An Act To Support Maine Families through Universal Family Care
Maine Legislature, Session 128, LD 1612
Committee: Health and Human Services
Sponsors: GATTINE, BELLOWS, COLLINGS, HAMANN, MADIGAN, SYLVESTER, WARREN, CARSON
Amends: 5 MRSA §12004-G, 5 MRSA §12004-I, 22 MRSA §7288, 22 MRSA §7289

Legislative Document
No. 1612
H.P. 1110
House of Representatives, May 17, 2017
An Act To Support Maine Families through Universal Family Care
Reference to the Committee on Health and Human Services suggested and ordered printed.
ROBERT B. HUNT
Clerk
Presented by Representative GATTINE of Westbrook.
Cosponsored by Senator BELLOWS of Kennebec and
Representatives: COLLINGS of Portland, HAMANN of South Portland, MADIGAN of 
Waterville, SYLVESTER of Portland, WARREN of Hallowell, Senator: CARSON of 
Cumberland.
Be it enacted by the People of the State of Maine as follows: 
Sec. 1.  5 MRSA §12004-G, sub-§14-I is enacted to read: 
14-I.   
Sec. 2.  5 MRSA §12004-I, sub-§30-B is enacted to read: 
30-B.   
Sec. 3.  22 MRSA sub-T. 4, Pt. 4 is enacted to read: 
PART 4 
FAMILY CARE SERVICES 
CHAPTER 1606 
UNIVERSAL FAMILY CARE 
§7285.  Definitions 
As used in this chapter, unless the context otherwise indicates, the following terms 
have the following meanings. 
1.  Advisory committee.  "Advisory committee" means the Universal Family Care 
Trust Fund Advisory Committee described in section 7289. 
2.  Board.  "Board" means the Universal Family Care Trust Fund Board described in 
section 7288. 
3.  Eligible person.  "Eligible person" means a person determined to be eligible 
under the program 
4.  Executive director.  "Executive director" means the executive director of the 
board. 
5.  Fund.  "Fund" means the Universal Family Care Trust Fund established under 
section 7287. 
6.  In-home and community support services.  "In-home and community support 
services" means health and social services and other assistance required to enable adults 
Health Care 
Universal Family 
Care Trust Fund 
Board 
Expenses Only 
MRSA §7288 
Health Care 
Universal Family 
Care Trust Fund 
Advisory Committee 
Not Authorized 
MRSA §7289 
with long-term care needs to remain in their places of residence.  These services include, 
but are not limited to, self-directed care services; medical and diagnostic services; 
professional nursing; physical, occupational and speech therapy; dietary and nutrition 
services; home health aide services; personal care assistance services; companion and 
attendant services; home repair, chore and homemaker services; respite care; hospice 
care; counseling services; transportation; small rent subsidies; various devices that lessen 
the effects of disabilities; and other appropriate and necessary social services. 
7.  Universal Family Care Program.  "Universal Family Care Program" or 
"program" means the program created under section 7286. 
§7286.  Program established 
The Universal Family Care Program is established.  The program provides child care 
and in-home and community support services to individuals and families determined to 
be eligible under this chapter.  The program must have a unified system for intake and 
eligibility determination for all consumers.  Income may not be a factor for eligibility for 
any services provided under the program.  The board oversees all funding for services 
provided pursuant to the program. 
§7287.  Universal Family Care Trust Fund established 
The Universal Family Care Trust Fund is established as a nonlapsing fund managed 
by the board to support the program.  The fund may receive any revenue appropriated or 
allocated to the fund and receives all funds deposited in the fund from any other source.  
Funds in the fund may be invested in the same manner as permitted for investment of 
funds held in the State Treasury. 
§7288.  Universal Family Care Trust Fund Board 
The Universal Family Care Trust Fund Board, established in Title 5, section 
12004-G, subsection 14-I, oversees and manages the fund and its use under the program 
in accordance with this chapter. 
1.  Membership of the board.  The board consists of the following members: 
A.  Two members who are child care providers; 
B.  Two members who represent placement agencies as defined in section 1717, 
subsection 1, paragraph C-1; 
C.  Two members who are employees of child care providers who are providing 
direct care services, one of whom is an employee of a child care center as defined in 
section 8301-A and one of whom is an employee of a family child care provider as 
defined in section 8301-A; 
D.  Two members who are employees of home care agencies who are providing 
direct care services; 
E.  Two parents or guardians of children under 4 years of age and receiving child care 
services at the time the parent or guardian becomes a member of the board; and 
F.  Two members receiving home care services, or family members or guardians of 
individuals receiving home care services. 
