Maine voters will see several proposals on their state ballot Nov. 6, the first one being a citizen’s initiative to establish in-home and support services for the elderly and disabled.

Question 1 on the 2018 General Election ballot was introduced by Maine People’s Alliance in an effort, according to the organization, to establish a Universal Home Care program that will “provide in-home and community support services for all people with disabilities living in Maine who require assistance” and “make homecare a more attractive career, including higher wages and greater professionalization.” 

The proposed Act To Establish Universal Home Care for Seniors and Persons with Disabilities asks Maine voters if they want to create the Universal Home Care Program to provide home-based assistance to people with disabilities and senior citizens, regardless of income, funded by a new 3.8 percent tax on individuals and families with Maine wage and adjusted gross income above the amount subject to Social Security taxes, which is $128,400 in 2018.

According to the Maine Office of the Attorney General, the bill establishes a new Universal Home Care Program to provide “in-home and community support services” to senior citizens (65 years of age or older) and persons with physical or mental disabilities residing in Maine who need assistance with at least one activity of daily living.

Individuals residing in a hospital, nursing care facility, intermediate care facility for persons with intellectual disabilities, adult family care home, or residential care facility would not be eligible for the program. Income would not be a factor in determining eligibility, and the services would be made available at no cost to the individuals or their families.

In-home and community support services are defined as meaning health care, social services and other assistance required to enable adults with long-term care needs to remain in their homes.This includes self-directed care services; medical and diagnostic services; professional nursing care; physical, occupational and speech therapy; dietary and nutritional services; personal care assistance; home health aide services; respite care and hospice care; as well as small rent subsidies, transportation, and devices that lessen the effects of disabilities.

A nine-member Universal Home Care Trust Fund Board would be responsible for designing the program and overseeing its administration in accordance with the statute and to the extent of available resources in the Universal Home Care Trust Fund described below.

The board would consist of three representatives from each of the following constituencies:
• personal care agencies
• individual providers and direct service providers employed by in-home and community support service agencies
• recipients of the services, or their family members or guardians

The initial board would be appointed to serve for one year, after which each of these three constituencies would have the power to elect their own representatives to the board in accordance with procedures established by the board. The board would be authorized to hire an executive director and staff to administer the program.

The board’s responsibilities would include creating a process for assessing individuals’ needs and determining the extent of services each person may receive, establishing quality and safety standards for care, setting reimbursement rates for providers, creating a system for providing stipends to family caregivers, and managing the program within the limits of available resources in the fund. If the demand for services exceeded available funds, the board would be authorized to curtail services and to provide varying levels of service to eligible persons based on an assessment of their needs. The legislation authorizes the board to create waiting lists and take other measures as needed to create an orderly process for providing eligible persons with benefits as soon as sufficient funding is available.

The legislation would require service providers to spend a minimum of 77 percent of the funds received through the program on direct service worker costs. Individual workers employed directly by their clients to provide services, rather than through an agency, would be treated as state employees for purposes of the Maine Labor Relations Act, which establishes collective bargaining rights, defines prohibited employment practices, and creates a grievance process for handling labor disputes.

The program would be funded by a new tax of 3.8% on both wage income and non-wage income in excess of a threshold called the “universal home care tax income threshold.” That threshold is equal to the limit on the amount of wages that are subject to Social Security taxes under existing federal law. For wages earned in 2018, this amount is $128,400. It is adjusted annually pursuant to federal law. All of the tax revenue collected would be deposited in the Universal Home Care Trust Fund, to be administered by the Universal Home Care Trust Fund Board.

The tax on wage income, including wages, salaries, tips, and other employee compensation, would be paid by both employers and employees, at the rate of 1.9 percent each, on the amount of wage income that exceeds the threshold. The portion of the tax paid by employees would be withheld from their wages, in the same manner as Social Security taxes. 

The new tax also would apply to non-wage income. Each taxpayer would pay a tax of 3.8 percent on the amount of Maine adjusted gross income (“MAGI”) that exceeds the threshold, reduced by the amount of the tax on wage income paid by the employee and his or her employer.

