Medicaid expansion enrollment is lagging behind projections in Maine. These are the barriers.
More than 42,000 people eligible for MaineCare under the expansion provisions have signed up since Gov.
People who work with MaineCare-eligible populations say access and a lack of education are among the biggest barriers to signing people up. A provision in federal Medicaid rules may be causing older people to stay away. Health officials say they're closer to their goal than the numbers reflect but acknowledged barriers still exist.
Health officials say the number of people currently enrolled does not reflect everyone MaineCare has covered this year.
In November, Lambrew told the Legislature's joint appropriations and financial affairs committee that those numbers do not account for the lag time between when someone is covered and when they are approved, and that enrollee estimates -- which Lambrew told the
Lambrew said she feels good about where the state is on expansion and that it may be closer to its goal than it realizes. She said her department has seen 60 percent more applications for MaineCare during open enrollment than last year as of last week, a factor she attributed in part to a state campaign to raise awareness around coverage options.
Barriers such as education, access and wait times may be preventing people from getting coverage.
When it comes to MaineCare, those issues can be as simple as not knowing how to sign up or whether they're eligible. Many learn they could be covered under MaineCare when they try to sign up for coverage on the Affordable Care Act exchange, Schneckenburger said. Other times, misunderstandings about coverage occur -- like a woman who thought she had MaineCare after getting a letter from DHHS explaining medical privacy rights.
System problems can also be a challenge, Schneckenburger said. People sometimes get incorrectly denied and don't know it, or face hourslong waits when trying to connect with a state eligibility assistant. When that happens, people often give up, she said.
Lambrew said her department faced many systematic problems earlier this year and has worked to improve its application processing and wait times, pointing to the call center DHHS opened in
"We appreciate that sometimes people have to wait a long time, and we are always trying to see what are the next improvements we can make to improve our customer service," she said.
A federal requirement may be causing older residents to shy away from MaineCare. Elderly populations were projected to make up almost 50 percent of the MaineCare expansion's population by the
Providers who work with enrollment say that may be due to the state's estate recovery program, which states are required to have in order to receive federal Medicaid dollars. The process allows states to seek reimbursement for Medicaid benefits from the estate after a person who received Medicaid benefits after age 55 dies.
There are several rules governing recovery, including that the state has to wait until the person who received benefits no longer has a spouse or any children under the age of 21 or who is blind or disabled. Things like "reasonable" funeral expenses and attorneys' fees are not subject to recovery. There are also hardship and caregiver waivers.
She said residents either seek cost-sharing plans -- which usually do not cover preventive care or prescriptions -- get MaineCare coverage but then do not use it, or forego insurance altogether.
"We really just try to educate them and steer them towards their best coverage option," Gammon said. "If you're someone who has diabetes or a chronic condition, you need to have health insurance."
Lambrew said estate recovery is rare in
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