Medicaid Nursing Home Rates by State

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Maine

Medicaid nursing facility payment · Statewide price · researched October 2026

Maine’s Medicaid agency and its state plan are the official source for these rules. This page summarizes them as researched in October 2026; check the state’s own documents, listed under Sources, before relying on them.

At a glance

Rate method

Statewide price

Case-mix level

Resident-level

Classification

PDPM

Rate updates

Once a year

Managed care (LTC)

No

Quality program

NF Quality Bonus Pool (QuEST)

Paid outside the rate

Small

Bed hold

Hospital and leave

Published rates

Statewide schedule

Assisted living

Covered

Personal needs allowance

$40 / month

Overview

• Since 1/1/2025 MaineCare pays a statewide-priced rate with three parts (MBM Ch.
• III Sec. 67, Principle 22).
• (1) Direct care: a statewide 'Hours Per Day' (HPD) price built from 4.44 nursing hours per resident day x wages (the greater of the BLS median or the industry average) + 31% benefits + 8% other direct costs, trended by CPI-W Northeast: $244.87 for CY2025 and $232.01 for CY2026 onward (contract labor share cut from 20% to 10%), plus a 1% COLA on 1/1/2026.
• This is multiplied by each resident's own PDPM nursing-component weight (0.47-2.91).
• (2) Routine care: one statewide price of $137.20 (2023 median cost trended to 6/30/2025, set at the 75th percentile after an 85% occupancy floor), plus the 1% COLA.
• (3) Capital: the home's own allowable capital cost per day of care, paid as an interim rate and cost-settled at audit.
• Through CY2027, 'guardrails' limit each home's direct and routine gain or loss against its 2023 cost-based amount (Year 1: +20%/-0%;
• Year 2: +10%/-5%;
• Year 3: +5%/-10%), so homes are still moving toward the statewide price.
• At weight 1.0 a home at the full 2026 price with average capital ($42.26) gets about $415/day (232.01 x 1.01 + 137.20 x 1.01 + 42.26; derived, not published).

What matters in Maine

• Since 1/1/2025, statewide prices replace cost-based rates: direct care $232.01 and routine $137.20 per day before the 2026 COLA.
• Case mix is per resident: direct care x that resident's PDPM nursing weight, 0.47 to 2.91; routine and capital are flat.
• Guardrails through 2027 hold each home near its 2023 cost: gains capped at 10% and losses at 5% in 2026.
• Capital, including the 6% provider tax, is paid at audited actual cost, a dollar-for-dollar pass-through.
• An $8.1 million yearly quality pool runs 2025-2027; withholds of 1-2% are planned but not yet adopted.
• No managed care: MaineCare pays nursing homes fee-for-service; next full rebase is set for 1/1/2028.

Frequently asked

Does Maine apply nursing home case mix per resident or per facility?

Per resident. Each MaineCare claim multiplies the home's direct care rate by that resident's PDPM nursing weight (0.47 to 2.91) from the latest OBRA assessment. Routine and capital rates are the same for every resident.

How does Maine return the nursing home provider tax in Medicaid rates?

The 6% tax on net operating revenue is an allowable capital cost. Capital is paid per day and cost-settled to audited actual cost, so MaineCare repays its share of each home's tax in full rather than through a flat add-on.

When will Maine nursing homes receive the full statewide price?

Guardrails run through 2027, limiting each home's change against its 2023 cost (+10%/-5% in 2026, +5%/-10% in 2027). The next full rebase is set by statute for rates effective 1/1/2028.

How much is paid outside the posted rate in Maine?

Small: only the $8.1M yearly quality pool sits outside the per diem; no IGT, UPL or directed payments.

What does Maine Medicaid pay on Medicare coinsurance days?

Full: MaineCare pays the Medicare coinsurance for full duals up to the Medicare allowed amount; lesser-of only for QMB-only.

Does Maine require a minimum share of spending on care?

No current spending floor; the price is built to fund 125% of minimum wage, but homes are not audited against it.

How the rate is set

How the method got here

Verified October 11, 2026

Cost basis

Uses cost reports

Yes

Cost report

MaineCare nursing facility cost report (state form, calendar-year basis, filed within 5 months of year end with financial statements and the Medicare cost report if Medicare-certified; MBM Ch. III Sec. 67 Principle 13).

