May 21, 2018
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Money saved by not expanding Maine’s Medicaid now freed for priority populations

By Ricker Hamilton, Special to the BDN

It is disingenuous to the people of Maine to try and uncouple the prioritization of funding to help the elderly and the disabled with the goal of expanding the Medicaid program to 100,000 able-bodied adults. The two are inextricably linked.

I think we can all agree the state of Maine has fixed resources to care for people in need. Expansion would cost the state at least $18 million because the state will not get 100 percent federal funding for 14,000 parents who previously received Medicaid, known as MaineCare in our state.

Not spending the money on expansion frees up money to address the state’s priority populations. Some $10 million of that sum has already been earmarked for people with intellectual and developmental disabilities and for nursing homes, many of which are struggling to make ends meet in the current reimbursement structure.

The governor’s firm stance against Medicaid expansion ensures millions of unspent state dollars are available to fund services for the elderly and developmentally disabled. If those funds were not available, those waiting for services today would be waiting tomorrow, the next day and the day after while able-bodied adults — many of whom would qualify for federally subsidized health insurance at pennies on the dollar — received free health care.

The governor and the Maine Department of Health and Human Services have been working to rein in uncontrolled and unsustainable spending since this administration took office. The MaineCare budget had grown by more than $1 billion over a decade and has required funding above and beyond what was earmarked in the state budget year after year. To complicate matters, this administration faced the loss of more than $600 million in one-time federal funding and inherited $765 million in debt to Maine’s hospitals because our state could not pay its bills on time and previously balanced the state budget on the backs of Maine hospitals.

The governor stayed true to his word by paying off more than $765 million in debt to hospitals and funding the state’s move to a “pay-as-you-go” hospital payment system. Along with this achievement, the administration has worked diligently to align MaineCare coverage with federal requirements.

The reduction in services and many efforts to contain the costs of high-cost users in the MaineCare system have resulted in significant savings and previously unseen success. In fact, Maine’s Medicaid spending in state fiscal year 2014 is projected to come in at budget or slightly below budget, a feat that has been rarely duplicated in this $3.5 billion program.

This could only have happened with a multi-faceted effort to not only reduce enrollment but to embark on projects that save money. The MaineCare program and its members have benefited from efforts like the Emergency Department collaborative, which has reduced the inappropriate use of emergency departments across the state and saved a total of $8 million in state and federal funding.

While we have made significant strides in reducing the waitlists for services — thanks in part to $10.4 million in additional funding proposed and approved by Gov. Paul LePage in the previous biennial budget — there’s still work to be done to ensure developmentally and physically disabled do not continue to wait.

Maine DHHS is working on a new assessment process to truly align the services being provided with the member’s needs. We agree this work is critical and we must create a sustainable, effective system that delivers high-quality support for adults with intellectual disabilities. In addition, we must address the undeniable challenges that come when children graduate from high school and no longer have the same access to needed services.

Sustainable systems can only be built on a stable financial foundation that is strengthened by a Medicaid program where priorities are established, health outcomes are defined and measurable, and costs are contained.

Ricker Hamilton is the Deputy Commissioner of Programs for the Maine Department of Health and Human Services and former director of the Office of Aging and Disability Services.


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