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Between labor shortages and stubborn MaineCare rates, a local organization’s struggles to provide community care 

By Houssein Mouhoumed

Agencies funded by the MaineCare program have been dealing with a tight labor market exacerbated by the COVID-19 pandemic. This last year, hundreds of human services workers have been forced to double down and face the mess created by the pandemic with limited aid and support.  

One such agency that depends on state funding is Gateway Community Services, an LLC in Portland providing services such as counseling and case management to community members. But according to Bethany Cianciolo, a case manager supervisor at Gateway, the state’s reimbursement rates haven’t changed in years.  

I did case management about 8 years ago for a different agency and then when I came back as a supervisor, the rate they are paying is still the same,” Bethany said. “That’s a big deal, especially now. We are living in a pandemic world where prices of goods are going up, and our reimbursement rates are not going up at the same rate. It is making it really challenging for people—good workers—to stay in this field.” 

Maine is one of the dozen states across the country to give money to essential workers who put their lives on the line to save our communities during the pandemic. The state has allocated up to $126 million to existing and new health care workers, but it’s still not enough to match the cost of living in Portland.  

Employees are leaving the field due to these low pay rates, forcing agencies to combine their roles to better their services. Some agencies are placing people on waitlists, which worsens the workload counselors and case managers have in their hands. Additionally, the needs of the clients are not met on time, eventually leading to bigger problems. 

People don’t usually want to get a case manager or counselor, Bethany explained, but rather they do so because they need support from one.  

“What happens is that sometimes we will miss that window of opportunity, sometimes things will get worse for them or the Community,” Bethany said. “Sometimes if we do not do it within a few weeks for some of the referrals we will not be able to reach the client—maybe they lost their phone, they cannot pay for minutes, [or] they have become homeless since then…” 

She makes a direct correlation between not being able to get helped on time and homelessness, which is another issue for Portland. Portland city council has approved a new homeless shelter which will house hundreds of people, but it’s still not enough.  

“All our referrals are people with some sort of mental health diagnoses, so they are at substantial risk of all sorts of things: higher risk of suicide, higher risk of not caring for themselves, substance abuse issues, etc.,” Bethany said. “The goal is to act now and if you can’t act now, we just have people who are sitting around, and we can’t [help] them.” 

Case managers and counselors are working more than usual to respond to the needs of the community. According to Bethany, agencies across the state are struggling to fill open positions. She says that they are posting open positions with bonuses but still are getting almost no leads. These understaffed conditions lead to burnout, ultimately leading to high staff turnover rates. 

On top of all these issues, the healthcare field is facing another challenge in Maine, in the form of Governor Janet Mills’ vaccine mandate. Un-vaccinated employees will have to make a tough decision between keeping their jobs or leaving them.  

With all these issues that this industry is facing, the outcome would undo years’ worth of work done by agencies like Gateway Community Services.  

“We have so many people waiting who are waiting for services and are probably people who are in need more than ever because of the pandemic and the other social issues,” Bethany said. “And we just don’t have the people to serve them.”  

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