How Maine pays for disability services

Waiver inventory

Maine has no 1915(i), no 1915(k)/Community First Choice, and no 1115 authority for the IDD population. Section 19 (Elderly and Adults with Disabilities, ME.0276) is excluded as aging and physical disability focused. Waiver list verified at medicaid.gov

State-only funded programs

None identified as a distinct service-funding stream. Maine finances adult IDD and autism services almost entirely through MaineCare. What I did find that is state-financed:

• OADS Intake and Eligibility direct case management for people who lack MaineCare coverage and therefore cannot be served by a community case management agency under Section 13. OADS reports this covers typically less than 1% of individuals receiving case management. maine.gov
• Maine's public guardianship and conservatorship program and Adult Protective Services, both operated by OADS as state functions and identified in the biennial plan as system supports and protections rather than service funding. lldc.mainelegislature.org

I checked the 2025-2026 Biennial Plan for Adults with Intellectual Disabilities or Autism, the OADS SFY26 Q2 quarterly report, the OADS data reports index, and the OADS adults with intellectual disability and autism service pages, and found no state-only funded service program with a published appropriation.

County / regional / local funding

None identified. Maine has no county boards of developmental disabilities, no county levies, and no regional center allocations. OADS operates through eight state districts (York; Cumberland; Androscoggin, Franklin and Oxford; Waldo, Lincoln, Knox and Sagadahoc; Kennebec and Somerset; Penobscot and Piscataquis; Washington and Hancock; Aroostook) for intake and eligibility, but these are administrative regions of the state agency with no independent revenue. OADS contracts with 41 case management agencies statewide, all state-funded through MaineCare. maine.gov

Funding scale

• SFY2026 Q2 (October 1 to December 31, 2025) Sections 21 and 29 combined expenditures: $151,058,102.99. SFY2026 Q1 was $192,939,020.27. maine.gov
• State vs federal share, SFY2026 Q2: Section 21 state share $45,783,107.11, federal share $75,335,226.60. Section 29 state share $11,122,786.26, federal share $18,816,983.02. Combined state $56,905,893.37, federal $94,152,209.62, a 37.7% state share. Same source.
• Per member per month and per member per year, SFY2026 Q2: PMPM $21,469.55, PMPY $242,187.90 (Sections 21 and 29 combined). SFY26 Q1 was PMPM $21,484.71, PMPY $242,342.52. Same source.
• FY2023 baseline for comparison: Section 21 enrollment 3,240 with $527,566,580 in expenditures; Section 29 enrollment 2,640 with $100,010,249. lldc.mainelegislature.org
• FMAP: 62.06% FY2025, 61.29% FY2026, 60.62% FY2027. Maine's FMAP is on a declining trajectory, which shifts cost onto the General Fund at constant service volume. kff.org
• People served in DD waivers: 6,362 across Sections 18, 20, 21, and 29 as of March 31, 2026. maine.gov
• Waiting list: Section 21 waitlist 2,524 as of 3/31/2026 (2,324 as of 12/31/2025, of which 739 were Priority 2 and 1,727 Priority 3). Section 29 waitlist 15 as of 3/31/2026 (63 as of 12/31/2025). Section 18 waitlist 286. Section 20 waitlist 14. Unduplicated total 2,824. 73% of people on the Section 21 waitlist lack other insurance coverage. Same source and maine.gov
• Wait time: Of 506 individuals authorized to begin Section 18, 20, 21, and 29 waiver services between April 1, 2024 and March 31, 2025, only 46% had actually started services by March 31, 2025. People meeting Section 21 Priority 1 criteria receive immediate service offers. Same source.

Residential funding detail

Maine funds four distinct residential models under Section 21, with Section 29 limited to shared living and hourly in-home support.

