A mixed early diagnosis from doctors, hospitals on DHHS plan to tighten MaineCare

Jan. 26--Gov. Paul LePage's administration's proposal to further restrict eligibility requirements for Medicaid elicited a mixed response Thursday from Maine hospitals and doctors.

Some of the proposed restrictions on Medicaid recipients are common in commercial insurance plans and can drive more responsible use of the health care system, said Jeff Austin, a lobbyist for the Maine Hospital Association.

But hospitals are worried about the proposal to eliminate a provision that directs Medicaid to cover claims incurred during the 90 days before a recipient becomes officially eligible.

When uninsured patients need treatment, hospitals help them to determine whether they're eligible for insurance, including Medicaid, said Austin. Those who qualify for the program, known as MaineCare, can then apply, and hospitals are compensated for the care they provide while the application is pending, he said. That can take up to 90 days.

Without the provision, hospitals would end up shouldering the costs of such treatment.

"The retroactivity provision is a big help, and removal of it will immediately hurt hospitals," Austin said.

His group also is keeping an eye on the department's proposal to charge beneficiaries monthly premiums.

"Charging premiums to people who have no ability to pay them is tantamount to just removing them from the program, which we oppose," he said. "Charging small premiums to individuals who can afford them is probably not objectionable."

The association will wait to issue a formal position on the plan until the Maine Department of Health and Human Services officially applies to the federal government, Austin said. Maine DHHS said it plans to apply for the reforms "in the coming days."

The Maine Medical Association, which represents physicians, similarly viewed the plan to charge beneficiaries' premiums and co-payments as potentially workable, provided the low-income population that Medicaid serves can afford them.

Gordon Smith, executive vice president of the Maine Medical Association, suggested the LePage administration might reconsider expanding Medicaid under the Affordable Care Act, if the state could exert greater control over the costs and coverage.

"Maybe they'll feel that putting some more people on Medicaid, because it would look more like a private plan, would be more appealing," he said.

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