Maine’s Medicaid program is in perpetual crisis. Don’t let expansion make it worse.

By Mary Mayhew, Special to the BDN
Posted March 12, 2014, at 8:54 a.m.

Every day, state agencies make difficult decisions to manage requests for services and programs amid limited resources. This prioritization is not done in a vacuum, and funding one part of state government affects available resources in other programs. Regardless of assertions by this or any other media outlet to the contrary, we know it’s true. We experience this reality with every state budget assembled in Augusta.

Why, then, would anyone question whether the Medicaid expansion being debated in Augusta, which will require more than $800 million in state resources over 10 years — according to an Alexander Group report — will affect spending on other critical programs and services such as investments in job training, support for our children’s education, or improvements in our transportation infrastructure?

Think about your household budget. If your rent or mortgage payment increases, you must make reductions in spending elsewhere or make adjustments to make ends meet. State government must do the same.

This paper’s blatant advocacy for Medicaid expansion has created stories that fail to consider the facts. This department’s estimate of expansion costs is based on actual spending in previous years — not pretend savings assumptions as manufactured by the Legislature. They know — and we know — that nearly 15,000 parents will not receive full federal funding and will cost the state $18 million annually.

This paper fails to inform readers that many who would be covered by expansion are eligible for significant subsidies, resulting in premiums as low as $5 per week, to cover the cost of health care insurance through the federal government.

Maine’s Medicaid program has been in a state of perpetual financial crisis for more than a decade. This administration has wiped out more than $750 million in inherited Medicaid hospital bills and has curbed growth in the program. MaineCare has doubled in size over the last decade with spending increasing more than $1 billion. The governor’s focus on fiscal discipline has limited Medicaid spending growth to just 0.8 percent from fiscal years 2013 to 2014 and a little more than 1 percent from fiscal years 2014 to 2015. This cost containment comes after bailing out the sinking Medicaid ship from the previous administration’s expansions of MaineCare beyond the state’s ability to pay.

Now, there is legislative analysis that predicts this massive expansion of Medicaid will cost just $683,000 over the next three years. This completely ignores reality. The state spent $18 million just to cover the Medicaid expenses of more than 14,000 parents last year and will incur this same expense next year if Maine expands. Maine will not receive any additional federal funding for this group of individuals under the Affordable Care Act.

The state of Maine will incur costs in addition to this $18 million as a result of increased enrollment because of the individual mandate, people dropping their employer-sponsored or commercial coverage to get no-cost Medicaid coverage, and of course the millions in administrative costs to manage another 100,000 people on Medicaid. The $683,000 price tag is simply nonsense.

In our daily work, we hear from people facing immense challenges in their lives as parents, children and caregivers of those in desperate need of care in the home and community. Most of you know someone in this situation. It may be aging parents who are caring for their adult child with Down syndrome whose condition is worsening as is their own health. They now must consider nursing care for a child they have raised from birth because there is a wait for home and community services.

It’s the parents of an autistic child who are panicked because the system can’t continue services after the child leaves school. The waitlists stand at more than 3,000 but are woefully understated because people recognize the futility that comes with waiting for years to get services.

This administration has prioritized funding for the neediest. Gov. Paul LePage put $26 million into the most recent budget to fund community-based services and reduce waitlists. But the resources needed are far greater.

MaineCare today consumes 24 percent of all state funding — one out of every four tax dollars. Funding waitlists will cost the state more than $45 million annually, and the cost of expanding Medicaid to more than 100,000 able-bodied adults is, according to our analysis, more than $800 million over 10 years.

We do not live in a world of unlimited resources. If the Legislature votes to expand Medicaid, regardless of proposals that predict mythical savings to magically cover all costs, Maine will not be able to care for those most in need today or in the future.

The LePage administration is doing all it can to help Maine’s most needy, including the elderly and the disabled. They remain our priority, and we must continue to put their needs at the forefront of the expansion debate.

Mary Mayhew is commissioner of the Maine Department of Health and Human Services.

 

http://bangordailynews.com/2014/03/12/opinion/contributors/maines-medicaid-program-is-in-perpetual-crisis-dont-let-expansion-make-it-worse/ printed on September 17, 2014