Advocacy group files suit to stop Medicaid cuts set to take effect March 1

Posted Feb. 21, 2013, at 11:54 a.m.
Last modified Feb. 21, 2013, at 5:30 p.m.

AUGUSTA, Maine — An advocacy group that represents low-income Mainers has filed a lawsuit against the U.S. Department of Health and Human Services in U.S. District Court seeking to block Medicaid cuts for elderly and disabled recipients scheduled to take effect March 1.

Maine Equal Justice Partners, in cooperation with the National Health Law Program and the Center for Medicare Advocacy, filed its request Wednesday for a temporary restraining order on behalf of five Maine residents whose health care coverage through MaineCare, the state’s Medicaid program, would be terminated.

On Thursday, the groups asked that the lawsuit be treated as a class action, which would open it to approximately 6,000 Maine residents who stand to lose some or all of their Medicaid coverage as a results of cuts proposed by Gov. Paul LePage’s administration, according to Jack Comart, litigation director for Maine Equal Justice Partners.

In January, the U.S. Department of Health and Human Services allowed some of the cuts the LePage administration requested last year as a way of coping with a Maine Department of Health and Human Services budget shortfall.

The plaintiffs in the suit are Louis and Katherine Bourgoin, both of Lewiston, Heidi Brooks of Lewiston, Katherine Sherrard of Kennebunk and Donna Stevens of Waterville. All are between 42 and 67 years old and disabled, according a news release from Maine Equal Justice Partners.

Louis Bourgoin, 68, has been diagnosed with Stage 4 liver cancer and undergoes chemotherapy treatment, according to his wife, Katherine Bourgoin, 69. He also has a stomach tumor, she said. They have Medicare, the federal health care coverage available to people age 65 and older. Until March 1, Medicaid pays to supplement their Medicare.

“We are just surviving now,” said Katherine Bourgoin. “With this, it means that we will have even less. I don’t know if we can continue staying in our apartment.”

Both are retired and receive Social Security. She also receives a small pension. In total, the Bourgoins’ monthly income is less than $2,500. They pay market rent and have been told by a caseworker at the hospital where Louis Bourgoin undergoes chemotherapy that he would qualify for free care there until July.

“We have a letter that we will no longer qualify for MaineCare because our income is too much,” Katherine Bourgoin said. “We can just wait and watch and see what they can take away from us.”

The plaintiffs and their representatives are scheduled to confer with U.S District Court Judge John Woodcock in Portland on Friday, Comart said.

“Federal law protects low-income people and people with disabilities from losing their health insurance coverage through Medicaid,” Comart said Thursday in a prepared statement. “By granting Maine permission to reduce eligibility, the secretary of Health and Human Services has violated the law by cutting health care benefits for people with disabilities and for low-income seniors. Those actions are unacceptable.”

Maine Equal Justice Partners plans to argue that eliminating coverage for the plaintiffs and other Maine residents who qualify for Medicaid under similar circumstances would violate the “maintenance of effort” section of the Affordable Care Act, which largely prohibits states from scaling back existing Medicaid services in advance of the law’s major expansion of Medicaid in 2014. Medicaid is a joint state and federal program that provides health insurance for low-income and some disabled people.

Maine officials asked the federal government to allow the state only to cover low-income parents whose income matched or fell short of the federal poverty level — which in 2012 was $23,050 annually for a family of four — a move that would have eliminated coverage for 27,000 people. Instead, federal officials allowed the state to scale back eligibility requirements to 133 percent of the federal poverty level from the current 200 percent.

In all, the cuts proposed by the state would have eliminated coverage for 36,000 residents. They were approved in the Legislature last year as part of two supplemental budget packages and originally were scheduled to take effect Oct. 1, 2012. The cuts allowed by the federal government would save the state approximately $4 million of the $20 million the LePage administration originally sought.

Comart said all the plaintiffs have incomes below 133 percent of the federal poverty limit. The lawsuit applies specifically to elderly and disabled people, not to parents or other Medicaid recipients scheduled to lose benefits March 1.

Adrienne Bennett, LePage’s press secretary, said declining federal matching funds for Medicaid, combined with ongoing state fiscal challenges, force the administration to seek added flexibility in managing the Medicaid program.

“The state needs greater independence to make sure the Medicaid program serves its core mission,” she said Thursday in an email to the Bangor Daily News. “During the past decade, Maine expanded its welfare program and eligibility levels which make us the fifth most generous state in the nation. Unfortunately, Maine cannot afford to pay for welfare for one in three Mainers and it is forcing the state to prioritize limited resources and scramble for money in other areas of government, including education, to fill the gap.”

Citing a presentation on Medicaid cost-containment strategies delivered to the MaineCare Redesign Task Force in October 2012, Bennett said the federal matching fund rate decreased from 74.73 percent in 2010 to 62.57 percent in 2013. That reduction added $210 million to the state’s share of Medicaid funding, she said.

House Speaker Mark Eves, D-North Berwick, said Democrats were surprised when the federal government granted the LePage administration’s waiver request.

“No senior should have to choose between filling their prescription or putting food on the table,” Eves said Thursday in a statement.

Assistant House Republican Leader Alex Willette, R-Mapleton, said the Legislature already addressed the issue. “These were tough decisions made by Democrats and Republicans in a bipartisan effort to curb our chronic MaineCare overspending,” he said Thursday in an email to the Bangor Daily News. “The courts are not the proper forum for policy debates, and, hopefully, that will be reflected in the outcome.”

Democrats contested Willette’s statement that they supported the cuts. “We opposed them from day one” said Jodi Quintero, spokeswoman for Eves.

John Martins, a spokesman for the Maine Department of Health and Human Services, said Thursday that the department does not typically comment on pending litigation.

Brian Cook, a spokesman for the U.S. Centers for Medicare and Medicaid Services, said no one from his agency could comment because of the pending litigation.

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