The proponents of the legislation have stated that the 3.8 percent tax is intended to be applied on an individual basis, meaning that it would apply only to the amount of each individual’s earned and unearned income above the threshold for that individual. This intent is expressed in some of the language and structure of the bill.

However, other critical language in the bill – in particular, use of the term MAGI – could be interpreted in a way inconsistent with this intent. For a married couple filing a joint income tax return, MAGI is defined in law as the couple’s aggregate or combined income, so use of the term MAGI in the bill could mean that a married couple filing a joint income tax return would be subject to this tax if the couple’s MAGI exceeded the threshold, even if each individual’s wage and non-wage income fell below the threshold.

A YES vote will enact the initiated legislation. 

A NO vote opposes the initiated legislation. 

Support for Question 1

Maine People’s Alliance, a nonprofit based in Bangor, Lewiston and Portland whose mission is to foster social change, introduced the measure.

“In our rapidly-aging state, too many seniors are being forced from their homes and too many people with disabilities can't get the care they need," said Miri Lyons of Boothbay Harbor, a former homecare worker and a family caregiver for a child with a disability, in a press release issued by the Maine People’s Alliance (Homecare for all referendum campaign submits more than 67,000 signatures). "Homecare for all will fix that. It's a guarantee that if you need help staying in your home, you can get it."

Furthermore, the organization notes the measure would “include measures to assist family caregivers and make homecare a more attractive career, including higher wages and greater professionalization.” 

"I work full time and make $11.50 an hour. Starting pay at my company is minimum wage. I rely on food stamps and Section Eight to keep my son fed and housed," said Maddie Hart, a home care worker from Auburn, in the press release. "My work is challenging, dangerous, and skilled. Homecare workers deserve to be paid enough to support our families. This referendum will help get us there."

Opposition to Question 1

Stop the Scam, consisting of business organizations, has mounted an effort to defeat Question 1. Stop the Scam includes the Maine State Chamber of Commerce, Maine Hospital Association, Spectrum Healthcare Partners, Maine Association of Community, Service Providers, NFIB Maine, Retail Association of Maine, Maine Innkeepers Association, Maine Restaurant Association, Maine Tourism Association, Maine Grocers and Food Producers Association, Maine Association of REALTORS, Maine Auto Dealers Association, Maine Bankers Association, Retail Lumber, Dealers Association of Maine, Maine Energy Marketers Association, Home Care and Hospice Alliance of Maine, Maine Beer and Wine Distributors, Maine Forest Products Council, Maine Listings, Maine Motor Transport Association, Associated General Contractors of Maine, Maine Beverage Association, Maine Real Estate and Development Association, Manufacturers Association of Maine, Associated Builders and Contractors of Maine, Professional Logging Contractors of Maine, Maine Health Care Association, Maine Pellet Fuels Association, Ski Maine Association, Portland Regional Chamber of Commerce, Maine Aggregate Association, Maine Insurance Agents Association, Mid-Maine Chamber of Commerce, Kennebec Valley Chamber of Commerce, Bangor Region Chamber of Commerce, Greater Portland Board of REALTORS and Maine Commercial Association of REALTORS. 

Home Care and Hospice Alliance opposes Question 1 because, according to the organization, there is no means test and no residency requirement, the program violates patient privacy and creates a new board entirely separate from state government and would not be directly accountable to the taxpayers or Legislature. 

“We are calling on the Maine People’s Alliance to sign a pledge to stop the lies and stop misleading Maine people,” said Home Care & Hospice Alliance of Maine representative Newell Augur, who chairs NO on Question One/Stop the Scam, in a press release. “The number of families and businesses who will see their taxes increase is far more than what the Maine People’s Alliance purports, and their attempts to minimize the impact this bill will have on Maine families and our economy are disingenuous.”

“Proponents falsely claim that there is an opt out provision in their proposal,” Stop the Scam said about the measure requiring private health information be distributed to constituency organizations. “In fact, the provision only gets elder and disabled adults off a mailing list. It does not give them the authority to prevent the transfer of their private health information from taking place. They also wrongly deny the bill would require all caregivers, even those taking care of a family member, to join the Maine state employees’ union.”