Edelberg, Janet DiBiase, David Cowing, Melissa Bliss, Mary E. Rush, Jamie Whitehouse, Mindy Ward, Lynn Augustine, Sara Fleurant, Cheri W., Paula Bush, Brett Bulmer, Megan Salvin, Karen Berry, Jennifer Putnam, Janice Tobias, Ann-Marie Mayberry, Donna Alger, and possibly others who joined after the meeting began or left before it concluded.
Cullen Ryan opened the meeting by introducing himself and welcoming attendees and introducing participants. He reiterated that the Coalition is an open and inclusive clearinghouse of information and that all are welcome.

Minutes from the August 10, 2026 meeting were approved. Janet DiBiase moved to accept the minutes, and Rob Moran seconded the motion. No corrections or opposition were offered. Cullen invited members to report any later-discovered errors, so the public record remains accurate.

Featured Speaker: Catherine Thibedeau, Strategic Advisor, Catherine Thibedeau Consulting LLC
Topic: Who Will Shape the Future of IDD Services? Mergers, Partnerships, Private Equity, and What They Mean for People and Public Funds.

Cullen introduced Catherine and described the presentation as an important examination of major changes affecting intellectual and developmental disability services. Catherine shared her experience leading Independence Advocates of Maine and supporting its merger into 3Rivers, as well as her current consulting work with providers and associations in Maine and nationally.

Begin Presentation: Catherine explained that providers are confronting several pressures at the same time: workforce shortages, inadequate or delayed rate adjustments, increasing regulatory and documentation requirements, changing service and case-management rules, technology demands, rural service challenges, heightened scrutiny of Medicaid billing, and growing consolidation within health and human services.
Presentation Highlights:
  • Maine’s community-provider system grew following the closure of Pineland and other institutional services. Many provider organizations remain locally rooted, mission-driven nonprofits, but the environment around them has changed substantially.
  • National merger and acquisition activities now include autism and IDD services. Private-equity-backed firms may purchase several small providers and combine them, creating both potential efficiencies and risks.
  • Partnerships, affiliations, parent-subsidiary structures, shared-service arrangements, mergers, and acquisitions exist along a continuum. Each carries different legal, financial, governance, liability, and operational consequences.
  • Potential advantages of collaboration or consolidation include stronger administrative capacity, purchasing power, recruitment, access to capital and technology, shared expertise, quality systems, and the ability to test new approaches more quickly.
  • Risks include loss of local control, unclear accountability, reduced transparency, disruption of relationships, pressure to prioritize financial returns, and decisions that may not keep people receiving services at the center.
  • Revenue in this sector is largely MaineCare reimbursement. Revenue indicates organizational size, but it supports the full cost of service delivery, including direct support professionals, clinical and administrative functions, facilities, vehicles, technology, insurance, and compliance.
  • Medicaid program-integrity systems distinguish intentional fraud from improper payment. An improper payment may occur even when a service was provided if authorization, credentialing, documentation, billing, or another required step cannot be proven.
  • The service delivery and billing chain is complex. Eligibility, assessment, planning, authorization, provider enrollment, staff qualifications, service documentation, and billing must all align, often across different people and systems.
  • Catherine encouraged participants to stay curious, follow both the money and control, ask who owns and governs an organization, request understandable information, and keep people receiving services at the center of every decision.
  • In Catherine’s view, many Maine providers may need to look different to survive over the next 10 to 15 years. She encouraged Maine stakeholders to shape that change deliberately before a crisis allows outside market forces to shape it for them.
Discussion, Questions, and Comments:

A parent said checks and balances are important but expressed concern that repetitive and disorganized paperwork can draw attention away from care. She asked what provider revenue represents.

Catherine explained that revenue is primarily MaineCare reimbursement used to fund the full organization and service-delivery infrastructure. She agreed that regulatory requirements carry a substantial burden and said new requirements should be adequately funded so providers can comply without destabilizing services.

Cullen observed that many separate steps must align before a service can be billed and that an error at any point may be portrayed publicly as fraud.

Catherine clarified that long-standing federal and state program-integrity systems address fraud, waste, abuse, and improper payments; not every improper payment is fraud. She reviewed the ‘Proof of Services’ chain and gave examples of how missing authorizations, expired credentials, incomplete documentation, or misaligned systems may create billing risk even when care occurred.

Catherine also noted that Maine providers have worked extensively to update language and practices for the federal HCBS Settings Rule while medical-necessity and service-verification requirements still remain. Both sets of expectations must be met.

A self-advocate asked who is responsible when ownership and corporate relationships become complex and a person experiences serious harm or poor service.

Catherine said responsibility may depend on the legal and corporate structure and may ultimately require regulators, insurers, attorneys, or the Attorney General to sort out. She encouraged individuals and families to organize their questions and demand ownership, governance, decision-making, and liability information in an understandable form.

A self-advocate emphasized that people receiving residential services live in their homes and that the phrase ‘group home’ can be stigmatizing.

Catherine agreed and discussed the tension between respecting a person’s privacy, autonomy, and control in their home while maintaining appropriate accountability for publicly funded services delivered there.

