Report

This report is one of a series of reports prepared by the USM Muskie School on MaineCare members who are dually eligible for MaineCare and Medicare Services.  This first report provides a high level overview of the MaineCare and Medicare use and expenditure patterns for all members who were dually eligible in state fiscal years (SFY) 2008-2010.  This report provides baseline data on the characteristics of Medicare-MaineCare members who are dually eligible, the distribution of expenditures across categories of service for MaineCare and Medicare, and the cost of care for people with select chronic conditions. The report includes information on members considered full benefit as well as those who are partial benefit members.  Partial benefit members are also know as Qualified Medicare Beneficiaries, Specified Low Income Medicare Beneficiaries; Qualified Individuals; and Qualified Disabled and Working Individuals.  Individuals who are dually eligible for MaineCare and Medicare typically have multiple chronic conditions, high medical and long term care costs, and low income. Medicare covers hospital, medical, skilled long term care and pharmacy services while Medicaid pays for behavioral health, community based long term services and supports and nursing home services. The integration of services and benefits for people who are dually eligible is a challenge for states and the federal government. As states move to introduce value based purchasing initiatives through health homes, accountable care communities and other managed care efforts, the need to coordinate services and align incentives between the Medicaid and Medicare programs becomes increasingly critical. Many states are involved in dual eligible demonstrations to improve the integration of services, benefits and care.

Suggested Citation: McGuire C, Gressani T, Bratesman S, Fralich J, Griffin E.  Members Dually Eligible for MaineCare and Medicare Benefits: MaineCare and Medicare Expenditures and Utilization, State Fiscal Year 2010. (Chartbook).  Portland, ME: University of Southern Maine, Muskie School of Public Service; October 2012.

To better understand the nature of the residential facilities serving more than 19 percent of Maine’s Long Term Services and Supports (LTSS) population, the Maine Department of Health and Human Services commissioned the Muskie School to conduct a survey of residential facilities as part of its update to Maine’s LTSS profile. The goal of the Maine Residential Settings Characteristics Survey, conducted between July and September 2010, was to measure the "homelike" characteristics of residential settings.

The survey sample comprised a total of 636 facilities which included all licensed residential care facilities or private non-medical licensed institutions. The survey response rate was 82.9%, and survey questions collected information about the facilities' physical characteristics and features, services, resident characteristics, and policies relating to autonomy and privacy.

Suggested citation:

Fralich J, McGuire C, Griffin E. "Homelike" Characteristics of Maine's Residential Services: A Survey of Maine's Residential Service Settings (2010). (Chartbook).  Portland, ME: University of Southern Maine, Muskie School of Public Service; November 2012.

Direct service workers play a central role in the quality of the long-term services and supports provided to older people and people with disabilities in home and community settings. Nationally, and at the state level, there is a critical need for more information about this workforce in order to inform workforce policy and measure improvements in workforce quality and stability over time. Maine was one of seven states to administer baseline surveys under a grant funded by the U.S. Centers for Medicare and Medicaid Service. Survey questions focused on workforce volume, stability, and compensation, as well as, cultural competence, workforce challenges, workforce training and worker qualifications.

This Chartbook provides the results of two direct service workforce surveys conducted in the summer of 2012: one for Personal Attendants who work for adults with disabilities and families in participant-directed programs; and the second for Provider Organizations serving adults with intellectual disabilities and older adults with disabilities.

Key Findings from the Personal Attendant Survey:

• 51% of direct service workers employed as personal attendants in Maine’s participant-directed programs have an annual household income of less than $22,000.
• 37% have no source of health-insurance and another 28% are insured under MaineCare.
• The majority of personal attendants became a personal attendant because a friend or family member needed care (69%). Many also value the personal satisfaction (59%) and flexible schedule (52%) that this work offers. 
• Most personal attendants express a high level of satisfaction with their work.
• Personal attendants are less satisfied with their wages.

Key Findings from the from the Provider Organizations:

• 91% serve people with developmental disabilities, intellectual disabilities, or autism, while 55% serve persons with mental health or psychiatric conditions and 47% serve persons 65 years or older adults and 45% serve people with physical disabilities.
• Two-thirds of the Direct Service Workers employed by Provider Organizations work 36 or more hours per week.
• An average of 89 workers per Provider Organization work primarily in residential settings; an average of 29 workers per Provider Organization provided primarily in-home supports.
• At the same time, the Provider Organizations served fewer people in residential settings than in home settings, with an average of 42 persons receiving residential services and 50 persons receiving in-home supports per Provider Organization. Provider Organizations tended to serve more people in day programs or with rehabilitative or medical supports.
• Two-thirds of a Provider Organization’s Direct Service Workforce has had more than 12 months of continuous paid employment.
• Workers providing day program and other community support services tended to be paid more than workers providing job or vocational services, residential services, or in-home supports.
• 39% of Provider Organizations pay 76% or more of the health insurance premium for their Direct Service Workers.
• 92% of Provider Organizations offer vacation or paid time off to their full time workers.
• Provider Organizations were more likely to identify finding qualified workers as a workforce challenge, with worker turnover the second most frequently identified challenge.

Suggested Citation: Westcott D, Griffin E, Fralich J. Maine Direct Service Workforce Survey Results of 2012. (Chartbook).  Portland, ME: University of Southern Maine, Muskie School of Public Service; November 2012.