To counter possible vote to expand MaineCare, DHHS and Mayhew turn to Trump

Jan. 26--AUGUSTA, Maine -- The state's plan to shrink eligibility for MaineCare -- the government health insurance program for low-income Mainers -- is a bid to leverage a friendly President Donald Trump administration to combat a likely referendum to expand MaineCare coverage this year.

Portrayed by the state as a "unique opportunity" to make Maine a leader of welfare policy in the country, some critics say the proposal contradicts public sentiment, as evidenced by thousands of signatures secured to support the referendum.

The state's request for federal approval of new restrictions on MaineCare recipients, announced by Department of Health and Human Services Commissioner Mary Mayhew on Thursday, has so far spurred predictably partisan reactions from Republicans and Democrats.

The former believe the plan is either a responsible way to prioritize limited state resources, while the latter calls it disastrous for low-income Mainers. MaineCare is Maine's version of Medicaid.

The application to the federal government, which Mayhew said will be filed in the coming days, seeks work requirements for able-bodied adults to stay on the program, time limits on the program, an asset test that would account for a Medicaid applicant's possessions, monthly premium payments and fees for missed appointments.

Republican Sen. Eric Brakey of Auburn, who is the co-chairman of the Legislature's Health and Human Services Committee, said the measures sought by Gov. Paul LePage's administration are a matter of prioritizing resources.

"I am encouraged by Gov. LePage's request to increase accountability in Medicaid -- Maine's largest welfare program -- which accounts for 29 percent of the Maine state budget and over $2.4 billion in taxpayer spending," said Brakey Thursday morning in a written statement to the Bangor Daily News. "We have an obligation to the people of Maine to promote accountability within Maine's welfare programs and ensure our limited taxpayer resources are being used to serve Maine's most vulnerable, not those abusing the system."

Democratic Sen. Ben Chipman of Portland, who also is on the health and human services committee, said Maine should be increasing the number of people receiving health insurance through Medicaid, not reducing it.

"We need to be moving in the direction of covering more people with health care insurance. This would seem to give the department a way to cut more people off MaineCare," said Chipman.

Mayhew said the timing of the state's waiver request was spurred by two events: First, the submission of signatures Wednesday to request a statewide referendum on expanding MaineCare under the provisions of the Affordable Care Act, and second, the election of Trump as president.

"We believe that President Trump and the incoming executive leadership in Washington present Maine and other reform-minded states with a unique opportunity to reshape the Medicaid program to best fit the needs of their citizens," said Mayhew in a written statement. "That means expecting able-bodied adults to work, contribute to the cost of their coverage and pay a small fee if they miss an appointment in exchange for taxpayer-funded health insurance. Like our other welfare programs, Medicaid should be a temporary hand up, not a lifetime benefit for able-bodied adults."

Mayhew says the proposed changes are part of a long-term effort to stabilize the state budget and end the days of having to deal with multimillion dollar shortfalls year after year.

"These reforms will be instrumental to Maine as we continue our spirited comeback from the days of annual and semi-annual budget deficits, bloated government and a broken economy," wrote Mayhew in a Jan. 25 letter to U.S. Rep. Tom Price of Georgia, Trump's nominee for U.S. Health and Human Services secretary.

MaineCare serves about 270,000 Mainers, which Mayhew said is 22 percent fewer since LePage took office. LePage's budget proposal, which is under consideration in the Legislature, seeks to eliminate coverage for able-bodied parents with earnings above 40 percent of the federal poverty level. The current threshold for those people is 100 percent of the federal poverty level.

Advocates for low-income Mainers, such as Christine Hastedt of Maine Equal Justice Partners, said the new proposal will undoubtedly reduce the Medicaid rolls after her organization and the Maine People's Alliance collected tens of thousands of signatures on Election Day for the Medicaid expansion referendum.

"It was pretty clear that Mainers want more access to health care," said Hastedt.

Here are the details of what Mayhew is proposing:

-- Work requirements: DHHS intends to request that MaineCare recipients adhere to work and education requirements similar to those that are in place for the Temporary Assistance for Needy Families or food stamp programs.

-- Time limits: DHHS will propose a five-year lifetime limit on receiving Medicaid for what DHHS calls "able-bodied adults," with some exceptions.

-- Transportation services: Medicaid provides rides for a range of services, including methadone treatments for opioid addicts. DHHS is proposing that taxpayer-funded rides be restricted to only appointments for a required Medicaid service and that a system be put in place to ensure that all other transportation options have been exhausted.

-- Premiums and co-pays: DHHS seeks to have Medicaid recipients who have the ability to earn income pay monthly premiums based on income. Recipients who don't pay the premiums would be removed from MaineCare temporarily, possibly six months. DHHS also proposes $20 co-pays -- including for emergency room visits for all MaineCare recipients -- that would be waived if the recipient did not access any MaineCare services in a given month.

-- Missed appointments: DHHS proposes that MaineCare providers be allowed to charge patients a fee when appointments are missed without notice.

-- Asset test: Maine has already implemented an asset test for its food stamp program, which takes into account property such as homes, recreational vehicles and bank accounts. DHHS proposes implementing the same test for MaineCare eligibility.

-- Retroactive eligibility: DHHS will propose to end retroactive coverage of services incurred in the 90 days before Medicaid eligibility.

Hastedt said federal rules might challenge Maine's proposal because the section of law under which Maine is seeking approval is designed for pilot programs that are "likely to assist in promoting the objectives of the Medicaid Act," which essentially are to extend health care coverage to low-income people.

Attempts in New Hampshire and Ohio to impose monthly premiums in 2016, for example, were rejected by the Centers for Medicare and Medicaid Services, according to correspondence provided by Hastedt.

Despite that, some think Trump, who favors creating block grants and letting states design their own Medicaid programs, will be open to drastic changes in welfare policy.

"I believe we'll see some of these changes granted," said Republican Sen. Tom Saviello of Wilton, who tried and failed to expand Medicaid in 2016 under a plan that would have used federal funds to help some Mainers purchase private insurance.

"This fits into what I think have been some of the changes that the president has suggested," he said. "In that past they would have been turned down, but I think now there is a chance."

Jackie Farwell of the BDN contributed to this report.

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