2.  Term; vacancy.  By February 1, 2018, the Speaker of the House of 
Representatives shall appoint 6 members to the first board that satisfy the requirements of 
subsection 1, paragraphs A to F, and the President of the Senate shall appoint 6 members 
to the board that satisfy the requirements of subsection 1, paragraphs A to F, except that 
of the members appointed under subsection 1, paragraph C, the Speaker of the House 
shall appoint the employee of a family child care provider and the President shall appoint 
the employee of a child care center.  A member of the first board serves for a one-year 
term or until the election of that member's successor under subsection 3.  A vacancy on 
the first board is filled in the same manner by the appointing authority for the unexpired 
portion of the term. 
3.  Election of board.  The department shall establish procedures to provide for 
elections of board members after the terms of the first board expire.  At least one year 
prior to each election, the department shall provide to the board lists of all licensed child 
care providers and licensed home care agencies including owners, directors, staff 
members and direct care employees.  The board shall determine and compile a list of the 
names and addresses of all parents and guardians with children receiving child care 
services and home care services through the program and provide the list to the 
department.  Based on compiled lists, the department, in consultation with the board, 
shall identify all persons who have direct interests related to each member's required 
qualifications under subsection 1, referred to in this subsection as "that member's 
constituency."  The department shall establish and administer a system of nomination and 
secret ballot voting by mail under which each member is elected by vote of that member's 
constituency. 
4.  Terms; compensation; vacancy.  A member of the board elected under 
subsection 3 serves a 3-year term and may serve no more than 4 terms.  Members  receive 
no compensation for service but are entitled to any necessary expenses, including travel 
expenses, incurred in the discharge of their duties.  A vacancy during the term of a 
member elected under subsection 3 may be filled by appointment by the commissioner 
for the remainder of the member's term.  A member representing those receiving child 
care services in subsection 1, paragraph E or home care services in subsection 1, 
paragraph F who no longer receives those services may serve out the remainder of the 
member's term.  A member of the board appointed or elected under subsection 1, 
paragraph A, B, C or D is no longer eligible to serve if that member no longer meets the 
requirements of the respective paragraph unless that person is moving to new 
employment that will permit the member to meet the same requirements and the gap in 
employment is no longer than 4 weeks. 
5.  Board responsibilities.  The board: 
A.  Shall manage the fund to ensure the long-term sustainability of the fund; 
B.  Shall determine the amount of funding from the fund to be used for services 
funded under the program; 
C.  Shall set reimbursement rates for services under section 7290 or 7291 eligible for 
reimbursement under the program in a manner that maximizes access to those 
services, supports workforce development and ensures service quality; 
D.  May by rule manage eligibility under the program to ensure the program does not 
negatively affect the financial health of the fund; 
E.  May create advisory committees to advise the board on the program and fund; 
F.  May collect and disseminate information related to the program; 
G.  Shall report annually, no later than December 31st, to the Legislature on the status 
of the fund, including revenues, expenditures on child care and in-home and 
community support services, administrative costs, provider reimbursement rates and 
any other relevant information relating to the fund; 
H.  Shall advise the Governor and the Legislature on appropriate policies related to 
child care and in-home and community support services; and 
I.  Shall undertake any other functions necessary to implement the program and 
enable the board to carry out its powers and duties under this chapter. 
6.  Administrative support; executive director.  The board shall employ an 
executive director to administer the program, to provide administrative, managerial and 
technical support for the operations of the board and to compile annual reports.  The 
executive director must have financial and accounting expertise.  The board shall 
determine the appropriate salary of the executive director, who serves at the pleasure of 
the board.  The executive director may hire additional professional staff necessary to 
administer the program. 
§7289.  Universal Family Care Trust Fund Advisory Committee 
The Universal Family Care Trust Fund Advisory Committee is established under 
Title 5, section 12004-I, subsection 30-B. 
1.  Members.  The advisory committee is composed of the following, or their 
designees: 
A.  The commissioner; 
B.  The Commissioner of Labor; 
C.  The Commissioner of Education; 
D.  The Treasurer of State; 
E.  The President of the Senate; and 
F.  The Speaker of the House of Representatives. 
2.  Duties.  The advisory committee shall, on a quarterly basis, review the policies 
and financial management of the fund and provide guidance and advice to the board and 
the executive director. 
§7290.  Child care services 
Notwithstanding any other provision of law, child care is available free to parents and 
guardians under the program in accordance with rules adopted by the board.  
Notwithstanding any other provision of law, federal child care subsidies under the 
Temporary Assistance for Needy Families program, established in chapter 1053-B, and 
the federal Child Care and Development Fund block grant as well as all money in the 
fund designated by the board to support the services funded under this section must be 
applied by the department in accordance with this section and rules adopted under this 
section. 