Base year and rebasing

The current prices use 2023 as-filed MaineCare cost reports (direct care HPD and wages; routine median), trended to 6/30/2025. The rule still says rebase every two years (Principle 14.2), but PL 2025 c. 664 (LD 2177, effective 7/29/2026) amended 22 MRS 1708(3) so that NF rates 'will be rebased for rates effective January 1, 2028', and after that on the 22 MRS 3173-J rate-reform cycle (a rate determination at least every 5 years, with annual COLAs in between). Capital is updated each year from the latest as-filed cost report and settled to audited cost.

Components

Component	Method	Notes
direct care (HPD price x resident PDPM weight)	Statewide price: HPD 4.44 (CY2026+: RN 0.98, LPN 0.38, CNA 2.64, contract 0.44) x hourly compensation (RN $45.92, LPN $30.75, CNA $20.73 + 31% benefits; contract $66.32) = $197.57, + 8% other direct care = $214.75, x 8.038% CPI-W NE trend = $232.01 (CY2025 was $244.87 with 20% contract labor). +1% COLA 1/1/2026. Multiplied by the resident's Maine-standardized PDPM nursing weight.	Rule says the price was built so homes can pay essential support workers at least 125% of the Maine minimum wage (22 MRS 7402). Regional indices are all 1.00. Guardrails through CY2027 keep each home's pre-case-mix direct rate near its 2023 cost.
routine care	Statewide price $137.20/day: 2023 median routine cost $113.80, trended 14.67% (PPI nursing care facilities; CPI-U energy NE for utilities) to $130.49, adjusted to an 85% minimum occupancy and set at the 75th percentile. +1% COLA 1/1/2026. Not case-mix adjusted.	Covers administration, housekeeping, laundry, dietary, food and activities supplies (Principle 17). Guardrails apply separately from direct care.
capital	Facility-specific: total allowable capital cost / total days of care, from the latest as-filed cost report (interim rate), cost-settled to audited actual cost (Principles 22.4, 23-26). No trend.	Includes depreciation, interest, property taxes, real estate insurance and the nursing facility provider tax (Principle 18.10). Average used in the bariatric example: $42.26/day.
add-ons	Bariatric add-on (prior authorized): Tier 1 (450-599 lb) adds 2.45 CNA hours/day; Tier 2 (600+ lb, or 450-599 lb with 2 comorbidities) adds 4.90 hours, at $37.13/hour, plus bed-offline reimbursement (example totals $270.43 and $361.40/day before COLA). Ventilator add-on: custom prior-authorized rate (CPT 94004).	Bariatric add-on received the 1% COLA on 1/1/2026.

Inflation

Trend to the rate year at rebasing: CPI-W Northeast (direct care), PPI Nursing Care Facilities and CPI-U Energy Services Northeast (routine). Between rebasings, annual COLAs set by the Legislature/appropriation under 22 MRS 3173-J (1.0% on direct and routine effective 1/1/2026, PL 2025 c. 388 Part GGG). Capital is not trended.

Verified October 11, 2026

Case mix

System

PDPM

Applied at

Resident-level

How it works

Each claim carries the resident's own PDPM nursing group (revenue code 0022, MaineCare billing code e.g. AABA6); the home's 'HPD rate after guardrails' is multiplied by that group's Maine weight to get that resident's daily rate (DHHS PDPM billing guide, 12/27/2024; Sec. 67 Principle 22.2).

Classification

PDPM nursing component only (25 groups + default), with Maine-standardized weights: CMS 2023 nursing CMIs divided by Maine's CY2022-2023 day-weighted average CMI of 1.356, so the statewide average is 1.00. Range 0.47 (PA1 and default ZZZZZ) to 2.91 (ES3). PT/OT, SLP and NTA components are masked and not paid.

Applies to

Direct care component only (and the bariatric add-on's direct care piece). Routine and capital are not case-mix adjusted.

Acuity measured from

No facility average: payment follows the active OBRA assessment for each resident. The admission assessment pays from the admission date; later OBRA assessments pay from their ARD to the day before the next required ARD. Residents discharged before an assessment are billed at the default (0.47). Weights are to be recalibrated at rebasing.

Updated

Per resident with each OBRA assessment (admission, quarterly every 92 days, annual, significant change).

