More than 2,100 allegations of abuse, neglect, and exploitation were reported in fiscal year 2024 among adults with intellectual disabilities or autism receiving services under Maine’s Medicaid program, according to a new state report.
The stunning level of abuse was published with little public handwringing from Democratic lawmakers in a report submitted to lawmakers last month.
The report — bearing the anodyne name “2025-2026 Biennial Plan for Adults with Intellectual Disabilities or Autism” — downplays the significant fact that a massive percentage of adults with intellectual disabilities or autism have reported caretaker neglect, physical abuse, emotional abuse, and exploitation.
The abuse occurred within MaineCare’s Home & Community-Based Service (HCBS)
Waiver programs, which are provided under MaineCare’s Section 21 comprehensive waiver and Section 29 support waiver.
The number of abuse reports in FY 2024 — 2,157 total for clients receiving Section 21
and/or Section 29 services at the time the report was filed with Adult Protective Services (APS) — is significant considering the number of adults enrolled in the programs.
There are only 3,420 individuals enrolled in Section 21 and 2,640 enrolled in Section 29 — meaning APS received 2,157 reports of abuse within programs that provide home-based care for just 6,060 individuals.
“Allegations of caretaker neglect were the most common type (815), followed by emotional abuse (330) and physical abuse (301),” the report states.
“A total of 206 allegations involving individuals receiving services under Section 21 or Section 29 were substantiated,” the report states. “One hundred twenty-six allegations of caretaker neglect were substantiated, a substantiation rate of 15 percent. Self-neglect had the second highest substantiation rate of 13 percent.”
The report emerged from the Office of Aging and Disability Services (OADS), which oversees the state’s efforts to improve services for adults with intellectual or developmental disabilities (IDD) or autism.
Despite dubbing the document a “plan,” OADS offers only tepid remarks on how the office will change policies or investigative efforts to reduce the shocking level of abuse and neglect:
As of April 14, 2024, new APS rules went into effect that no longer allow for two levels of substantiation: Level I – High Severity and Level II – Low to Moderate Severity. Maine APS now only has the substantiation of High Severity. Because of this, it is predicted that the allegation investigations for 2024 and the years going forward will have a lower substantiation rate than prior years.
In other words, by modifying the standards for what’s considered a substantiated allegation of abuse, OADS hopes to see lower rates of substantiated allegations of abuse.
The report alleges that APS investigates claims through a centralized intake line and an online referral form, with mandated reporters—such as healthcare professionals—required to complete training every four years to identify and report abuse. Abused individuals or their family members can also confidentially or anonymously report abuse.
In fiscal year 2023, MaineCare Section 21 accounted for $527.6 million in MaineCare spending, while Section 29 accounted for $100 million, according to the report.
