Another plan to expand Medicaid in Maine heads to lawmakers

Posted May 30, 2013, at 5:57 p.m.
Last modified May 31, 2013, at 8:37 a.m.

AUGUSTA, Maine — Another proposal to expand the state’s Medicaid program is headed to the full Legislature after a committee vote Thursday afternoon in favor of expanding eligibility for the low-income health insurance program as allowed under the federal Affordable Care Act.

The Legislature’s Health and Human Services Committee voted 10-4 to send a Medicaid expansion bill to the House floor. The committee vote broke down the same way as a vote two weeks ago in which the panel voted to link Medicaid expansion with repayment of the state’s $484 million debt to its hospitals.

The committee’s Democrats supported the expansion, along with one Republican, Rep. Carol McElwee of Caribou. The remaining Republicans opposed it.

The bill approved by the committee proposes the Medicaid expansion alone. After the vote, Democratic legislative leaders said that they still plan to link Medicaid expansion and the hospital debt repayment, although the two proposals are now distinct bills following Gov. Paul LePage’s veto of the joint measure last week.

“We cannot repay our hospitals and make sure our hospitals are repaid for all that debt without accepting federal dollars” for Medicaid, said Senate President Justin Alfond, D-Portland.

Alfond said Democrats plan to take House and Senate votes on Medicaid expansion before taking up the hospital debt repayment bill LePage submitted after vetoing the joint measure.

The Medicaid expansion will go to the House floor with one change to the bill from the version previously considered by lawmakers. The updated bill includes an amendment that would repeal the expansion if federal funding rates drop below the percentages currently prescribed in federal law. The repeal would only take effect after the Legislature has met for at least a 30-day session during which lawmakers could reconsider the repeal.

The change is meant to appeal to Republicans who have raised concerns that the federal government could back away from the federal funding rates prescribed in the Affordable Care Act.

In Maine, about 50,000 adults without children would gain Medicaid coverage if the state opts to expand, according to the Legislature’s nonpartisan Office of Fiscal and Program Review. If the state chooses not to expand, about 25,000 childless adults and parents would lose their Medicaid coverage on Jan. 1, 2014.

Under the Affordable Care Act, the federal government would pay 100 percent of costs for new Medicaid recipients for three years starting Jan. 1, 2014. That 100 percent rate would gradually fall to 90 percent by 2020 and the state would have to make up the remaining share.

The state would receive its standard federal funding rate, which is currently 62.57 percent, to cover the residents Maine’s Medicaid program already covers.

The Health and Human Services Committee vote came the same day federal officials responded to a request from Mary Mayhew, Maine’s health and human services commissioner, to cover 100 percent of Medicaid expansion costs for 10 years.

Federal officials said they can’t offer funding rates that aren’t prescribed in the law.

In an interview Thursday, Mayhew didn’t entirely rule out Medicaid expansion but said Maine needs to address problems in its current Medicaid program — including 3,100 people with developmental disabilities on a wait list for services, low reimbursement rates that strain health care providers and frequent cost overruns — before considering an expansion under the federal law.

“It is a bit much to think that with the significant financial shortfall confronting the state in the biennial budget that is before the Legislature, that we should at the same time be adding more services without confirmation that we can address the current funding challenges,” she said.

Democratic leaders said they’re discussing the Medicaid expansion bill with Republican lawmakers in an effort to pass the bill with enough support to override a veto from LePage.

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