$1M Nursing Home Funding Delay Sparks Political Spat in Maine

Maine’s Democratic Gov. Janet Mills delayed action on a bill that would have given skilled nursing facilities in the state roughly $1 million in additional Medicaid funding over the next two-year state budget, which drew criticism from Republican legislators in the state.

The news was first reported by the Sun Journal last week

Republicans in the state criticized the decision to hold the bill, which was a top priority for them, the publication reported. In response, Democrats argued that some Republicans had voted against the budget, which contains additional state funds for nursing homes.


Maine has already extended a one-time funding boost for nursing homes that was approved by the Legislature 2018 over the veto of then-Gov. Paul LePage, Maine HHS spokesperson Jackie Farwell told Skilled Nursing News via e-mail. In Maine’s budget, which Mills signed in June, there is a cost-of-living adjustment of $8.5 million, she noted.

The roughly $1 million is separate from those funds. That infusion was part of Legislative Document 1758, intended to help SNFs cover their increasing labor costs. It passed with unanimous votes in both bodies of the Legislature in June, the Sun Journal noted.

But Mills held the bill until the state Legislature meets again, citing concerns about the Pine Tree State losing federal matching funds by exceeding the Upper Payment Limit (UPL).


States have to demonstrate that their Medicaid reimbursements do not exceed either the cost of providing the service, or the cost that Medicare would pay for the same service, Farwell noted. Those service included nursing home care.

Payments that go beyond the UPL are not eligible for matching federal funds, and the governor’s office made the assessment that the additional funding in L.D. 1758 would lead to Maine exceeding that limit, Farwell said.

“Had [Gov. Mills] signed this bill into law, it would have caused nursing home costs billed to MaineCare to exceed that federally required limit, which in turn would have stopped federal match funding,” she wrote. “The state would then have to make up for that loss, though the Legislature never allocated any money to compensate for it.”

The Maine Health Care Association, which represents nursing homes in the state, disagrees, CEO Rick Erb told SNN. Though he declined to go into specifics, he said there are other ways of calculating the UPL so that the additional funding in the bill would not lead to Maine exceeding the limitations.

The state’s Department of Health and Human Services (HHS) told the Maine Health Care Association that there is a meeting scheduled for next week to go over this issue, Erb said.

The Maine HHS is working with its consultant to evaluate the current UPL calculations, Farwell said, adding that any changes would not be immediate, since they require approval from the Centers for Medicare & Medicaid Services (CMS).

“The Governor believes in supporting Maine’s nursing homes,” she wrote. “That is why … her Administration will work with the Legislature in the coming months to accomplish a funding strategy that maximizes federal money, not jeopardize it.”

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