Move to PDPM

Moved from Maine's resident-specific RUG-III 45-group system (which needed an Optional State Assessment) to the PDPM nursing component for dates of service from 1/1/2025. OSAs stopped after 12/31/2024; homes bill the PDPM nursing group from the most recent OBRA assessment, with no new assessment required for the switch.

Verified October 11, 2026

Low-acuity residents

Yes. (1) Days Awaiting Placement (DAP): residents no longer medically eligible for NF care who are waiting for a residential care facility placement are paid a flat NF DAP rate under the residential care principles, $129.68/day for 7/1/2026-6/30/2027 (Ch. II Sec. 67.02-10 and 67.06(A)(3); DHHS bulletin 7/28/2026). They also get no hospital bed-hold days. (2) There is no separate carve-out rate for low PDPM groups, but the lowest groups carry low weights on the direct care part (PA1 0.47, PA2 0.51, CA1 0.67, BAB1 0.71), and residents discharged before an assessment are billed at the 0.47 default. Checked: Sec. 67 Ch. II and III, billing guide.

Verified October 11, 2026

Capital

Actual cost, not fair rental: the home's allowable capital costs (depreciation, interest, property tax, real estate insurance, provider tax) divided by total days of care, paid on an interim rate from the latest as-filed cost report and settled to audited actual cost each year (Principles 18, 22.4, 23-26). New capital needs Certificate of Need approval and a legislative appropriation (22.7.1). No occupancy floor on capital in the current rule.

Verified October 11, 2026

Budget adjustment factor

No across-the-board percentage cut. Budget limits work through (1) the guardrails (CY2025-2027), which cap each home's gain at +20%/+10%/+5% while limiting losses to 0%/5%/10%; (2) COLAs set by appropriation (1.0% for 1/1/2026 under PL 2025 c. 388 Part GGG, 'based on appropriations and allocations available'); and (3) capital paid only at audited actual cost.

Verified October 11, 2026

Add-ons and money outside the rate

Paid outside the posted rate

Level

small

Estimate

Under 5% of base. The only recurring payment outside the per diem is the $8.1M/yr Quality Bonus Pool (CY2025-2027), roughly 1-2% of MaineCare nursing facility spending (base total not confirmed in a primary source; derived on the assumption of several hundred million dollars a year). One-time payments ($15M in 2024) are not recurring. No IGT, UPL or directed payments found.

Components

Quality Bonus Pool $8.1M/yr (2025-2027, funded by the Transition Fund); one-time $15M relief (2024).

Source

https://www.maine.gov/dhhs/oms/providers/provider-bulletins/n…

Verified October 11, 2026

Payments by owner type

Applies

no

Detail

No IGT-funded or public-only supplemental payment was found. The only ownership rule is a cap: publicly owned NFs (owned and operated by the State or a local government) cannot receive more than the lesser of their Medicaid allowable cost or the Medicare rate (Principle 37). The rule also defines 'State Assistance' appropriations for public homes, but no current appropriation was found.

Funding

None found.

Source

https://www.maine.gov/sos/sites/maine.gov.sos/files/inline-fi…

Verified October 11, 2026

Quality program

Active

Yes

Program

Nursing Facility Value-Based Purchasing under rate reform: a Quality Bonus Pool (QBP) paid from the Nursing Facility Reform Transition Fund for CY2025-2027, plus planned performance withholds. The QuEST (Quality, Excellence, Staffing and Teamwork) initiative supports homes. Only the 2025 pool is written into the current rule (Sec. 67 Principle 22.6.3).

Funding

New state money: the Nursing Facility Reform Transition Fund (PL 2023 c. 643 Part SSS; $23.2M transferred from the General Fund surplus), plus federal match. From 2026 (per DHHS plan), unearned withholds are added to the pool. DHHS says the pool ends after CY2027 unless the Legislature appropriates more.

Size

$8.1M per year for CY2025, CY2026 and CY2027. CY2025 pool paid 3/11/2026 after CMS approval on 2/25/2026.

Paid as

Annual lump sum (remittance invoice prefix 'NFQB'); planned 1-2% withhold from the monthly rate, paid back quarterly.