Agency Home Support (T2016), the group home model. This is not a published per diem. Chapter III Section 21 sets hourly support reimbursement rates and requires the provider to compute a facility-specific per diem using the Appendix IIA formula: total weekly authorized support hours multiplied by the hourly rate for each support type, divided by 7 days, divided by the number of members in the facility. There are three hourly rate types: - Regular support hours up to 168 per week: $33.64 per hour (current, per the September 11, 2025 rate study). The in-rule figure effective 1/1/2022 was $32.13. - Hours in excess of 168 per week: $31.91 per hour (in-rule 1/1/2022 figure $28.75). - Medical support hours: $40.51 per hour (in-rule 1/1/2022 figure $38.69). A billing floor applies: if actual hours delivered fall below 92.5% of authorized hours in a week, the per diem is reduced. Facilities range from 1 to 6 members. Homes are licensed and rates carry a service provider tax component.

Shared Living (S5140). Paid as a per diem that steps down by number of members served, with an "increased level of support" variant: - Current: $189.49 per diem (1 member), $142.12 (2 members), $113.69 (3 members), presented on a 350-day billing year basis. - The in-rule Chapter III Section 21 table (effective 1/1/2022) lists S5140 at $163.71 per diem for one member, $241.75 with increased level of support, $122.78 for two members, and $184.17 for two members with increased support.

Family-Centered Support (T2016 U5), Section 21 only. In-rule per diems effective 1/1/2022: $143.03 (1 member), $305.52 (1 member, increased support), $117.80 (2 members), $277.70 (2, increased), $100.45 (3), $252.06 (3, increased), $85.13 (4), $229.44 (4, increased), $75.92 (5 or more), $216.35 (5 or more, increased).

Home Support Quarter-Hour (T2017), the in-home and own-home model. $10.94 per 15 minutes current ($43.76 per hour); in-rule 1/1/2022 figure $10.45. A remote-support monitor-only variant (T2017 QC) runs $3.07 per 15 minutes current, $2.93 in rule.

Where people actually live (SFY26 Q2, Sections 21 and 29 combined): group home (T2016) 1,977, shared living (S5140) 2,493, in-home supports (T2017) 769. Group home counts fell from 2,020 in Q1 while shared living rose from 2,400, a visible shift toward shared living. An additional 193 adults resided in an ICF under Section 50.

Room and board is not funded by the waiver. Maine's Section 21 and 29 rate models are built on service costs only. The rate study notes shared living and agency home support per diems are set on a 350-day billing year specifically to account for occasional absences, which is a service-cost mechanism, not a housing payment. Room and board in group homes and shared living is met from the person's own income, principally SSI. I did not locate a Maine document stating a state-funded room and board supplement for these settings.

Rate structure links: maine.gov (Chapter III Section 21, including Appendices I, IIA, IIB) and maine.gov

Comparable service rates

Maine is mid-transition. The "current" column below reflects rates as documented by Burns and Associates / Health Management Associates in the September 11, 2025 final recommended rate model report prepared for Maine DHHS, which is the most recent official statement of Sections 21 and 29 rates in effect. A 1% cost-of-living adjustment took effect January 1, 2026 on top of these. The proposed replacement rates are shown for context but are marked as not yet in effect (the rate reform page lists "Effective Date: Pending Rulemaking").

Official rate schedule links

• MaineCare Provider Fee Schedule portal, the authoritative posting location under 22 M.R.S. §3173-J(7): mainecare.maine.gov (this host presented an incomplete TLS certificate chain during this session and I could not retrieve it; it is cited because Chapter III Section 29 names it as the official rate location)
• MaineCare Benefits Manual Chapter III Section 21, Allowances for Home and Community Benefits, with Appendices I, IIA, and IIB rate tables and the agency home support per diem formula: maine.gov
• MaineCare Benefits Manual Chapter III Section 29, Allowances for Support Services (filing 2024-104), service and unit list plus reimbursement methodology: maine.gov
• MaineCare Benefits Manual Chapter II Section 21 (filing 2022-087), covered services: maine.gov
• MaineCare Benefits Manual Chapter II Section 29 (filing 2024-012): maine.gov
• Final Recommended Rate Models, Sections 18, 20, 21, 29, September 11, 2025, with current-versus-proposed rate comparison: maine.gov
• Final Recommended Rate Models, Lifespan: maine.gov
• Proposed Rate Models, April 14, 2025: maine.gov
• MaineCare Rate System Reform hub, with the full rate determination schedule and every notice: maine.gov
• Maine Secretary of State rules index for 10-144 Chapter 101: maine.gov

