September 22, 2019
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Attempt to nail down Maine Medicaid expansion costs makes no progress

Robert F. Bukaty | AP
Robert F. Bukaty | AP
In this Tuesday, Nov. 7, 2017, file photo, supporters of Medicaid expansion celebrate their victory in Portland, Maine.

Questions about how much expanding the state’s Medicaid program would cost took center stage Wednesday during the Legislature’s first discussion of last month’s referendum.

But the budget committee meeting ended with no answers.

The state cost during the next couple of years to expand Medicaid eligibility — passed by voters in a November referendum — depends on when Maine applies to the federal government for the expansion, how quickly newly eligible Mainers sign up, how much will be saved when Mainers move from current state-funded programs to Medicaid and, most importantly, whether the executive branch will do anything to spur the process.

“We’re a ways away from figuring out how much money we’re going to need and when we’re going to need it,” said Rep. Drew Gattine, D-Westbrook, who co-chairs the Legislature’s Appropriations Committee.

At issue is the fact the voter-approved bill mandates expansion but includes no language about how to fund it. Proponents of the measure considered proposing raising the income tax to pay for expansion but opted to omit any funding mechanism from the signature drive that put the question on the ballot.

Now, Gov. Paul LePage is issuing ultimatums about what kind of funding source he’d support. Meanwhile, the Legislature’s fiscal office and Department of Health and Human Services disagree about how much it will cost.

Luke Lazure, a health care policy analyst for the Legislature’s Office of Fiscal and Program Review, told Appropriations Committee members on Wednesday that much of the difference between the department’s estimates and his stem from the fact that the department is not taking into account savings that would be generated.

“We assume some savings and the department assumes none,” said Lazure. “That’s the big difference.”

In a Dec. 11 letter to legislative leaders, LePage also wrote that the money appropriated by the Legislature for Medicaid expansion must be based on the DHHS estimates, not OFPR’s.

OFPR pegged the cost after full implementation at more than $54 million in the first year, rising to more than $81 million by 2021, which would be matched with $525 million in federal matching funds.

The Department of Health and Human Services estimate the cost of expansion would be at least $63 million next year, $82 million in fiscal year 2020, $97 million in 2021 and more than $100 million every year after that, according to the governor’s office.

As for short-term fiscal impacts, Lazure said the amount of new money that must be appropriated during the current two-year budget cycle depends on how quickly expansion can take place. The numbers presented to date are based on the state moving quickly with the process, with Mainers making less than 138 percent of the federal poverty level first becoming eligible in July 2018.

No one from DHHS participated in Wednesday’s hearing despite a request for them to do so. LePage has said any questions for DHHS must be in writing and submitted directly to him.

Rep. John Martin, D-Eagle Lake, submitted some of the questions.

“I wonder if the department could let us know the timeline for the number of people necessary to implement the program and how they envision that will proceed,” Martin said, drawing a pithy response from Rep. Jeff Timberlake, R-Turner, who was sitting at the other end of the budget committee chamber.

“I think the chief executive answered that in his letter,” said Timberlake. “As soon as we put the money up and finance it, he’ll start.”

LePage, who has always firmly opposed expanding Medicaid because of the cost to taxpayers, laid out a number of conditions, including that there be no tax increases, that money from the budget stabilization fund not be tapped, that the funding mechanism be ongoing, and that waitlists for services for elderly and disabled people be eliminated before state government pays to expand Medicaid eligibility.

The budget committee doesn’t meet again until January when the full Legislature returns for a four-month session.

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