AUGUSTA, Maine – A state-funded study on the impact of Medicaid expansion was modified from its first to final draft, according to a Bangor Daily News and Sun Journal review of multiple revised documents.

Late on Friday, the Maine Department of Health and Human Services released three earlier versions of the Rhode Island-based Alexander Group’s feasibility study on Medicaid expansion. The release followed requests for the documents from the Sun Journal and Bangor Daily News under Maine’s Freedom of Access Act.

While the draft reports were produced, neither the governor’s office nor DHHS has fulfilled a secondary request for communications between the state and the Alexander Group regarding the three revisions to the study that took place between Dec. 16, when the first draft was submitted to the state, and Jan. 10, when the final report was released to the public.

A subsequent request seeking that data was sent to state officials again on Monday.

The first and final drafts of the report show that changes were made — some cosmetic, some substantial — that saw the report grow from 95 to 131 pages. While the edits were being made, reporters made several unsuccessful attempts to obtain the documents.

Efforts to contact Gov. Paul LePage’s office and DHHS Monday were unsuccessful. State offices were closed in observance of Martin Luther King Jr. Day.

Much of the report’s growth from first to last draft can be explained by the addition of several expansion scenarios, which outline a spectrum of possibilities if Maine expands.

While the numbers in the report and its final projections and conclusions remain relatively similar, changes included subtle revisions in political rhetoric and small formulaic changes that may have yielded larger changes in conclusions.

For example, the original version of the report said MaineCare enrollment — even without expansion — would grow from 285,416 today to more than 370,000 in 2014. The final version added about 35,000 to that figure, saying enrollment would grow to 406,100 in 10 years.

That may be because the Alexander Group did not originally include in its analysis roughly 45,000 Mainers who receive partial benefits under MaineCare. Subsequent versions of the report did, which may explain why enrollment growth predictions in the final draft were higher than in the original.

The document appears to have been edited to present a more seemingly detached analysis of the Medicaid expansion equations. The most politically sensitive passages were softened or removed outright: Sections outlining poor health care outcomes for those enrolled in Medicaid were trimmed or stricken, as were segments and a related appendix outlining the political breakdown of Medicaid expansion, noting “there appears to be a partisan pattern on how states are deciding to expand.”

An initial version even suggested that considering expansion at all was a waste of time.

Alexander originally wrote that, given the current level of spending on MaineCare, “there seems to be little point in talking about the expansion scenario that significantly increases costs and accelerates the cost growth rate.” That passage was removed in the final report.

Other language changes in the report de-emphasize forecasts that may bring into question efforts by Republican LePage to create jobs and grow the state’s economy.

The first draft calls the dramatic increase in Maine’s poverty rate “phenomenal.” The final report referred to the increased poverty rate as simply “one causal factor” driving Medicaid growth.

The projected growth in the number of Mainers living under the Federal Poverty Limit is important because it drives the increase in residents expected to receive Medicaid benefits if the program is expanded.

Alexander’s critics have said his projection of rapid growth in the poverty rate is unrealistic.

The final version of the report thanked DHHS Commissioner Mary Mayhew and her entire staff, and made clear the impact the department had on the study. Alexander wrote that the department contributed not only data necessary for analysis, but recommendations on the report itself, which were included in the final draft.

The conclusion on both the first and final draft also emphasizes “state-based” solutions to the problems facing Medicaid, with the federal government granting more flexibility to states through Medicaid waivers.

The overall projected cost of a Medicaid expansion in Maine was also reduced slightly from the first draft to the last.

The report, the first part of a five-part study of Maine welfare programs, that was authorized under a nearly $1 million, no-bid contract between DHHS and the Alexander Group, which is headed by Gary Alexander, the former commissioner of the Department of Public Welfare in Pennsylvania and Rhode Island.

Majority Democrats have panned the report and have accused LePage of cronyism because his administration hired Alexander’s company to do the research on a no-bid contract.

Democrats in Maine and in states where Alexander has previously worked, have panned the consultant as an ideologue. In Maine, they’ve called him a “crony” hired by LePage to validate the governor’s stance against Medicaid expansion.

Republicans, including LePage, have called Alexander one of the best consultants in the country, and have chastised Democrats for dismissing his report out of hand.

The remaining four parts of the Alexander Group’s analysis of welfare programs in Maine had varying target dates between Dec. 20, 2013, and May 15, 2014, but a spokesman for DHHS said those deadlines have been extended.

“The department is focused on ensuring that quality work is done to assess the needs of the program and make sure that our programs are operating efficiently and effectively,” DHHS spokesman John Martins wrote in an email. “No new target date for completion has been set, but progress is being made and the department looks forward to benefiting from the completed analysis in the coming weeks.”

Martins also pointed out that 40 percent of payment to the Alexander Group would be withheld until the required work has been completed.


Mario Moretto

Mario Moretto has been a Maine journalist, in print and online publications, since 2009. He joined the Bangor Daily News in 2012, first as a general assignment reporter in his native Hancock County and,...


Scott Thistle

Scott Thistle is the State Politics Editor for the Lewiston Sun Journal. He has covered federal, state and local politics in Maine for nearly two decades.