Measures

Measure	Source	Weight	How points are earned
Percent nursing staff turnover	CMS Care Compare (PBJ)	50% (CY2027 plan)	Minimum = national 20th percentile; high achiever = higher of national or state median
Long-stay antipsychotic use	MDS QM (Care Compare)	25% (CY2027 plan)	Same minimum / high-achiever thresholds
CoreQ resident and family satisfaction (long stay)	CoreQ survey via AHCA/NCAL TrendTracker	25% (CY2027 plan)	Needs 20 returned surveys and a 30% response rate for each of resident and family; scored late 2026
CY2025 participation: name a quality champion by 6/1/2025; 7 hours of QuEST events and a 1-hour HIE session by 10/1/2025	State	pass/fail	All three required to share the 2025 pool

Scoring period

Calendar year. CY2025 = participation only. CY2026 = meet the minimum on 2 of 3 measures. CY2027 = meet the minimum on all 3, with scores driving the share. Quarterly scorecards since April 2025.

Payment formula

2025: qualifying home's MaineCare bed days / total MaineCare bed days of all qualifying homes x $8.1M, capped by the aggregate UPL. 2026 (proposed): same split for homes meeting 2 of 3 minimums. 2027 (proposed): split by measure scores and MaineCare bed days, with extra for high achievers.

Eligibility

All MaineCare NFs meeting the year's criteria. Planned withholds: 1% in 2026 (exempt if the last 3 scorecards were above the minimum); in 2027, 2% for homes with less than 50% MaineCare/VA '70% Program' occupancy and 1% for others; from 2028, 4%/3%/2% by MaineCare share (<50%, 50-70%, 70%+), with low-share homes barred from the high-achiever pool.

Cadence

Pool paid annually; withholds earned back quarterly once adopted.

Scores published

No. Facility scorecards go to each home; thresholds are posted (NF Quality Thresholds 2026, https://www.maine.gov/dhhs/sites/maine.gov.dhhs/files/inline-…).

Notes

The withhold was due 1/1/2026 but was delayed for rulemaking (DHHS 9/3/2025 and 12/17/2025). No adopted Sec. 67 amendment adding withholds or the 2026-2027 pool rules was found as of 10/2026 (the rule was last substantively amended 4/21/2025). A separate 'deficiency rate' (90% of the per diem until survey deficiencies are fixed, Principle 34) is a penalty, not an incentive.

Verified October 11, 2026

Provider tax

Charged

% of net patient revenue

Standard amount

6% of annual net operating revenue (gross charges less bad debt, charity care and payer discounts), for facility fiscal years from 10/1/2011 (was 5.5% from 1/1/2008; 6% before). Paid monthly as 1/12 of estimated liability, with an annual reconciliation return.

Lower for high-Medicaid homes

no

Returned in the rate

The tax actually paid (only amounts collected by Maine Revenue Services) is an allowable capital cost (Principle 18.10). Capital is paid per day of care and cost-settled to audited actual cost, so the MaineCare share of each home's tax is reimbursed in full. Under 36 MRS 2873(4)(A), revenue from the 5.5% to 6% increase must first reimburse homes' MaineCare share of the increase, with the rest funding COLAs for NFs and medical/remedial PNMIs.

Source

https://legislature.maine.gov/statutes/36/title36sec2872.html

Verified October 11, 2026

Provider tax notes

Health care provider tax on nursing homes: 6% of annual net operating revenue (36 MRS 2872(2)(E), since 10/1/2011). MaineCare treats the tax actually paid as an allowable capital cost, so the Medicaid share comes back through the cost-settled capital rate (Sec. 67 Principle 18.10).

Verified October 11, 2026

Supplemental payments

(1) Quality Bonus Pool: $8.1M/yr lump sums for CY2025-2027 from the Nursing Facility Reform Transition Fund. (2) One-time $15M 'immediate relief' payment to nursing facilities (PL 2023 c. 643 Part SSS-2, 2024). (3) Earlier one-time COVID-era supplemental payments ($25M across NFs, RCFs and adult family care homes in August 2022, PL 2021 c. 635). No IGT-funded, UPL or county-home supplemental program was found.

Verified October 11, 2026

Other add-ons

(1) Bariatric add-on, two tiers, prior authorized (Principle 22.5). (2) Ventilator add-on: custom prior-authorized rate, billed as an ancillary (CPT 94004) and not cost-settled (Principle 38). (3) Extraordinary circumstance allowance for unforeseen cost increases (Principle 31). (4) Capital adjustments for CON-approved projects or refinancing (Principle 32). No COVID-era add-on remains.

