The Lifespan Waiver Application: 6 Issues and Possible Solutions
Maine’s DHHS is submitting the new Lifespan Waiver Application to CMS. Before they do this they collect public comments and your voice can help shape the waiver by providing feedback to them. Public Comment Period ends through May 13, 2026. Comments can be submitted to Maine DHHS at Heather.Bingelis@maine.gov.
Community Connect Maine has highlighted 6 broad issues and possible solutions to help people understand what is in the waiver. They are here:
Workforce- Services May Not Be Delivered: Even when services are approved, individuals and families often struggle to find staff to actually deliver them. Workforce shortages already exist across the system, and expanding access through the Lifespan Waiver will increase demand. This creates a gap between what is authorized on paper and what people receive in real life, often leaving families to fill in the missing support. When there is no family member available or capable of providing support, that puts the person at risk. -Possible Solution: Implement a sustainable workforce plan, monitor gaps, track unmet needs.
2. Many Changes at Once: The Lifespan Waiver is being introduced alongside other major changes: new rates, new service structures, new coordination models, new behavior regulations, new licensing requirements, and evolving expectations about existing waivers. For individuals, families, and providers, delivering services with so many changes can be overwhelming and confusing, especially when multiple changes affect services at the same time without clear guidance. -Possible Solution: More gradual transition, phased rollout, protections for those receiving services
3. Assessment Without Appeals: The Supports Intensity Scale (SIS-A) is being used to determine funding levels and services at multiple points in the process, but there is no structure in place to challenge the conclusions reached in the assessment, and no clearly defined independent process to appeal the decisions based on that assessment. If the assessment does not accurately reflect a person’s needs, it can result in reduced supports with limited ability to challenge or correct the outcome. -Possible Solution: Meaningful appeals process, mapping to detail decision steps, timely corrections.
4. Budget Limits: Under the Lifespan Waiver, funding is organized into tiered budgets based on the SIS-A. While this creates structure, it may not reflect the full complexity of real-life situations. Some individuals, especially those with higher or fluctuating needs, may require supports that exceed the limits of their assigned tier. -Possible Solution: Create greater flexibility beyond tiered budgets to ensure supports are based on individual needs. When a designated tier does not adequately meet a person’s needs, person-centered planning should guide decisions about funding, services, and necessary exceptions.
5. Exception Process: When needs exceed standard funding levels, individuals must apply for an exception to request additional support. However, the criteria and decision-making process are not clearly defined. Individuals, families, and providers may not know what qualifies, how decisions are made or how to appeal denials, creating uncertainty when obtaining additional support is most critical. -Possible Solution: Clear criteria, written decisions, appeals.
6. Accountability: The waiver does not clearly define how unmet needs will be consistently identified and tracked across the system. While there are oversight structures, they often focus on compliance and safety rather than whether services are fully meeting people’s needs.
-Possible Solution: Track unmet needs, require public reporting, and use data to drive continuous improvement. Strengthen the role of the Maine Developmental Services Oversight and Advisory Board, already designated as an independent oversight body, by regularly providing systemic data on unmet needs. Without clear tracking and independent visibility, gaps can go unnoticed until they escalate into crises.
