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The Legislature considered several bills this session to expand health care coverage for Maine people with low incomes through the Affordable Care Act (ACA). The Cover Maine Now Coalition and many other allies advocated for the passage of legislation that would make health insurance available to close to 70,000 uninsured people with low incomes in Maine. Despite those efforts, the Legislature rejected the opportunity to accept federal funds that would make this coverage possible. MEJP and its allies will continue our efforts to achieve greater health care coverage in Maine; the benefits to the state would be many – both to its economy and to the health and well-being of thousands of its people.

We’re happy to report, however, that the Legislature rejected several proposals that would have significantly cut healthcare programs that assist vulnerable Mainers, and took some steps forward to increase access to healthcare services.

The case for accepting federal funds through the Affordable Care Act (ACA) to improve access to health care in Maine has only grown stronger over the last year. A study released by Manatt Health Solutions in April found that Maine could achieve $27 million in savings in 2016 if the Legislature accepts the federal funds already set aside for the state for health coverage. Other states that accepted the funds are seeing significant economic benefits including state budget savings, reduced hospital bad debt and charity care, job creation and tax cuts. Maine would see these benefits as well, while providing health insurance to an estimated 70,000 people in Maine.

Among the bills that attempted to achieve Medicaid expansion in Maine, LD 854, An Act to Increase Access to Health Security by Expanding Federally Funded Health Care for Maine People passed in the house but failed in the Senate by just one vote. Another bill, LD 633, An Act to Improve the Health of Maine Citizens and the Economy of Maine by providing Affordable Market-based Coverage Options to low-income Uninsured Citizens was carried over to the 2016 legislative session. This bill provides hope that Maine will join 29 other states in providing affordable health coverage to people with low income.

Medical Assistance Preserved for Seniors and People with Disabilities:  Fortunately, the Legislature rejected a budget proposal that would have significantly cut the Medicare Savings Program (MSP) and the Drugs for the Elderly (DEL) Program that assists seniors and people with disabilities to afford prescription drugs and other medical costs. The proposals would have reduced the eligibility limit for these programs from 175% to 135% of the federal poverty level (from $1,702 to $1,313 a month for a single person and from $2,294 to $1,770 a month for a couple). In order to preserve eligibility at 175% of the poverty level, a compromise was made to implement an asset test in the DEL program similar to the asset test in the MSP.  This means that 14,486 seniors and people with disabilities continue to get help with their Medicare Part A and B costs and some help with their Medicare Part D drug costs and another 21,025 maintained some assistance that they would have lost through MSP. Approximately 800 people were able to hold on to the help they get through the DEL program.

MaineCare Decisions Based on Disability Will Not Be Delayed:  The Administration, once again, proposed to delay the time the Department of Health and Human Services (DHHS) has to process MaineCare applications based on disability from the current 45-day limit to 90 days.  It also proposed to no longer provide temporary MaineCare benefits when DHHS takes more than 45 days to make a decision.  The Legislature rejected these proposals as it has in the past.

Proposal to Limit Options for Vulnerable Seniors Was Defeated:  The Administration proposed to no longer provide help to Maine seniors with dementia and other conditions who need long-term residential care in a place other than a nursing facility.  This proposed change would have meant that people with incomes of more than $1800 a month would no longer receive help.   Since care in a residential facility runs to about $4500 a month, these frail seniors would be left without a place to live when they are no longer able to live at home.  Fortunately, the Legislature rejected this short-sighted proposal.   

Hospital Free Care Will Continue to Catch Those Who Fall through the Cracks:  A bill that would have changed the current hospital Free Care laws in Maine, reducing the eligibility level for assistance, was defeated.  While some hospitals provide free care to people with higher income, all hospitals must continue to provide free care to people with income up to 150% of the federal poverty level ($17,655 annual income for an individual, $30,135 for a family of 3).  This law also applies to hospital-owned practices, such as doctors’ offices and clinics. 

Although a greater number of Mainers now have health coverage, thanks to a Marketplace plan through the Affordable Care Act, many still rely on hospital free care for help with cost-sharing (e.g. to help pay a deductible or coinsurance). Many other people in Maine must rely on free care because they lack insurance. Thousands of Mainers with incomes below the poverty level fall in the “coverage gap” meaning they do not qualify for any help or subsidies on the Marketplace and remain uninsured.  Others are faced with the “family glitch” meaning they are not eligible for Marketplace subsidies because they have access to a family member’s employer sponsored plan, which often may be too expensive. 

MEJP worked with Consumers for Affordable Health Care to educate legislators about these gaps in health coverage in Maine, and the devastating impact that reducing hospital free care would have on these individuals. 

Efforts Continue to Increase Access to Affordable Dental Care:  LD 474, An Act to Improve Access to Dental Care in Maine was proposed to help adults get the dental care they need to avoid more expensive care or tooth loss. The bill also included diagnostic and preventive dental services for pregnant and postpartum women and for up to one year after the birth of a child. It would set up a process for providing dental services to other adults enrolled in MaineCare that would help to avoid more costly medical or dental care, often received in hospital emergency rooms. This bill was merged with LD 860, Resolve, To Adjust Reimbursement Rates for Dental Services and Improve Access to Dental Care under the MaineCare Program, which received bipartisan support and passed in both the Maine House and Senate. The merged bill was referred to the Appropriations Committee and has been carried over to the 2016 legislative session.

Increased Access to Family Planning Services: The Legislature passed a bill that is estimated to help at least 13,000 uninsured or underinsured women and men receive coverage for birth control, testing and treatment for sexually transmitted infection or cancer and annual exams. LD 319, An Act To Strengthen the Economic Stability of Qualified Maine Citizens by Expanding Coverage of Reproductive Health Care and Family Services was passed and has become law. This bill expands MaineCare coverage for certain family planning services to adults and adolescents who have incomes less than or equal to 209% of the federal poverty level (about $23,500 annual income for an individual). Along with many other bills, the Governor is challenging this new law and its outcome remains uncertain for the moment.       

(August 2015)