1.  Children under one year of age.  Beginning July 1, 2019, in accordance with 
rules adopted by the board, a parent or guardian with a child or children under one year of 
age, upon application to the department, receives vouchers from the department to pay 
the full cost of enrollment in a child care facility or nursery school of the parent's or 
guardian's choosing, including a facility or school licensed under chapter 1673 or 1675 or 
an unlicensed facility or school.  The department shall, upon application by a parent or 
guardian who is not employed and has a child or children under one year of age for whom 
that parent or guardian provides child care, pay to that parent or guardian $125 each 
month per child. 
2.  Children under 2 years of age.  Beginning July 1, 2020, in accordance with rules 
adopted by the board, a parent or guardian with a child or children under 2 years of age, 
upon application to the department, receives vouchers from the department to pay the full 
cost of enrollment in a child care facility or nursery school of the parent's or guardian's 
choosing, including a facility or school licensed under chapter 1673 or 1675 or an 
unlicensed facility or school.  The department shall, upon application by a parent or 
guardian who is not employed and has a child or children under 2 years of age for whom 
that parent or guardian provides child care, pay to that parent or guardian $125 each 
month per child. 
3.  Children under 3 years of age.  Beginning July 1, 2021, in accordance with rules 
adopted by the board, a parent or guardian with a child or children under 3 years of age, 
upon application to the department, receives vouchers from the department to pay the full 
cost of enrollment in a child care facility or nursery school of the parent's or guardian's 
choosing, including a facility or school licensed under chapter 1673 or 1675 or an 
unlicensed facility or school.  The department shall, upon application by a parent or 
guardian who is not employed and has a child or children under 3 years of age for whom 
that parent or guardian provides child care, pay to that parent or guardian $125 each 
month per child. 
4.  Rules; local market rates.  Pursuant to section 7293, the board shall adopt rules 
governing the provision of vouchers and payments for child care under this section.  The 
board shall determine an appropriate methodology for studying local market rates before 
setting payment rates under this subsection.  The rules must provide that, no later than 
July 1, 2019, payment rates for child care services are at least equal to the 75th percentile 
of local market rates for the various categories of child care services and the payment 
rates for child care services for children with special needs must be higher than the 75th 
percentile of local market rates. 
§7291.  In-home and community support services 
Notwithstanding any other provision of law, in-home and community support 
services are available to all eligible persons under this section in accordance with rules 
adopted by the board.  Notwithstanding any other provision of law, all available federal 
matching funding for Medicaid services and Medicaid waiver programs and all state 
funding for elder services provided in the home as well as all money in the fund 
designated by the board to support the services funded under this section must be applied 
by the department in accordance with this section and rules adopted under this section.  In 
accordance with rules adopted by the board pursuant to section 7293: 
1.  Assessment.  Eligibility under this section must be assessed by a medical 
professional; 
2.  Assistance needed.  An eligible person must need assistance with at least one of 
the activities of daily living as defined in section 7302, subsection 1-A; 
3.  Residence.  An eligible person receiving services under this section must reside in 
that person's own home or in another private home in the community but may not reside 
in a hospital, nursing facility, intermediate care facility for persons with intellectual 
disabilities, adult family care home or private nonmedical institution; and 
4.  Extent of services.  Services provided under this section must be provided to the 
extent they are necessary to allow the eligible person to remain living in that person's own 
home or in another private home in the community and as long as they are necessary to 
assist with the eligible person's activities of daily living. 
§7292.  Outreach 
Beginning April 1, 2018, in accordance with rules adopted by the board, all 
employers in the State must display in work places posters notifying employees of the 
universal child care and in-home and community support services available under the 
program.  The Department of Labor shall produce and distribute all posters required 
under this section. 
§7293.  Rules 
The board shall adopt rules necessary to implement this chapter.  Rules adopted by 
the board pursuant to this section are routine technical rules as defined in Title 5, chapter 
375, subchapter 2-A. 
Sec. 4.  Program development and implementation.  The following 
provisions govern the development and implementation of the Universal Family Care 
Program established under the Maine Revised Statutes, Title 22, chapter 1606. 
1.  Development of revenue source.  By December 15, 2017, the Department of 
Administrative and Financial Services, Bureau of Revenue Services shall develop and 
submit to the Joint Standing Committee on Health and Human Services draft legislation 
to establish universal family care taxes to provide funding for the Universal Family Care 
Program, established in the Maine Revised Statutes, Title 22, section 7286.  The draft 
legislation must be structured to include 3 elements: 
A. A tax on wages that applies in a manner substantially equivalent to the federal 
Social Security's Old-Age, Survivors, and Disability Insurance program tax, with the 
same rates as the federal tax rates and applicable in the same manner to employees 
and employers but that applies only to earnings above the annual contribution and 
benefit base of the federal tax; 
B. A self-employment tax applicable to taxpayers who are subject to the federal 
Self-Employment Contributions Act tax that applies to net earnings in a substantially 
equivalent manner and at the same rates as that federal tax but that applies only to net 
earnings above the annual limit of net earnings subject to taxation under that federal 
tax; and 
C.  A tax on unearned annual income over $127,000, indexed to changes in the wage 
and earning thresholds applicable under paragraphs A and B, that applies in a manner 
similar to the federal Net Investment Income Tax imposed under 26 United States 
Code, Section 1411 with a tax rate that is the same as that applicable to net earnings 
subject to tax under paragraph B. 
