Using data collected from the U.S. Census Bureau, we estimate that approximately 22,900 Mainers will be eligible for services under the Universal Home Care program. The estimated cost of delivering services to these individuals varies between $268 million and $375 million, depending on the care model under which services are delivered. As Maine’s population continues to age, the price tag of the Universal Home Care program will grow.

Within the initiative is a program to provide stipend to family caregivers in Maine that, by design, appears ripe for abuse. Family caregivers in Maine currently offer approximately $2 billion in unpaid care each year. It is clear, given the estimated costs of the Universal Home Care program and the unpaid care that currently exists in Maine, that the $310 million in anticipated revenues will not be enough to cover all eligible persons or provide stipend to all eligible family caregivers. Therefore, the program is not truly “universal,” and it is likely that rationing of services or further tax increases will be necessary to serve the full eligible population.

Question 1 includes a mandate that requires providers participating in covered programs to devote 77 percent of reimbursements received from the Universal Home Care Trust Fund on “direct service worker costs.” However, this term is left undefined in the initiative, leaving uncertainty over how providers must expend 77 percent of the funds they receive from the program.

Data show that current wages for home care workers in Maine reflect between 63 and 67 percent of the reimbursement to provider agencies. The 77 percent mandate within Question 1 could cause a measurable disparity between the wages of home care workers serving clients under the Universal Home Care program versus clients in existing Medicaid and state-funded programs. In addition, the 77 percent mandate could leave provider agencies without adequate compensation to make up for the costs associated with employment.

The undemocratic design of the Universal Home Care Trust Fund Board abandons our traditions of representative government. The Board’s autonomy over the program and use of the Universal Home Care Trust Fund leaves many remaining questions for which we cannot answer.

However, implementing the Universal Home Care program in coordination with existing programs will prove chaotic for any Board tasked with doing so. Enacting a program that is to supplement, not supplant, existing programs is difficult when the program being enacted has less stringent eligibility requirements and is not obligated to abide by federal rules imposed through Medicaid.