April 24, 2018
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Analysis of ‘childless adults’ on MaineCare revealing

By Sara Gagné-Holmes, Special to the BDN

With the clock ticking on the current budget year, Gov. Paul LePage’s administration is proposing to eliminate health care for thousands of Maine people — working parents, the elderly, and people with disabilities — in order to balance the budget.

Like the governor, many are quick to blame the MaineCare program for the budget challenges of the state. The truth is that overall spending in the program has remained relatively flat for five years. Expenditures for the MaineCare program totaled $2.24 billion in 2006 compared to $2.44 billion in 2011. This is an increase of only 8.9 percent in expenditures over a five-year period when medical care inflation has grown at a rate of 19.9 percent during the same time period.

Yet, the governor’s budget puts forward proposals to make deep cuts to eligibility for the MaineCare program.

One such proposal would eliminate health care for about 18,000 childless adults who are covered by MaineCare. Another 16,000 people who otherwise are eligible are on a waiting list for the program.

It’s not the first time that this program, which provides necessary medical care to very poor adults, has come under fire.

We know the Legislature is working hard to find answers to many difficult questions, but as it considers the elimination of this health care program, we think it’s critical they have an accurate understanding of who is served by the Childless Adult Waiver.

Unfortunately, so much of the public debate regarding this program is driven by rhetoric, misunderstanding and anecdote, which creates either an incomplete or deceptive picture of MaineCare and its overall impact on Maine.

Working with Professor Sandra Butler of the University of Maine School of Social Work and with Dr. Laurel Coleman, board certified in Internal Medicine, Geriatrics and Hospice/Palliative Care and an attending physician at the Geriatric Assessment Clinic at Maine Medical Center, we have compiled a report that reviews important national and state data and takes a qualitative look at the population served by the MaineCare Childless Adult Waiver program.

What we have found is that despite the rhetoric that the childless adults are “young” and “able-bodied” and the talking point that Maine provides more or better services than other states, the truth is very different.

Maine is not an “outlier” in providing coverage to low-income childless adults. In fact, Maine is one of 20 states offering some form of coverage. And beginning in 2014, all states will be required to provide Medicaid coverage to this group under provisions of the Affordable Care Act.

The childless adults covered by MaineCare are among the poorest people in the state. To qualify for help, they must have income at or below $10,890.

They tend to be sicker, and often have serious medical conditions that limit their activities and ability to function without care.

Sixty percent are 35 or older; and 43 percent are 45 or older. Forty-seven percent of those who receive services fall into a diagnostic grouping of disease, 24 percent have been diagnosed with a mental disorder and 11 percent were treated for injury or poisoning. For example, more than 1,500 members have diabetes, 1,820 members suffer from hypertension and 637 have asthma.

People with these conditions need access to health services and prescriptions to maintain their health. Many members have been diagnosed with cancer, accounting for more than 2,150 claims. Without the health care they receive through MaineCare, some of these people could die.

As part of our research, we went beyond the statistics and numbers to provide a better understanding of what could happen if these individuals lose the health care services provided under MaineCare. Dr. Butler interviewed a small subset of people who receive MaineCare through this program, and Dr. Coleman then assessed their medical circumstances and predicted how they would fair without health insurance.

Based on the available information, without MaineCare, we can expect many of these people to see their health deteriorate. They will face early and preventable disability, and they will be forced to rely upon high-cost emergency room services.

Already poor and often sick, without coverage they will become poorer and sicker, with less chance for recovery. Their lives will be shorter.

In addition to the personal tragedies, the higher costs of care will be shifted to private insurance holders, and the loss of matching federal dollars will ripple through the economy, costing thousands of jobs in communities around the state.

The proposal to eliminate coverage for childless adults is irresponsible and dangerous, and unnecessarily puts at risk thousands of people. Its purported savings are a sham and the human costs — in terms of health, economic impact and job loss — are too much to bear.

Sara Gagné-Holmes is executive director of Maine Equal Justice Partners, a nonprofit legal aid organization that works to find solutions to poverty.

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