Feds bring good news to LePage, lawmakers

Posted May 30, 2013, at 6:15 p.m.

The state of Maine heard good news Thursday about details pertaining to Medicaid expansion under the federal health reform law. But no one would know it from the LePage administration’s interpretation.

The U.S. Centers for Medicare and Medicaid Services confirmed in a letter to Maine Department of Health and Human Services Commissioner Mary Mayhew that the federal government does not have authority to grant full match rate funding for parents who earn up to 138 percent of the poverty level. It will continue, as it is currently doing, to pay 62 percent of the costs of providing Medicaid to nondisabled parents if Maine participates in Medicaid expansion under the Affordable Care Act.

This is information explained within the ACA and should not be a surprise. A total of 18 states already provide Medicaid to parents earning 100 percent of the poverty line or more. They will not receive enhanced match rates under Medicaid expansion, while the remaining states will see their parent population funded at a full rate for three years when the ACA takes complete effect in 2014.

But LePage said it’s unfair for Maine not to receive more funding since it was an early expander of the program. “Once again, the federal government has failed to come through for Maine. Despite our generosity in expanding welfare over the last decade, we are being offered less than what other states are getting,” he said in a press release.

It’s unfortunate to refer to the continued federal funding level as a type of penalty because it might make people believe the state is giving up something. In reality, nothing would change from the current arrangement. The administration argues that Maine is planning to drop this population from coverage starting Jan. 1, so technically Medicaid expansion would add new parents to Medicaid who would otherwise not be eligible. But they are eligible right now, and DHHS includes transitional funding for them in LePage’s proposed 2014-15 budget.

The letter also made clear the federal government will bear the full cost of expanding Medicaid eligibility to childless adults if the LePage administration confirms certain details about services. The 100 percent funding will continue for three years and then taper down to 90 percent thereafter. Maine expected to get an enhanced rate for this population, but full funding is an excellent development.

The letter also put to rest the issue of whether the federal government would pay all the costs of Maine’s Medicaid expansion for 10 years. This was an unrealistic request by LePage that would have run counter to law. The centers confirmed, “These rates are set by law, and CMS has no authority to change the matching rates by regulation or waiver.”

Still, LePage said he was disappointed that “the feds won’t work with us to provide the additional years of funding I requested.” What is disappointing, really, is the delay this unreasonable request caused. Maine will eventually run out of time to benefit from federal funding for expansion, as the 100 percent support is tied to years 2014, 2015 and 2016. The state should be working toward expansion, not fighting against it.

Finally, the letter revealed another positive message: The federal government is open to reforming how the Medicaid program operates in Maine. It states, “We are ready to move ahead with discussions about possible strategies as soon as you are ready to do so” and then provides the name of an official with whom the state can work directly. This quells LePage’s argument that he wants to wait on Medicaid expansion in order to negotiate a better deal and puts the onus on Maine to explain what it wants to do.

On Thursday, in a 10-4 decision, the Legislature’s Health and Human Services Committee voted out another version of LD 1066, sponsored by Rep. Linda Sanborn, D-Gorham, to expand Medicaid. This one has an amendment attached: Maine will drop out of the Medicaid expansion program if the federal match rate falls below its promised 90 percent. One lone, brave Republican voted for the bill: Rep. Carol McElwee, R-Caribou.

Backed by the information in the letter from the federal government and the new amendment, the full Legislature should follow McElwee’s lead.

http://bangordailynews.com/2013/05/30/opinion/editorials/feds-bring-good-news-to-lepage-lawmakers/ printed on September 19, 2014