AUGUSTA, Maine — A day after Gov. Paul LePage called for a drastic overhaul of the MaineCare program, organizations that serve the state’s vulnerable were left reeling in the face of painful cuts.
With reactions ranging from a hopeful wait-and-see attitude to outright indignation, health and social services providers and advocates for the elderly, the poor and children worked to tease specifics from the sweeping proposal. LePage zeroed in on MaineCare, the state’s version of the federal Medicaid program, in his plan to address a $220 million shortfall over the next two years in the Department of Health and Human Services budget. MaineCare, including state and federal spending, represents a third of the total state budget.
LePage’s proposal called for tightening eligibility requirements, eliminating services and repealing coverage entirely for thousands of MaineCare recipients to bring Maine’s program closer to national averages. He said his plan makes tough choices to rein in skyrocketing enrollment and tackle the reality of dwindling federal reimbursements.
An estimated 65,000 Mainers are slated to lose heath coverage under the plan.
The proposal would end MaineCare support for residential facilities for the mentally and physically disabled, labeled “private, non-medical institutions,” to save $47 million in state funds. The facilities often house senior citizens who no longer own a residence but don’t need nursing home care.
“These people have given up everything to get this level of care,” said Karen Higgins, executive director of the Phillips-Strickland House in Bangor, where 42 of the 48 residents rely on MaineCare. “They have no home to go back to.”
Many depend on the state program to fill the gap between their pensions, which the state collects, and the cost of care, she said.
“These folks are paying a percentage, in some cases a large percentage, of that care,” Higgins said.
The proposal also would slash contributions to programs that help low-income seniors pay for prescription drugs and Medicaid premiums.
“I can’t believe this,” said John Hennessy, advocacy director for the 230,000-member Maine AARP. “Our members are devastated.”
He bristled that the administration has referred to services including dental care and podiatry, which can spare diabetic patients from foot amputations, as “optional.”
“What are they going to do?” Hennessy said. “These are low-income elderly people.”
At Miller Drug in Bangor, 40 to 50 percent of the customers use MaineCare, and many seniors already can’t afford their prescriptions, said pharmacist Bill Miller. However, Miller said he does support a provision to remove 19,000 childless, nondisabled adults, known as non-categoricals, from the MaineCare rolls.
“The elderly, they can’t work,” he said. “Your non-categoricals, most of them could work if they were able and willing to find a job. The senior citizens may be willing but they’re not able to join our [work] force.”
Those who have been axed from coverage no doubt will wind up in hospital emergency rooms, said Jeff Austin, a lobbyist for the Maine Hospital Association.
“They find that emergency room door in the middle of the night,” he said. “That’s where they’ll find their care.”
Along with childless adults, about 20,000 parents who exceed tighter income limits and 19- and 20-year-olds would be eliminated from MaineCare.
Maine hospitals also are facing lowered reimbursement rates and limits on visits, as well as indirect impacts from cuts to dental and mental health services, Austin said.
“The leading cause of ER usage for the uninsured is dental pain,” he said.
For every $1 the state cuts, providers lose $3 — the $1 in state money and $2 in federal matching money — Austin said. As reimbursements to hospitals dwindle, private insurance costs rise to make up the difference, he said.
“Even those with [private] coverage are not immune from some of the cuts in the proposal,” Austin said.
The Maine Hospital Association plans to work with the governor and both political parties to find solutions, he said.
The MaineCare overhaul is part of a supplemental budget proposal that lawmakers will evaluate when the Legislature convenes in January.
Funding for HeadStart, which serves children of low-income families, is also on the chopping block, as are health initiatives paid for through the Fund for a Healthy Maine.
At Spurwink Services of Portland, a residential care and community health nonprofit group that serves 6,500 children and adults throughout the state, president Dawn Stiles is holding her breath for more specifics on the MaineCare overhaul.
“We’re waiting for clarification and more details,” she said. “We’re going forward and taking care of our clients.”
She credited DHHS for working with providers to find money for children’s residential services, but the cuts would affect a wide range of Spurwink’s offerings, Stiles said.
“It’s a huge concern,” she said.
The Appropriations Committee plans to hold hearings on the supplemental budget Dec. 14 and 15. The next week, members of the Appropriations Committee and the Health and Human Services Committee will conduct work sessions on the budget bill.
The administration wants the MaineCare changes to take effect by April 1, 2012, putting pressure on lawmakers to act by the end of January.
Correction: An earlier version of this story incorrectly reported that hospitals would lose $3 in federal reimbursements for every $1 the state cuts. The correct numbers are $1 in state money and $2 in federal matching money for every $1 in state cuts.