Notable features and flags

• February 4, 2026: DHHS published the Comment Summary with Department Response and Final Draft Rate Models for Sections 18, 20, 21, 29 and the new Lifespan program. The rate reform page still lists "Effective Date: Pending Rulemaking," so the redesigned rates are not yet in force. The redesign would replace the agency home support hourly-plus-formula structure with fixed tiered per diems that vary by home size (2, 3, or 4+ beds) and assessed acuity (Tiers 1 through 4), running from $360.05 to $796.83 per day. Shared living would move from a flat per diem to four acuity tiers ($204.72 to $259.93 for one member). Respite per diem would nearly double, from $318.93 to $585.76.
• January 1, 2026: A 1% cost-of-living adjustment took effect on Sections 21 and 29 rates, directed by P.L. 2025, Ch. 388 (Part GGG). Note that the separate January 1, 2026 COLA rulemaking notice covering 13 other sections did not include 21 or 29, which are handled through their own rate determination track. Under 22 M.R.S. §7402(1) the labor component of essential support worker rates must equal at least 125% of Maine's minimum wage. maine.gov
• February 26 to 27, 2026: DHHS posted amendments to both the Section 21 and Section 29 waivers, updating Direct Care Worker service specifications for a revised certification curriculum, revising Appendix C-4 annual caps on combined services, adding grievance procedures required by the CMS Ensuring Access to Medicaid Services final rule (CMS-2442-F), and updating cost neutrality for waiver years 1 through 5. The comment period closed March 29, 2026.
• February 4, 2025: Section 21 (ME.0159) was submitted for a five-year renewal running through July 1, 2030, aligning it with Maine's four other 1915(c) waivers, adopting the CAHPS satisfaction survey, moving provider verification from a three-year to a five-year cycle, and clarifying that family members may be paid only for Shared Living and Non-Medical Transportation.
• Lifespan Waiver, target July 2026: Authorized by P.L. 2023, Ch. 412, Part LLLLL, this would consolidate Sections 21 and 29 into a single waiver with enrollment starting at age 14. As of this research the program is not operational and its rates remain pending rulemaking. Existing Section 21 and 29 recipients would not be forced to transition.
• Section 21 waitlist is the structural problem. 2,524 people waiting against 2,990 enrolled as of March 31, 2026, and the waitlist grew during SFY26 (2,284 in Q1 to 2,324 in Q2 to 2,524 by Q3-end). Section 29 by contrast is effectively unwaitlisted at 15 people. Only 46% of people authorized for waiver services in the prior year had actually started them within twelve months, which points to provider capacity rather than funding authorization as a binding constraint. Case management agencies themselves report vacancies and waitlists in the OADS quarterly data.

Confidence

Solid: enrollment and waitlist counts by waiver and quarter, the state and federal expenditure split for Sections 21 and 29 (Maine publishes this directly, which is unusual and valuable), PMPM and PMPY, residential setting counts, CMS control numbers, FMAP, the Chapter III Section 21 in-rule rate tables and the agency home support per diem formula, and the September 2025 current-versus-proposed rate comparison. Estimated: nothing material; where two vintages of a rate exist I have shown both with their dates rather than picking one. Not found: the live MaineCare Provider Fee Schedule values reflecting the January 1, 2026 COLA, because mainecare.maine.gov presented an incomplete TLS certificate chain and could not be retrieved in this session, so the rates above are pre-COLA and should be read as roughly 1% low; the Section 13 targeted case management rate; any state-only funded IDD service program with a published appropriation; and any state-funded room and board supplement for group home or shared living residents.

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