Verified October 11, 2026

Units paid separately

(1) Acquired brain injury (ABI) units: cost-based - a direct care price set by OMS plus routine, rehab ancillary and capital at actual cost, settled annually (Principle 35). (2) Community-based specialty units (medical-psychiatric, for former Riverview/Dorothea Dix patients and others): actual allowable cost, inflated and settled (Principle 36). Phase II of rate reform proposed HPD-based PDPM-adjusted rates for these units (Guidehouse draft, 9/3/2025); adoption not confirmed. (3) Ventilator care: prior-authorized custom add-on. (4) Publicly owned NFs: total MaineCare per diem capped at the lesser of Medicaid allowable cost (Medicare cost report) or the Medicare rate (Principle 37). (5) Residents awaiting residential care placement: NF DAP rate $129.68/day. (6) Guardrails do not apply to homes bought after 1/1/2025 or former remote island facilities.

Verified October 11, 2026

Payment rules

Managed care for long-term care

Status

no

Detail

MaineCare has no capitated MCOs for long-term care. NF days are billed fee-for-service to the Office of MaineCare Services under MBM Ch. II/III Sec. 67, with per-home rate letters and DHHS-paid quality pool lump sums. Medicare Advantage plans may pay for Medicare-covered days (Ch. II 67.05: NFs must notify DHHS when a Medicare managed care plan pays the daily rate).

Verified October 11, 2026

Who pays

fee_for_service: MaineCare pays nursing facilities directly on fee-for-service claims (UB-04 with revenue code 0022 and a MaineCare HIPPS-style code). No capitated managed care plan pays for nursing facility care; MaineCare's 'managed care' is primary care case management (MBM Ch. I 1.03-11).

Verified October 11, 2026

Managed care rate floor

Not applicable: no Medicaid managed care plans pay for nursing facility care in Maine.

Verified October 11, 2026

Included in the daily rate

The daily rate covers room, dietary and nursing services, minor medical and surgical supplies, and use of equipment (Ch. II 67.05-13(A); Sec. 60 lists included supplies). Billed separately: physical, occupational, speech and respiratory therapy and other ancillaries (reasonable cost or maximum allowance; PT/OT max 2 hours each per day), pharmacy (Sec. 80), DME needed for bariatric residents, physician and hospital services. Community support services for people with developmental disabilities are paid outside the per diem.

Verified October 11, 2026

Bed hold

Hospital stays

Paid, up to 7 days (midnights) per inpatient hospital stay if the resident is expected to return (since 4/1/2013); prior approval by member transfer form on the day of admission or next working day. The share of the per diem paid is not stated in the rule.

Leave days

Paid, up to 20 overnight leaves per state fiscal year if in the plan of care; cannot extend a hospital bed hold.

Occupancy rule

None.

Notes

No bed hold for residents admitted from home for an expected stay under 30 days, residents under 'extraordinary circumstances', or residents in Days Awaiting Placement. Families may pay for extra hold days, up to the usual semi-private rate.

Source

https://www.maine.gov/sos/sites/maine.gov.sos/files/inline-fi…

Verified October 11, 2026

Personal needs allowance

Per month

40

Effective

Current per MaineCare Eligibility Manual (10-144 CMR ch. 332, Part 14, 6.1.4, as updated 10/1/2026); start date of the $40 amount not found

Notes

$130/month for veterans receiving the reduced $90 VA pension (not in a VA facility) and for single VA-pension recipients in VA nursing facilities. Sheltered-workshop earners keep more, up to the maximum dependent allowance. Residential care facility residents keep $70 ($50 if on SSI). Not COLA-indexed.

Source

https://www.maine.gov/sos/sites/maine.gov.sos/files/inline-fi…

Verified October 11, 2026

Medicare coinsurance days

Method

full

Rule

MBM Ch. I 1.07-5(A): nursing facilities may bill MaineCare for Medicare coinsurance and deductible, and the total from Medicare and MaineCare cannot exceed the Medicare allowed amount. The lesser-of limit (cost sharing only up to what MaineCare would pay under the state plan) applies only to QMB-only members (no other Medicaid), effective 1/1/2014 if CMS approved. Medicare Advantage cost-sharing treatment was not found.

Effect

For full-benefit duals the home usually receives the full Part A coinsurance for days 21-100; for QMB-only members it usually receives $0, since the Medicare rate exceeds the MaineCare rate.

