Without MaineCare, childless adults say they won’t survive

Posted Dec. 16, 2011, at 11:54 a.m.
Last modified Dec. 16, 2011, at 5:39 p.m.
BDN map by Eric Zelz
Enrollment in MaineCare's Childless Adult Coverage Group, by county:The LePage administration proposes to save about $22 in fiscal year 2013 million by eliminating "noncategoricals," or childless adults, from the rolls of MaineCare coverage. The darker the red, the greater the enrollment in the state program. (click here for a larger map) SOURCE: Automated Client Eligibility System (ACES), May 1, 2011

ORLAND, Maine — Janet Bouchard has heard about the deep cuts Gov. Paul LePage has proposed to the state’s MaineCare program. The Orland woman may not know the ins and outs of the administration’s plan to overhaul the program and bring it into a new era of fiscal sustainability, but she does know that her life is on the line.

“If I lose my MaineCare, that’s it,” she said. “I’m on oxygen, I’ll have no way to get my oxygen, no way to get my medications, no way to go to the doctor.”

Bouchard is one of about 19,000 childless adults who are slated to lose MaineCare coverage under the proposal. Known as “noncategoricals,” they represent about a third of the 65,000 Mainers facing a full loss of benefits. Meanwhile, another 14,000 to 16,000 childless adults remain on a waiting list for MaineCare, according to Stefanie Nadeau, director of MaineCare services.

The administration’s plan, designed to close a $220 million shortfall over the next two years in the Department of Health and Human Services budget, calls for tightening eligibility requirements, eliminating services and repealing coverage entirely for thousands of MaineCare recipients to bring Maine’s program closer to national averages. MaineCare is the state’s version of the federal Medicaid program.

The state expects to save about $22 million in fiscal year 2013 by eliminating noncategoricals from the rolls. The cuts would take effect on July 1, 2012, after a mandated notification period, Nadeau said.

Maine began offering benefits to childless adults in 2004 and is one of just seven states that do so today, she said.

The noncategorical group consists of beneficiaries ages 21 to 64 with no dependents in the home and no disabilities. The number of people enrolled in this group has nearly doubled from about 10,000 at the beginning of 2010 but remains lower than a peak of 24,000 in 2005.

LePage has said eliminating coverage for some groups as part of his overall plan to make MaineCare more affordable in the face of rising enrollment and dropping federal reimbursements will prevent across-the-board budget cuts.

Childless adults would be stripped of benefits under the plan because they’re not among Maine’s most vulnerable, said Adrienne Bennett, a spokeswoman for the governor.

“We’re talking about able-bodied, healthy people here,” she said.

Bouchard, 55, went on MaineCare in 2008 after injuring her back and shoulder during a shift at a Bucksport convenience store and gas station. In addition to chronic pain from that fall, she also suffers from panic disorder, acid reflux, migraines and mild sleep apnea, which makes breathing difficult, she said. MaineCare pays for her doctor’s visits and five prescriptions. She refuses to take pain medications for fear of getting hooked.

Bouchard’s health problems prevent her from working and she has no income other than her boyfriend’s disability checks, she said. She applied for disability status but was denied and is pursuing an appeal through the courts, she said.

“If MaineCare cuts off, we won’t even be able to pay the bills,” she said.

The average net income of a childless adult enrolled in MaineCare is $568 per month, according to May demographic data compiled by DHHS. Many beneficiaries cannot afford to buy health insurance on the private market. Other groups are denied private health coverage because of pre-existing health conditions.

The least expensive monthly premium for a standard individual health plan in Maine was about $766 as of July 1, according to the state Bureau of Insurance website. That rate varies based on age, and some high-deductible plans are less expensive.

“We as a state have to do better at making the commercial insurance market more affordable,” Nadeau said.

The demographic data also show that just under a quarter of MaineCare-enrolled childless adults work, while 7 percent report income from unemployment, pension or retirement funds and disability payments. To be eligible, recipients must earn no more than the federal poverty level, or $10,890 annually for an individual.

“I can’t afford to buy insurance,” said Betina Pelletier, who runs a day care out of her home in Oakland. Both she and her elderly mother, whom Pelletier cares for full time, are on MaineCare. Her mother had a stroke several years ago and has no short-term memory, so she forgets if she has eaten or taken her medications, Pelletier said.

“Because I have to be in the home to take care of her, it limits my ability to earn an income,” she said.

Pelletier, 46, suffered a heart attack at age 30 and uses MaineCare to pay for 11 prescriptions that would cost her several hundred dollars a month at full price. She also has diabetes, depression and high cholesterol.

The state would be better served by keeping her on the MaineCare rolls, Pelletier said.

“It’s a lot cheaper for them to help take care of me than for them to pay to put my mother in a nursing home,” she said.

Rupert Wilmoth, 46, of South Portland said he doesn’t know how he’ll pay for prescriptions or doctor’s visits without MaineCare. He went back on the program in January after waiting two years to rejoin.

“I need it,” he said. “It’s a really tough situation out here. And I know the state is cutting a lot of things, but MaineCare is not one of the things they need to cut.”

Wilmoth works a night shift at a company that manufactures agricultural products, but said he can’t afford private health insurance.

“I don’t know what people like me are going to do,” he said.

Public hearings on the proposed cuts will wrapped up Friday before the Legislature’s Appropriations and Health and Human Services committees. Hundreds of people testified at the hearings over the course of three days, the majority in opposition to the plan, though some speakers favored it.

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