April 1st, 2017

Advocates worry about Medicaid reforms

The state of Maine is seeking federal permission to limit the eligibility of “able bodied” adults for Medicaid benefits to five years among other coverage restrictions designed to lower costs.

Maine Commissioner of Health and Human Services Mary C. Mayhew announced the state’s intention to seek demonstration waivers from the federal government in a Jan. 25 letter to then-incoming U.S. Secretary of Health and Human Services Tom Price posted on her state department’s Web site.

The waivers would allow Maine to implement a series of proposed reforms changing the benefits and type of access Mainers have to MaineCare, as the state’s Medicaid program is called.

Mayhew indicated the proposed time limit for Medicaid eligibility would be a lifetime period of five years with unspecified limited exceptions. When contacted for clarification, department spokeswoman Samantha Edwards said details for the waiver application are still being finalized.

Edwards added that the definition of able-bodied adults would be the same used by the federal Supplemental Nutrition Assistance Program (SNAP), which means a person between the ages of 18 and 49 who has no dependents and is not disabled.

Other reforms include work requirements, cost sharing premiums and coinsurance, an asset test to prohibit those with significant savings or property from enrolling, the prevention of access to non-emergency transportation to and from medical services and the elimination of retroactive coverage of services in the 90 days prior to Medicaid eligibility.

The changes, Mayhew wrote, will allow the state to prioritize limited resources to benefit its most vulnerable populations of children, elderly and disabled individuals. She noted that MaineCare serves 270,000 people, just over 20 percent of the state’s population. That represents a 22 percent reduction in enrollment since Gov. Paul LePage (R) took office in 2011.

“As we continue our work to maintain fiscal discipline and stability in our Medicaid program and to ensure that it is supporting our most vulnerable Mainers, we must have greater flexibility at the state level to implement these reforms,” Mayhew wrote.

Section 1115 of the Social Security Act gives the Secretary of Health and Human Services authority to approve experimental, pilot, demonstration projects that promote the objectives of the Medicaid and Children’s Health Insurance Program (CHIP) programs.

The Centers for Medicare and Medicaid Services reviews requests and allows a public comment period. If approved, waivers are typically granted for an initial five-year period and can be extended for an additional three years.

Waivers are meant to give states additional flexibility to design and improve their Medicaid programs. While Mayhew noted the proposed cost cutting measures would require beneficiaries to be more actively involved in their care, it’s unclear how the emphasis on personal responsibility fits Medicaid’s mission of providing health care for the needy.

But Maine is among several Republican-led states seeking demonstration waivers to reduce spending, encouraged by the receptiveness of President Donald Trump’s administration to allow states to reshape how health care is delivered.

“The 1115 waivers are bad from our perspective,” said Robyn Merrill, executive director of Maine Equal Justice Project, a non-profit legal aid provider for low income Mainers.

“We are very concerned about any changes that would make it harder to access affordable coverage because there are already too many people who are going without the care they need, and there’s no excuse for that in this country and in this state.”

Maine is the only New England state that opted not to expand Medicaid to low-income working age adults under the Affordable Care Act. The federal health law provided funding to 31 states plus the District of Columbia to extend health insurance to low-income uninsured individuals who were not already among the population of children, elderly and disabled people eligible for government insurance.

Cover Maine Now! gathered more than 66,000 signatures from registered voters last year to put a statewide question on the November 2017 ballot asking if Maine should expand its Medicaid program.

The large coalition said participating in the expansion would have extended coverage to approximately 69,500 Maine adults, who would have annual incomes up to $16,395 a year for an individual or $27,821 for a family of three.

Mayhew in her letter called the state’s opting out of Medicaid expansion “one of the most prudent decisions Maine has ever made.” She noted that when LePage took office in 2011, one out of four Mainers were MaineCare beneficiaries and the state regularly faced budget shortfalls of hundreds of millions in tax dollars.

The Maine Psychological Association has always been opposed to limits on care, whether it is a cap on dollar amounts or time limits, Executive Director Sheila M. Comerford said.

“Mental health problems are often controlled, not cured and require far more investment in treatment than a five-year window,” Comerford said.

“Everyone is nervous,” Comerford added. “With discussions about the fate of the ACA in Congress literally changing daily, it’s hard to know what will happen and harder to plan for anticipated upheaval in consumers’ lives.”

By Janine Weisman

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