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MAIN
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A Joint Project of the Maine
Association of Interdependent Neighborhoods |
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Volume 9 No. 1 |
February 2005 |
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MAIN
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A Joint Project of the Maine
Association of Interdependent Neighborhoods |
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Volume 9 No. 1 |
February 2005 |
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MaineCare and the BudgetGovernor Baldacci submitted his proposed budget for state fiscal years 2006 and 2007. We are faced with:
a $730 million projected budget deficit for the next two years;
an immediate need to pay for property tax reform and increased education spending; and
the public commitment not to raise broad-based taxes.
Education and human services are the largest part of the state budget. Education will be getting more state money, not less, because voters want local property tax relief. We expected that Human Services would be hit hard. It was! We were pleased, however, that the Governor's budget didn't include a laundry list of cuts in services like we saw last year.
Nevertheless, severe cuts in MaineCare (Maine's Medicaid program) have been proposed. These cuts are mainly for those in the “non-categorical” MaineCare category and in mental health and mental retardation services. We know we will also have to work hard to protect current levels of prescription drug coverage for Medicare participants who are enrolled in MaineCare and the Drugs for the Elderly and Disabled program. You'll find more information about proposed cuts in mental health services and prescription drugs in other articles in this newsletter.MaineCare Cuts Coming for “Non-categorical” Adults!
MAIN and MEJP worked for many years to get coverage for the last category of Maine people to be eligible for MaineCare. These are people who had no health care no matter how poor they were - adults, age 21 to 64, without minor children at home who are not disabled (the “non-categoricals”). We were successful in 2002 when full MaineCare coverage was offered to this group with income below 100% of the poverty level ($798/month for an individual). The good news is that today, at any one time, about 24,000 non-categoricals are getting health care. The bad news is that, as a group, they have significant health problems, so they cost more to cover than initially thought. Now, this group is targeted for serious and immediate cuts because of this and because there is a limit (cap) on the number of federal Medicaid dollars that can be spent for their medical care.
It is not so much the state budget, as the cap on federal Medicaid dollars that is forcing these cuts. Because they do not fit a traditional Medicaid category, Maine had to get a “waiver” from the federal government to cover non-categoricals. Under the terms of that waiver, the total number of federal dollars we can spend on them is capped - and, like in the rest of MaineCare, services for non-categoricals are paid for with about 2/3rds federal dollars. Anything over that cap must be funded entirely with state dollars. With the state budget as bleak as it is, it will be impossible to fully fund this MaineCare group with all state funds. The question now is, how many people can we cover, what services can we provide, and how much in state dollars can we get to help fill critical needs.
The problem with the federal cap is large, serious, and immediate. Here is what the Administration has proposed to do to prevent Maine, over the next two years, from hitting the federal cap.
Immediately freeze enrollment in the non-categorical category; non-categoricals currently enrolled in MaineCare would not be cut off. Read update on the enrollment freeze.
Include in the benefit package for the non-categoricals only the following services:
Hospital (inpatient and outpatient)
Physician services
Federally Qualified Health Centers and Rural Health Centers
Prescription Drugs
Outpatient mental health (with proposed limits of 16 visits, paid at private practice rates)
Substance Abuse outpatient services
Substance Abuse related private non-medical institutions (residential treatment)
Family Nurse Practitioner Services
Nurse Midwife services
Family Planning services
Ambulatory Care clinic services
Ambulatory Surgical Center servicesThis means that very important services, including dental, transportation, community support services, residential services for those with mental illness, durable medical equipment, optometric, podiatrist, chiropractic, and others are proposed to be cut. Further, it means that to restore any of these services, we have to do it without the help of 2/3rds matching federal dollars.
MAIN members have discussed this problem in an emergency conference call with MEJP staff. The principles we arrived at include the following:
Every penny available under the federal dollar cap should be spent for this group, and state budget pressures should not affect this.
We should limit the damage as much as possible, shifting as many people as possible to disability, pregnancy or other categories to prevent any unnecessary cuts.
People currently receiving MaineCare should not be cut off.
Those left uninsured or waiting for coverage must be given the information and help they need finding other sources of health care.
All reasonable efforts should be made to work with the federal government to improve the federal cap.
State funds should be sought to protect those at greatest risk from any cuts.
What about the non-categorical expansion?
The income eligibility limit for non-categoricals is scheduled to expand from 100% to 125% of the federal poverty level on April 1st. Can that happen given the budget crunch they face? Given that enrollment will be frozen, our goal will be to keep the law in place that gives DHHS authority to expand. However, we expect that the expansion will be put on hold for the time being. We'll keep you informed about this difficult situation.