Source

https://www.maine.gov/sos/sites/maine.gov.sos/files/inline-fi…

Verified October 11, 2026

Required care spending

Applies

no

Rule

No current rule requires homes to spend a share of the rate on care or wages, with recoupment. The direct care price is built to fund at least 125% of the minimum wage for essential support workers (22 MRS 7402), but that statute sets what the rate must include, not what homes must pay. Past pass-through mandates were time-limited: the FY2018-19 and 2020-2022 special wage allowances (Principles 39-40) and the pre-2025 COLA rule, which recouped COLAs not matched by front-line wage growth (2019 rule Principle 31).

Source

https://www.maine.gov/sos/sites/maine.gov.sos/files/inline-fi…

Verified October 11, 2026

Occupancy rules

Applies

no

Rule

No facility-level occupancy penalty in the current rule. The statewide routine price was built from costs adjusted to an 85% minimum occupancy, so a home with low occupancy is paid the same price and absorbs the gap. Capital is actual cost / actual days of care. The pre-2025 rule cut fixed costs for homes under 85% (>60 beds) or 80% (<=60 beds) occupancy; that was removed by the 2025 reform. Bed conversions to residential care use the greater of pro forma days or 95% occupancy (Principle 22.8.1.3). Planned VBP withholds scale by MaineCare share of occupancy (see quality_incentive).

Source

https://www.maine.gov/sos/sites/maine.gov.sos/files/inline-fi…

Verified October 11, 2026

MDS accuracy penalties

Yes. DHHS MDS assessment reviews sample 24% of MaineCare residents' assessments (minimum 5). An error rate (unsupported records that raise the case-mix weight) of 34-<37% cuts the direct care rate (after guardrails) 2% for three months; 37-<41%: 5%; 41-<45%: 7%; 45%+: 10%. The cut applies to all MaineCare days in the 3-month period. Failing to correct MDS within 14 days of a written request can trigger the 90% deficiency rate (Principles 16.2.3.4-16.2.3.5).

Verified October 11, 2026

Published rates and changes

How often rates change

A home's rate changes

annual

When

Calendar-year rate letters effective January 1 (rate reform years run Jan-Dec: guardrail step, contract-labor change and COLA all hit 1/1). Capital interim rates are reset from the latest as-filed cost report (rule says by August 1 of the state fiscal year) and on approved capital changes, then settled at audit. Each resident's payment changes with every OBRA assessment through the PDPM nursing weight. Next full rebase: 1/1/2028 (22 MRS 1708(3)(G)).

Verified October 11, 2026

When rates change

January 1 (calendar-year direct and routine rates since the 1/1/2025 reform; e.g. 1/1/2026 COLA rate letters, revised 5/15/2026 and paid back to 1/1/2026). Capital interim updates and CON/refinancing adjustments mid-year. DAP rate on July 1 (state fiscal year).

Verified October 11, 2026

Posted rates

Home-level rates published

No

Where

Per-home rate letters are posted only on the secure Health PAS Online Portal. A statewide Section 67 fee schedule PDF (case-mix weights, prices) is posted on the MaineCare rate-setting pages (e.g. https://mainecare.maine.gov/Provider%20Fee%20Schedules/Rate%2… which returned 404 in 10/2026 during the portal change).

Format

pdf (statewide fee schedule); per-home letters not public

Cadence

Annual (January 1), with revisions as issued.

History

Not determined; the public fee schedule link was unreachable in 10/2026.

Home identifier

Per-home letters use the MaineCare provider ID (not public).

Verified October 11, 2026

Rate build-ups

Published

No

Where

Rate letters (secure Health PAS portal) show each home's build-up: comparison rates, guardrails, 'HPD Rate after Guardrails Applied', routine and capital rates. Statewide price build-ups are in the rule (Principle 22) and DHHS reform presentations.

What they show

Per home: direct care comparison rate vs 2023-based guardrail, HPD rate after guardrails (multiplied by the resident weight at billing), routine rate, capital rate, add-ons.

Format

pdf

Verified October 11, 2026

Recent changes

Verified October 11, 2026

Assisted living

Medicaid assisted living

Covered

yes

Program

State plan, not a waiver: (1) MBM Sec. 97 Private Non-Medical Institution Services, Appendix C (medical and remedial residential care facilities, Maine's main assisted living/residential care setting); (2) MBM Sec. 2 Adult Family Care Services in Level III/IV residential care homes of 8 or fewer residents.