A provider said the planning process has shifted from providers to case managers and has become more administrative, reducing providers’ role and sometimes delaying service implementation through multiple review steps.

Catherine agreed that person-centered planning can become a bureaucratic process rather than a meeting focused on what the person wants and needs. She also noted that prolonged state review processes can create operational and billing risk for providers.

A parent raised concern about Maine’s reliance on Shared Living, including arrangements provided by aging family members. He asked how the system will respond as parents and other relatives become unable to continue providing support and non-family Shared Living providers remain limited. Catherine said Maine needs a structured, reliable way to assess needs and produce data that can drive system design, including an adequate safety net and a range of residential options. She described the potential value of a Supports Intensity Scale or comparable assessment process if implemented well with stakeholder involvement.

Catherine, in response to a self-advocate’s question about protecting against market activity, described providers in another state exploring a collaborative structure so they would be better positioned before very large organizations entered their market. She encouraged Maine organizations to discuss shared services, partnerships, and other options before they face an emergency or feel compelled to react to outside acquisition activity.

Participants thanked Catherine for making a complicated topic understandable.

Cullen noted that he allowed the discussion to run longer than planned because of its importance and thanked Catherine for the depth of the presentation.

End Presentation.

Presentation Link: Who Will Shape the Future of IDD Services? Mergers, Partnerships, Private Equity, and What They Mean for People and Public Funds, link to power point presentation.

Service Updates:

DHHS, Office of Aging and Disability Services (OADS) -  www.maine.gov/dhhs/oads (link to website)
Sara Fleurant reported that OADS responded to CMS requests concerning the 1915(b)(4) Lifespan Community Resource Coordinator waiver. The waiver supports a process for agencies to apply to deliver the service through selective contracting rather than an any-willing-or-qualified-provider process. CMS approved the State’s responses and had no further questions. OADS continues to work with CMS on the Lifespan 1915(c) waiver.
 
DHHS, Children’s Behavioral Health Services, Office of Behavioral Health (OBH) - www.maine.gov/dhhs/obh/support-services/childrens-behavioral-health (link to website)
Cullen reported that repeated outreach has not yet resulted in regular representation at Coalition meetings.
A self-advocate offered to contact Maggie in the policy department and include Cullen in the outreach. Members with other contacts were asked to share them with Cullen.
 
Department of Labor (DOL), Division of Vocational Rehabilitation (DVR) - www.maine.gov/rehab/dvr (link to website)
Cullen noted the Coalition’s consistent connection with the Department of Labor. Following a leadership transition, Steve Ball is expected to serve as the Department’s representative, although no update was available this month.
 
Department of Education (DOE), Office of Special Services and Inclusive Education (OSSIE) - www.maine.gov/doe/learning/specialed (link to website). 
No representative attended this month. Cullen noted that the Coalition has established contacts with the Department and expects future participation.
 
Disability Rights Maine (DRM) - DRM (link to website)
Megan Salvin reported that the Speaking Up For Us (SUFU) conference would take place the following week at the University of Maine in Orono, with workshops for self-advocates. DRM had also held a voting-rights training that morning and planned a young-voter-rights training at the Portland Public Library on September 30. Additional voting-rights trainings were being scheduled with community support programs serving adults with IDD. DRM also planned Election Day monitoring of polling-place accessibility and accessible voting equipment.
 
A self-advocate asked which of three accessible voting systems had been selected by the Secretary of State.

Megan said the answer had not been clear during DRM’s prior outreach and agreed to try again to obtain the information. Members also discussed absentee-ballot communications and the importance of accessible, accurate voting information.

A parent described her prior work with the League of Women Voters monitoring polling places and noted that election officials had generally been responsive.

Federal Policy, Funding, and Housing Updates:
Cullen summarized written updates provided by Bonnie Brooks.
The White House, Federal Government departments and Congressional committees continue to make decisions, issue reports, and conduct other activities of interest to the IDD community.
  1. U.S. D.O.J. Integration Mandate – As reported last month, the 6/18 DOJ mandate could dismantle many of the community integration guarantees in the ADA, Section 504, and the 1999 Olmstead Supreme Court decision. This says that federal disability rights laws do not give people the right to live in their own homes and communities.
 
           In 2024 HHS had promulgated regulations implementing Section 504 which included prohibiting discrimination on the         
           basis  of disability and Texas, Florida and Alaska had sued HHS, basically disagreeing with the inclusion requirements of the 
           regulation.

           On 8/31/2026, DOJ proposed a resolution on behalf of the U.S. H.H.S. and Texas, Florida, and Alaska, to settle that 2024       
           lawsuit, that would have now NOT prohibited discrimination on the basis of disability by recipients of federal funds. That       
           2024 lawsuit focused on the regulations’ provisions regarding community integration. A Joint Motion was filed to settle this
           lawsuit.

           This 8/31 resolution by the federal government and these 3 states would continue to allow these Plaintiffs to abandon their   
           duty to enforce the right of people with disabilities to live in their own homes and communities.