The Joint Standing Committee on Health and Human Services shall report out a bill to the 
to fund the Universal Family Care Program. 
2.  Start-up; appointment of first board.  No later than March 1, 2018, the initial 
Universal Family Care Trust Fund Board established under the Maine Revised Statutes, 
Title 22, chapter 1606 shall meet to develop and oversee the implementation of the 
Universal Family Care Program and to plan with the Department of Health and Human 
Services for the election of new members in November 2018.  By March 1, 2018, the 
board shall also examine the need for and develop a plan for maintaining or eliminating 
existing advisory councils relating to the child care and in-home and community support 
services portions of the program and shall submit a report of its recommendations to the 
Joint Standing Committee on Health and Human Services relating to the appropriate roles 
for those councils. 
3.  Waivers.  No later than March 31, 2018, the Department of Health and Human 
Services shall prepare and submit applications to the United States Department of Health 
and Human Services, Centers for Medicare and Medicaid Services to request any 
necessary waivers to implement the Universal Family Care Program under the Maine 
Revised Statutes, Title 22, chapter 1606. 
4.  Development of program over time.  By July 1, 2019, in accordance with the 
Universal Family Care Program established in the Maine Revised Statutes, Title 22, 
chapter 1606, the Department of Health and Human Services shall fund from the 
Universal Family Care Trust Fund established under Title 22, chapter 1606 services for 
5,000 individuals awaiting services under the department's rule Chapter 101:  MaineCare 
Benefits Manual, Section 21.  Selection of eligible individuals must be determined by 
priority need and lottery.  Each subsequent year, the department shall fund services for an 
additional 5,000 individuals awaiting such services until there are no more individuals 
awaiting such services. 
5.  Workforce training center.  The Department of Health and Human Services, in 
consultation with the Department of Labor and the Maine Community College System, 
shall develop workforce training programs for home care and child care workers 
providing services funded under the Universal Family Care Program established in the 
Maine Revised Statutes, Title 22, chapter 1606.  The Department of Health and Human 
Services shall submit a plan for establishing and funding the training programs by 
January 1, 2019 and shall by March 1, 2018 submit a report of its recommendations to the 
Joint Standing Committee on Health and Human Services. 
SUMMARY 
This bill establishes the Universal Family Care Program of universal child care and 
in-home and community support services for all individuals and families who are eligible.  
Eligibility for universal child care is based on the age of the child, and eligibility for 
in-home and community support services is based on medical eligibility.  Income is not a 
factor for eligibility.  The bill establishes the Universal Family Care Trust Fund, which is 
managed by a board composed of members who represent child care providers, home 
care agencies, employees of child care providers and home care agencies and consumers 
of child care and home care services.  The board employs professional staff and receives 
advice from an advisory committee composed of the Commissioner of Health and Human 
Services, the Commissioner of Education and the Commissioner of Labor as well as the 
Treasurer of State, the President of the Senate and the Speaker of the House of 
Representatives.  Base funding for universal child care is from child care funds from the 
Temporary Assistance for Needy Families program and the federal Child Care and 
Development Fund block grant.  Base funding for universal in-home and community 
support services is from federal matching funding related to home and community 
support services and state funding for elder services provided in the home. 
To complete the funding for the Universal Family Care Program, the Department of 
Administrative and Financial Services, Bureau of Revenue Services is directed to develop 
and submit to the Joint Standing Committee on Health and Human Services draft 
legislation to establish universal family care taxes.  The taxes are to be structured to 
include 3 elements: a tax on wages that is substantially equivalent to the federal Social 
Security's Old-Age, Survivors, and Disability Insurance program tax, but that applies 
only to earnings above the annual contribution and benefit base of the federal tax; a 
self-employment tax applicable to taxpayers who are subject to the federal 
Self-Employment Contributions Act tax that is equivalent to that tax and applies to net 
earnings above the annual limit subject to taxation under that federal tax; and a tax equal 
to the wage and self-employment taxes that is imposed on unearned annual income and 
that applies in a manner similar to the federal Net Investment Income Tax.  The bill 
directs the Joint Standing Committee on Health and Human Services to report out a bill to 
the Second Regular Session of the 128th Legislature to establish universal family care 
taxes to fully fund the Universal Family Care Program.