Along with the Home Care & Hospice Alliance of Maine, the Maine Council on Aging, the Maine Health Care Association, the Maine Hospital Association and the Maine Medical Association, the Alliance for Addiction and Mental Health Services and the Maine Association for Community Service Providers represent caregivers providing services to the over 300,000 Medicaid recipients in Maine. Many of these are the most vulnerable people in our communities. They are children and adults with severe and persistent mental illness; they are frail or indigent aging adults; they are individuals challenged with substance use disorder; they are Mainers with intellectual disabilities, autism or brain injuries. They are also hardworking, but lower-income, Mainers who serve us all every day by washing dishes, cleaning offices, caring for our children and providing services to other Medicaid recipients.
The people we represent are the doctors and nurses, hospitals and nursing homes, residential and community treatment agencies, therapists and counselors, support specialists and home health aides who take care of Medicaid recipients.
There is a pattern of policymaking in Maine that we believe is unfair to Medicaid providers, and those needing their services, that needs to be addressed. Too often, the Legislature’s policymaking is inconsistent in its impacts. To be more specific, the Legislature passes legislation that increases our costs, but it doesn’t increase our reimbursement rates to cover those costs.
For example, right now the Legislature, wearing its “labor relations” hat, is considering a bill that would make more workers in Maine eligible for overtime pay. While most states rely on the federal government to set the eligibility threshold, if this state legislation is enacted, over 30,000 workers may become eligible for overtime pay.
The purpose of this writing is not to debate whether Maine should have its own overtime law, or if so, what the overtime threshold should be. We support all workers getting the wages and benefits commensurate with the hard work they perform.
Our purpose is to highlight that if Maine is going to have its own law, there will be costs and unintended consequences. Unlike other businesses, Medicaid providers cannot simply raise our prices to cover these added costs. The Legislature, wearing its “Medicaid program” hat, has the final say on setting our reimbursement rates for the services we provide to Medicaid recipients.
Currently, no mechanism exists to tie one legislative action to the other.
It’s as if the Legislature has ordered the dinner but has no intention of paying the bill. They are leaving it to providers to figure out – and they will, as they have had to in the past. Unfortunately, the only way to do this is to cut back on the services offered, and ask each essential worker to carry a heavier load.
This scenario was most prominently on display a few years ago when the law was changed to increase the minimum wage. Whether the minimum wage should have been raised and to what amount is an important policy discussion. And again, we support workers being paid a living wage commensurate with their hard work. But when it was raised, the Medicaid reimbursement rate should also have been raised. Medicaid providers were left unable to pay the increasing wages, and lost many employees even before the pandemic workforce impacts hit. Now most are facing a workforce crisis, and access to services is being lost.
When the pending overtime legislation was recently considered by the Legislature’s Labor Committee, we asked that committee to consider the Medicaid reimbursement issue and to include funding sufficient to cover Medicaid’s share of the potential cost increase to its providers. This was not heeded.
We are now asking the governor to hear us: If this bill is going to be enacted, sufficient funding must be included to cover the Medicaid program’s share of the increased cost.
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