Strengthening Maine’s Care and Support Systems: Turning Ideas into Policy

The direct care workforce is the backbone of Maine’s healthcare and support system, providing essential services to older adults, people with disabilities, and individuals with behavioral health challenges across the state. Yet, this workforce faces daunting systemic challenges, including low pay, poor job quality, and outdated training and credentialing systems. These factors have created a staggeringly large care gap and led to unsustainably high costs to Maine’s economy, its government, and the people and families who depend on its care systems.

In response, Maine’s Essential Care & Support Workforce Partnership brought experts from across the state together into three working groups—focused on 1) wages and benefits, 2) credentialing and training, and 3) technology. Each group developed targeted recommendations to address the challenges facing Maine’s direct care workforce. As detailed below, these recommendations informed an omnibus bill championed by Speaker Ryan Fecteau that will be taken up in Maine’s current legislative session.

Working Groups and Their Recommendations

1. Wages & Benefits and General Working Conditions

This working group addressed one of the most pressing challenges facing the direct care workforce: low pay and benefits. They focused on ways to increase total compensation (not just wages, but also the hours available to workers), to help with access to needed benefits, and to improve working conditions to make essential care and support work more attractive and sustainable.

The Working Group’s recommendations include:

• Increase wages by raising the labor portion of the MaineCare reimbursement rate to 140% of the state minimum wage. Since the vast majority of direct care services are funded through the MaineCare program, the state can meaningfully improve job quality for thousands of direct care workers by increasing payments to providers (like home health agencies) and ensuring that payment increases make their way into workers’ pockets. This would be particularly impactful for the nearly one-third of direct care workers in Maine living in poverty, and the 42 percent relying on public benefits.
• Establish a Direct Care Professional Monthly Benefit Stipend, allowing workers to apply for financial assistance to help pay for the benefits most important to them. This state-created fund would help workers access benefits like healthcare, retirement, childcare, transportation, and educational expenses.
• Create a centralized resource hub to help workers and employers access assistance programs available from the state and their local communities. Even though many direct care workers are eligible for existing benefits, many are not enrolled in them. This state-run hub would help connect the dots.

2. Improving Credentialing & Training

This working group identified how Maine’s fragmented credentialing and training system creates significant barriers to entering the direct care workforce and finding opportunities for career mobility and advancement. Currently, workers do not have the stackable and portable credentials that would allow them to move between settings or move up a career ladder.

The Working Group’s recommendations include:

• Establish a Universal Standardized Core Curriculum that ensures consistency across training programs, improves worker preparedness, and facilitates career mobility. To do this, Maine should create a stakeholder group to oversee reforms, bringing together representatives from state agencies, higher education, providers, workers, and care recipients. Focus particularly on reducing redundant training requirements and certifications while improving the applicability and quality of workers’ training.
• Expand the capacity of education and training providers to reduce wait times for training.
• Increase accessibility through multilingual training options and flexible training schedules. This will allow more people to access and succeed in training.

3. Utilizing Technology to Bridge the Gap

This working group looked at ways to use technology to streamline workforce deployment and scheduling, support people who are currently not being served by Maine’s long-term care system, and enhance the efficiency of the workforce. Their central aim was to advance the use of technology to alleviate workforce shortages and improve service delivery.

Their primary recommendation was to require Maine’s Department of Health & Human Services to develop a Technology Plan to maximize direct care workforce job quality, and the quality and efficiency of care for older adults and people with disabilities.

The Maine Essential Care & Support Workforce Enhancement Act

Integrating recommendations from these three working groups, Speaker Ryan Fecteau introduced the Maine Essential Care & Support Workforce Enhancement Act in 2025. The bill, which has been carried over from last session and will be taken up at a hearing today (January 20), is an omnibus measure designed to more comprehensively address Maine’s direct care workforce shortage. If enacted, the bill would:

1. Raise Wages… by setting the labor portion of MaineCare reimbursement rates to 140% of the minimum wage and making a wage floor of 125% of the minimum wage for all essential care and support workers.
2. Develop a Universal Training and Credentialing System… establishing a stakeholder-driven process to design a universal, standard core curriculum, high-quality training programs, and credentials that ensure a streamlined, more accessible, and competency-based system.
3. Create a Technology Plan… requiring the state to create an Innovations in Care and Support Technology Plan, positioning Maine to harness technological advancements to support direct care workers and improve service delivery.
4. Expand the Advisory Committee… requiring the membership of the Essential Support Workforce Advisory Committee to include a broader range of stakeholders.
5. Begin Comprehensive Data Collection and Reporting… by directing the Maine Health Data Organization to identify gaps in workforce data and to develop a plan to measure and report on the total scope of unmet care needs in the state.
6. Budget for All Care Needs… by requiring the annual MaineCare budget to account for the estimated 23,500 hours of weekly authorized care that currently go unfilled, ensuring future budgets reflect the actual demand for services.

A Path Forward

While Maine has been developing this framework, the federal administration has begun a major shift toward deregulation and federal spending cuts that directly threaten the stability of the direct care workforce nationwide—placing further burden on individual states and long-term care providers to maintain existing service levels.

The recommendations from Maine’s Essential Care & Support Workforce Partnership have given the state a clear framework for recruiting and retaining the direct care workforce Maine’s people and economy desperately need. In the Maine Essential Care & Support Workforce Enhancement Act, the state has a legislative vehicle to take action. Based in the realities faced by workers and care recipients, the bill would raise wages, improve training and credentialing, and harness technology, and it would represent a significant step towards closing Maine’s care gap. If legislators pass this bill, it will help make Maine a leader in building the resilient, well-supported direct care workforce the state needs now and, especially, in the years ahead.