      2.  Applied Behavior Analysis (ABA) – Over several years, the IDD sector in Maine has discussed the use of ABA. 
           Independence Association was a major proponent of its use. Unfortunately, there are very few ABA-certified clinicians in   
           Maine – especially those specifically trained in ABA for adults. Recently, the use of ABA has come under CMS scrutiny. It has 
           now released a toolkit for states focused on the oversight of ABA services for Medicaid-funded children with autism. It is 
           meant to assist states to control rapidly increasing costs, inconsistency in clinical practices and potential fraud. CMS has 
           found several fraudulent practices. It is possible that CMS concerns will be expanded to include adults. 

      3.  Housing Shortage – The 2026 National Low Income Housing Coalition (NLIHC) reports that Maine has a critical shortage of     
           available, affordable rental homes for households whose income is at or below 30% of the area’s median income. Mainers 
           are spending over 50% of their income on housing, sacrificing medication and healthy food to do so. Maine has a need for
          19,495 more homes for extremely low-income households. 46% of these households are seniors and 24% are people with
           disabilities. 

​      4.  U.S. House of Representatives – The House Ways and Means Committee is facing major change in its membership and 
           leadership dependent on the mid-term elections. This is a key committee that has jurisdiction over Medicaid and other major
           federal health committees that impact people with IDD. 

      5.  Federal Rural Health Transformation Program (RHTP) – As previously reported, Maine received a major grant to be used over
           several years. The spending of these funds was specifically earmarked by the state while other available funds were put out
           to RFP under certain categories.  

      6.  Home and Community-Based Services (HCBS) Act – This legislation was introduced in August. It would ensure that older
           adults and people with disabilities have a choice between receiving long-term care at home or in institutional settings. It
           would make HCBS services a mandatory Medicaid benefit, gradually eliminate waiting lists, strengthen the home and 
           community-based care workforce, and provide greater support for family caregivers.  

      7.  2027 Social Security Increases – Several organizations, including AARP, have recently projected that the Social Security Cost
           of Living increases for 2027 will be between 3.4% and 3.7% which will be important to low-income Mainers including adults
           with IDD.  

      8.  National Fraud Enforcement Division (NFED) – As mentioned in the last federal update, this new division under the auspices
           of the U.S.D.O.J. was established in March. The Federal Register of August 18, 2026, published the final rule, giving D.O.J.
           jurisdiction over many areas including healthcare fraud.  

      9.  U.S.D.O.L. – Under the Obama administration, a rule was created in 2013 that put pressure on federal contractors to improve
           employment for people with disabilities by working toward assuring that at least 7% of the workers in each job group were
           people with disabilities. The Department of Labor under the current administration is officially putting an end to this 2013
           regulation, a setback for people with IDD seeking employment.  

Lifespan Housing Services Discussion: OADS Lifespan Project, link
Sara Fleurant highlighted two housing services proposed for the Lifespan Waiver: housing counseling and housing start-up funds. She was particularly encouraged by housing counseling because case managers currently assist with housing needs while carrying many other responsibilities.

A self-advocate asked whether housing counseling would support youth transitioning to adulthood. Sara said planning can begin before age 18 even though a youth cannot yet sign a lease. She described current consultations with transition-age youth and individuals who have long-term housing goals and emphasized the importance of training and a community of practice around existing housing resources.

A parent asked who would employ the housing counselor.

Sara explained that a provider agency would hire the position and deliver specialized housing-counseling services.

State Legislature Updates:
Cullen encouraged members to reach out now to candidates and people running for office, share what they have observed, and explain what they want from elected representatives. He said it can be harder to gain attention once the legislative session is underway and reminded everyone to vote.

Other Business:
Cullen invited participants to take advantage of the Coalition website and send Bridget or Cullen information for possible posting. The Coalition will continue sharing information and helping coordinate collective action as a new legislative session approaches.

Closing Remarks:
Cullen again thanked Catherine for her presentation and said the Coalition would continue gathering information so members are prepared to engage in collective action and inform decision-makers during the coming legislative session. The meeting adjourned with the next meeting scheduled for October 19, 2026.

Coalition Website - MAINE COALITION FOR HOUSING & QUALITY SERVICES

Upcoming Meetings and Featured Speakers:
  • October 19, 2026, 12:00–2:00 p.m. (third Monday due to the holiday): Dr. Lauren Michalakes, Station MD, on personalized access to medical services for people with IDD. Station MD, link.
  • November 16, 2026, 12:00–2:00 p.m. (third Monday due to the housing conference): Michelle Probert, Director of MaineCare Services, on anticipated Medicaid reductions in Maine and how the federal legislation enacted in July 2025 may affect the State. Cullen invited members to continue suggesting timely featured speakers and topics.

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].
Maine Coalition for Housing and Quality Services - This is your Coalition.  Thank you for being a part of it!
c/o 3-Rivers (effective 4/1/2026) 3-rivers.org
  • Home
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    • History
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    • Service Timeline
    • Services
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  • Agendas/Minutes
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  • Postings
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  • Section 21 & 29
    • Wait List Numbers Over Time
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