DHHS Will Submit a Formal Request to the Trump Administration for MaineCare Reforms
Waiver request would implement work requirements for able-bodied adults enrolled in MaineCare
AUGUSTA- The Maine Department of Health and Human Services (DHHS) will formally submit a Medicaid waiver request to the Centers for Medicare and Medicaid Services (CMS) that would allow the state greater flexibility in managing the MaineCare program. Under the waiver, called an “1115” or “demonstration project” waiver, the Department proposes a series of innovative reforms intended to prioritize limited resources for the neediest populations and promote individual responsibility for health and health care costs.
“With our Medicaid program finally on stable financial ground and a new administration in Washington, we have an opportunity to reshape our program and tailor it to best serve the needs of our state,” said DHHS Commissioner Mary Mayhew. “We must reestablish Medicaid’s core mission of supporting the elderly, disabled, and children. This is what is best for the people of Maine and the future of our state.”
The waiver request proposes a number of reforms, including to:
- Require able-bodied adults to comply with reasonable community engagement and work requirements;
- Count personal assets when determining MaineCare eligibility;
- Collect monthly premiums for adults who have the ability to earn income as a contribution toward their health care costs;
- Give providers the option to charge fees for missed appointments;
- Eliminate retroactive coverage for persons applying for MaineCare;
- Apply a transfer penalty to the purchase of Medicaid-compliant annuities; and
- Eliminate hospital presumptive eligibility determinations.
“These are commonsense guidelines that ensure able-bodied adults are utilizing the program appropriately. Under Governor LePage, we have successfully reined in spending within the MaineCare program that once failed to prioritize our neediest citizens and placed an undue burden on Maine tax-payers, and we look forward to continuing those efforts with the opportunity extended to us by the federal government through this waiver,” said Commissioner Mayhew.
The Department will use these reforms to promote the transition of individuals from MaineCare into the private insurance market through the introduction of common insurance elements such as copayments, premiums, and structured enrollment timeframes.
The 1115 waiver seeks to build off of the LePage Administration’s success in stabilizing the MaineCare program, which, in prior administrations, had been perpetually overspent. Over the last six years, the LePage Administration has accomplished the following:
- A reduction in MaineCare program enrollment by 24%.
- Contained spending growth to an average rate of 2% compared to the national average of 6%.
- Increased funding to nursing facilities by over 40%.
- Increased rates to home care by 60%.
- Invested $100 million to support the needs of individuals with intellectual and developmental disabilities.
- Increased support for primary care and mental health services for those struggling with mental illness.
The Department will officially submit the waiver request following two public hearings. Additional information is available online: http://www.maine.gov/dhhs/oms/rules/demonstration-waivers.shtml.