What is paid

Services only: a case-mix adjusted direct care price (MDS-RCA assessment) plus facility-capped personal care costs for Appendix C RCFs; resource-group prices (MDS-ALS) for adult family care. Room and board are paid by the resident from income/SSI plus the state supplement; residents keep a $70 personal needs allowance ($50 on SSI).

Rate

Appendix C RCF rates are facility-specific (rate letters, not public); last changed 7/1/2026 (case-mix and fixed-cost update) and 1/1/2026 (essential support worker wages). Adult family care: unadjusted price $55.29 x MaineCare weight (0.551-1.657) = $30.47-$91.62/day effective 7/1/2019 (Ch. III Sec. 2), with annual COLAs since.

Limits

State plan benefit, no enrollment cap found; requires medical eligibility. RCFs serving 6 or fewer residents without individualized programming are paid a flat rate outside Appendix C.

Source

https://www.maine.gov/sos/sites/maine.gov.sos/files/inline-fi…

Verified October 11, 2026

Sources

1. MaineCare Benefits Manual Ch. III Sec. 67, Principles of Reimbursement for Nursing Facilities (amended 4/21/2025, filing 2025-091; nonsubstantive 5/14/2026) · regulation
2. MaineCare Benefits Manual Ch. II Sec. 67, Nursing Facility Services · regulation
3. DHHS Nursing Facility Guide for Billing PDPM Nursing Component (v1.0, 12/27/2024) · agency page
4. DHHS NF Value-Based Purchasing Updates forum slides (10/15/2025) · agency page
5. DHHS NF QuEST CoreQ recap (12/17/2025) · agency page
6. MaineCare bulletin: NF 2025 Quality Bonus Pool payments released (3/6/2026) · agency page
7. MaineCare bulletin: Sec. 67 NF COLAs effective 1/1/2026 (12/1/2025) · agency page
8. MaineCare bulletin: REVISED Sec. 67 NF rate letters (5/15/2026) · agency page
9. MaineCare bulletin: CAH swing bed and NF Days Awaiting Placement rates SFY2027 (7/28/2026) · agency page
10. MaineCare bulletin: Stakeholder group on the Nursing Facility Reform Transition Fund (8/10/2026) · agency page
11. DHHS MaineCare Rate System Reform page (NF reform materials, Phase II specialty units) · agency page
12. DHHS/Guidehouse NF Specialty Unit Services rate update meeting (9/3/2025) · agency page
13. PL 2023 c. 643 Part SSS (Nursing Facility Reform Transition Fund; $15M one-time payment) · statute
14. PL 2025 c. 388 Part GGG (COLA for MBM Ch. III Sec. 67 effective 1/1/2026) · statute
15. PL 2025 c. 664 (LD 2177), An Act to Update and Improve the MaineCare Reimbursement System · statute
16. 22 MRS 1708(3), Compensation for nursing homes (as amended by PL 2025 c. 664) · statute
17. 22 MRS 3173-J, MaineCare rate-setting system (rate reform law, PL 2021 c. 639) · statute
18. 22 MRS 7402, Essential support worker reimbursement (125% of minimum wage) · statute
19. 36 MRS 2872, Health care provider tax imposed (nursing homes 6%) · statute
20. 36 MRS 2873, Return and payment of tax; application of revenues · statute
21. MaineCare Benefits Manual Ch. I Sec. 1, General Administrative Policies (1.07-5 Medicare cost sharing) · regulation
22. MaineCare Eligibility Manual 10-144 CMR ch. 332 (updated 10/1/2026), Parts 12 and 14 · regulation
23. MaineCare Benefits Manual Ch. III Sec. 97 Appendix C, Principles of Reimbursement for Medical and Remedial Service Facilities · regulation
24. MaineCare Benefits Manual Ch. II Sec. 97, Private Non-Medical Institution Services (2026 amendment) · regulation
25. MaineCare Benefits Manual Ch. II and Ch. III Sec. 2, Adult Family Care Services · regulation
26. MaineCare bulletin: Sec. 97 Appendix C RCF new rates effective 7/1/2026 · agency page
27. MACPAC Nursing Facility Payment Policies compendium (2019 baseline, Maine tab) - used only for the pre-2025 method · secondary

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