An Act To Allow Qualifying Medicaid Recipients To Hire Relatives and Legal Guardians for Consumer-directed Attendant Services
Maine Legislature, Session 128, LD 1708
Committee Amendment CA_A_H664 (House)

COMMITTEE AMENDMENT "A" to H.P. 1188, L.D. 1708, Bill, "An Act To 
Allow Qualifying Medicaid Recipients To Hire Relatives and Legal Guardians for 
Consumer-directed Attendant Services" 
Amend the bill by strildng out the title and substituting the following: 
'Resolve, Directing the Department of Health and Human Services To Allow 
Relatives and Legal Guardians To Provide Home and Community-based Services to 
Eligible Members' 
Amend the bill by striking out everything after the title and before the summary and 
inserting the following: 
'Sec. 1. Department of Health and Human Services request to amend 
waiver. Resolved: That, no later than January 1, 2019, the Department of Health and 
Human Services shall submit a request to the United States Department of Health and 
Human Services, Centers for Medicare and Medicaid Services to amend the existing 
1915(c) waiver that provides home and community-based services under the department's 
rule Chapter 101: MaineCare Benefits Manual, Chapter II, Section 19 to allow eligible 
members to receive services provided by relatives, including spouses, or legal guardians 
who are employed to provide those services; and be it further 
Sec. 2. Rulemaking. Resolved: That the Department of Health and Human 
Services, upon receiving notice of approval for the amendment to the 1915(c) waiver 
from the United States Department of Health and Human Services, Centers for Medicare 
and Medicaid Services pursuant to section 1, shall amend the department's· rule Chapter 
101: MaineCare Benefits Manual, Chapter II, Section 19 to allow for relatives, including 
spouses, or legal guardians to be employed as caregivers for the eligible members; and be 
it further 
Sec. 3. Report. Resolved: That the Department of Health and Human Services 
shall report to the joint standing committee of the Legislature having jurisdiction over 
health and human services matters with an interim report by April 30, 2019 outlining the 
progress of applying for, receiving and implementing the amended 1915(c) waiver 
COMMITTEE AMENDMENT 
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d, Co· 
COMMITTEE AM.ENDMENT "ft" to H.P. 1188, L.D. 1708 
pursuant to section 1. The department shall submit a final report no later than January 1, 
2020 with data on the number of people receiving services under the department's rule 
Chapter 101: MaineCare Benefits Manual, Chapter II, Section 19 who employ caregivers 
who are relatives, including spouses, or legal guardians, the costs or savings from the 
employment of relatives or legal guardians as caregivers and recommendations on the 
feasibility of future similar expansion to other MaineCare programs or other potential 
waivers available under Medicaid. 
The joint standing committee of the Legislature 
having jurisdiction over health and human services matters may report out a bill to the 
contained in the report; and be it further 
Sec. 4. 
Appropriations and allocations. Resolved: 
That the following 
appropriations and allocations are made. 
HEALTH AND HUMAN SERVICES, DEPARTMENT OF 
Long Term Care - Office of Aging and Disability Services 0420 
Initiative: Provides funding for the fiscal intermediary service required to allow eligible 
members to receive services provided by relatives, including spouses or legal guardians. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
Medical Care - Payments to Providers 0147 
2017-18 
$0 
$0 
2018-19 
$124,188 
$124,188 
Initiative: Provides funding to amend the existing 1915(c) waiver that provides home and 
community-based services under the Department of Health and Human Services rule 
Chapter 101: MaineCare Benefits Manual, Chapter II, Section 19 to allow eligible 
members to receive services provided by relatives, including spouses or legal guardians. 
GENERAL FUND 
All Other 
GENERAL FUND TOT AL 
FEDERAL EXPENDITURES FUND 
All Other 
FEDERAL EXPENDITURES FUND TOTAL 
2017-18 
$0 
$0 
2017-18 
$0 
$0 
2018-19 
$468,780 
$468,780 
2018-19 
$850,797 
$850,797 
Office of MaineCare Services 0129 
Initiative: Provides funding for the fiscal intermediary service required to allow eligible 
members to receive services provided by relatives, including spouses or legal guardians. 
COMMITTEE AMENDMENT 
Co· 
cy-
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COMMITTEE AMENDMENT "A" to H.P. 1188, L.D. 1708 
FEDERAL EXPENDITURES FUND 
All Other 
FEDERAL EXPENDITURES FUND TOTAL 
HEALTH AND HUMAN SERVICES, 
DEPARTMENT OF 
DEPARTMENT TOTALS 
GENERAL FUND 
FEDERAL EXPENDITURES FUND 
DEPARTMENT TOTAL-ALL FUNDS 
SUMMARY 
2017-18 
$0 
$0 
2017-18 
$0 
$0 
$0 
2018-19 
$124,188 
$124,188 
2018-19 
$592,968 
$974,985 
$1,567,953 
This amendment replaces the bill with a resolve. 
The amendment requires the 
Department of Health and Human Services to submit a request to the United States 
Department of Health and Human Services, Centers for Medicare and Medicaid Services 
to amend the current 1915(c) waiver so that eligible members receiving home and 
community-based services under the department's rule Chapter 101: MaineCare Benefits 
Manual, Chapter II, Section 19 will be able to receive services provided by relatives, 
including spouses, or legal guardians who are employed to provide those services. It 
requires the department to amend its rules after the amended waiver approval has been 
received from the Federal Government. The amendment requires the department to 
provide an interim report and a final report regarding the progress in applying for, 
receiving and implementing the amended waiver, as well as data on the number of 
individuals receiving services from relatives, including spouses, or legal guardians, any 
information about costs or savings and recommendations about the feasibility for 
similarly expanding other MaineCare programs or other potential waiver programs 
available under Medicaid. It also adds an appropriations and allocations section. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 02/28/18 frac::.. 
LD 1708 
LR 2622(02) 
An Act To Allow Qualifying Medicaid Recipients To Hire Relatives and Legal Guardians for 
Consumer-directed Attendant Services 
Fiscal Note for Bill as Amended by Committee Amendment A, (/1 ·tt 'I) 
Committee: Health and Human Services 
Net Cost (Savings) 
General Fund 
Appropriations/ Allocations 
General Fund 
Federal Expenditures Fund 
Revenue 
Federal Expenditures Fund 
Fiscal Detail and Notes 
Fiscal Note Required: Yes 
Fiscal Note 
FY 2017-18 
$0 
$0 
$0 
$0 
FY 2018-19 
$592,968 
$592,968 
$974,985 
$974,985 
Projections 
FY2019-20 
$789,831 
$789,831 
$1,300,771 
$1,300,771 
Projections 
FY 2020-21 
$789,831 
$789,831 
$1,300,771 
$1,300,771 
The bill includes General Fund appropriations to the Department of Health and Human Services of $592,968 in fiscal 
year 2018-19 to amend the existing 1915 (c) waiver that provides home and community based services under the 
Department of Health and Human Services rule Chapter 101: MaineCare Benefits Manual, Chapter II, Section 19, to 
allow eligible members to receive services provided by relatives, including spouses, or legal guardians and for the 
fiscal intermediary service required to provide payments for eligible members receiving services to relatives, 
including spouses or legal guardians. Federal Expenditures Fund allocations are also included for the FMAP match. 
LR2622(02) - Fiscal Note - Page 1 of 1