Maine’s human services chief argues for ‘person-based’ welfare reform, against Medicaid expansion

Mary Mayhew, commissioner of the Maine Department of Health and Human Services, speaks before the Portland Community Chamber Wednesday morning at a breakfast event at Holiday Inn By The Bay. Mayhew told attendees that 5 percent of the people enrolled in MaineCare programs account for 54 percent of the cost.
Mary Mayhew, commissioner of the Maine Department of Health and Human Services, speaks before the Portland Community Chamber Wednesday morning at a breakfast event at Holiday Inn By The Bay. Mayhew told attendees that 5 percent of the people enrolled in MaineCare programs account for 54 percent of the cost. Buy Photo
Posted Dec. 04, 2013, at 3:22 p.m.
Last modified Dec. 04, 2013, at 6:30 p.m.

PORTLAND, Maine — The head of the Maine Department of Health and Human Services reiterated Gov. Paul LePage’s stance against Medicaid expansion in the state, telling Portland business leaders Wednesday morning that the move would ultimately cannibalize other parts of the state budget.

Mary Mayhew, commissioner of DHHS, spoke to the Portland Community Chamber at one of the organization’s regular breakfast events Wednesday morning, saying Mainecare enrollment and costs have skyrocketed during the past 12 years and threaten to keep benefits out of reach for extremely needy Mainers still on waiting lists for aid.

Mayhew said LePage and his administration are attempting to control the problem by reinventing welfare programs as “pathways back to the workplace and self sufficiency” that connect enrollees to job training or other counseling programs.

“The vision we have is for a person-based system that is effective and efficient,” she said at Wednesday’s breakfast. “Welfare programs shouldn’t be the goal or finish line for anyone.”

The address came just a day after city leaders and homeless advocates held a news conference to blast the state’s decision to move DHHS offices from a facility in Portland’s Bayside neighborhood to a South Portland site near the Portland International Jetport.

That relocation, which Mayor Michael Brennan and others said Tuesday will put needy inner city people a potentially prohibitive distance from the state services they require, is the latest controversy surrounding Mayhew’s department.

Democrats have long also sharply criticized the LePage administration for resisting the expansion of MaineCare, the state’s version of the federal Medicaid program, as allowed by the Affordable Care Act. During this year’s legislative session, LePage twice vetoed Democrats’ bills to expand Medicaid eligibility, which the federal government would fund at 100 percent for three years before incrementally reducing its share of the cost of expansion to 90 percent. Advocates for expansion claim it would make health insurance available to approximately 70,000 Mainers who otherwise will likely lack coverage, including 25,000 Mainers due to lose Medicaid eligibility on Jan. 1.

Senate President Justin Alfond, D-Portland, said on Tuesday the administration’s decisions regarding its Portland offices and MaineCare constitute “a war on the poor.”

In reiterating the LePage administration’s opposition to Medicaid expansion Wednesday, Mayhew said Maine must look beyond the short-term federal financial commitment. She also said the current Medicaid caseload weighs down state finances, noting that Medicaid enrollment in the state has grown from about 160,000 people in 2000 to about 320,000 today, driving costs up from $1.2 billion to nearly $2.5 billion during that same span.

“This explosion in cost and enrollment is not sustainable,” Mayhew told the morning crowd. She said the 16-day federal government shutdown in October, the latest in a series of partisan budget staredowns on Capitol Hill, adds fuel to her position that states can’t count on federal money when it’s promised.

Even if the federal government funds the Medicaid expansion as it pledges, she said, it would create an additional $150 million in cost to the state by 2020-2021.

“It simply is going to take away from other state priorities,” Mayhew said.

House Speaker Mark Eves, D-North Berwick, countered after Mayhew’s speech Wednesday that the Kaiser and Heritage foundations have found that Maine may save $690 million over the next decade by expanding MaineCare because the state would avoid the costs of treating as many uninsured residents. He also cited a Harvard study suggesting Maine could avoid 395 deaths each year by accepting the additional Medicaid funding.

“The LePage administration is continuing its effort to deny and delay health care to tens of thousands of working Mainers, including nearly 3,000 veterans,” Eves said in a statement released early Wednesday afternoon. “Businesses in Maine know that accepting federal health care dollars to cover working Mainers is a good deal. No business leader would turn away an additional $700,000 a day for their company because of politics. But that’s what Gov. LePage is doing. Starting on Jan. 1, Maine will lose out on an additional $700,000 a day while nearly 25,000 Mainers lose care.”

Mayhew said Wednesday that 5 percent of MaineCare recipients account for more than 54 percent of the program costs, with people in that group — such as elderly or disabled Mainers needing around-the-clock care — receiving nearly $69,000 per person in annual benefits.

Mayhew said her department is focused on helping people in that group receive care as efficiently as possible, and on working with other state agencies — such as the Department of Labor — to provide services to help other enrollees “return to independence.” That process, she said, will free up resources to help more than 3,600 “priority” Mainers currently on waiting lists for help from MaineCare or other state programs.

For instance, she said DHHS workers were able to save $8 million in the most recent budget by working with welfare recipients to schedule appointments with primary care physicians to replace trips to the much-more-expensive emergency room.

Regarding the recently controversial state decision to move its Portland DHHS office into a South Portland building along with labor department offices — a decision Portland City Councilor Ed Suslovic said Wednesday morning further stresses the city’s relationship with its state counterparts — Mayhew said it was important for the health care and job hunting programs to be “co-located.”

Sawin Millett, Maine’s finance commissioner, issued a statement Wednesday evening to express his disappointment with the outcome of a meeting about the proposed office relocation he had Wednesday with Alfond and Brennan.

“I remain committed to ensuring the accessibility issues are addressed for needy Mainers in Cumberland County before DHHS and [the Department of Labor] transition to their new location in 2015,” Millett said in a prepared statement.

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