Maine resists Medicaid expansion

There were 2,231 uninsured Mainers between 18 and 64 with a serious mental health disorder who could have accessed treatment services last year if the Pine Tree state had participated in the Medicaid Expansion Program under the Affordable Care Act.

Maine remains the only state in the Northeast that rejected the program allowing states to expand Medicaid eligibility requirements for low-income Americans with incomes up to 138 percent of the Federal Poverty Level ($16,242 per year for an individual in 2015). Participating states now number 28, with Montana poised to become the 29th once its governor obtains federal approval for its expansion model. The District of Columbia also expanded Medicaid.

A June 2012 Supreme Court decision gave states the choice of whether or not to accept the ACA’s Medicaid expansion. A total of 17 states still reject the expansion program even though treatments would have been fully paid for by the federal government through 2016 and then gradually phased down to 90 percent covered by 2020 and remain at that level permanently. Adoption of expansion remains under discussion in four states: Alaska, Florida, Missouri and Utah.

The 21 states that have so far declined to opt-in to the new Medicaid Expansion Program “will leave their most impoverished, vulnerable and sickest citizens ‘out in the coverage cold’,” states a report released this spring by the American Mental Health Counselors Association (AMHCA).

Nearly 460,000 fewer adult Americans – including 2,000 Maine residents – would have experienced major depression if the then-24 non-Medicaid expansion states had joined the program last year because they could have had affordable coverage and early screening intervention, the report states. But 7,000 Connecticut adults and 2,000 residents each in Rhode Island and New Hampshire benefited from access to services to prevent depression as a result of opting-in for expansion. The report estimates that the numbers of Massachusetts and Vermont residents were less than 1,000.

The report relies on figures from the Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health to determine how many uninsured residents are without coverage in the opt-out states. Maine’s figures indicated 709 uninsured Maine adults ages 18-64 needed substance use disorder treatment while 704 needed prescription medication for serious psychological distress. Another 366 were in need of any prescription medication for a serious mental health illness. Ninety people needed inpatient mental health treatment and 362 people needed outpatient treatment.

AMHCA issued a call to action to policymakers to “just say yes” to expansion, noting the ACA’s important financial incentives. Proponents turned out in force to testify in favor of four bills seeking expansion of MaineCare – the name for the state’s Medicaid program – at an April 30 hearing before the Joint Standing Committee of Health and Human Services at the Maine Statehouse. The Maine Legislature has passed five bills authorizing the Medicaid expansion, but each has been vetoed by Gov. Paul Le-Page, and every time, override votes fell short of the two-thirds majority needed.

MaineCare expansion would cost the state $17.2 million in calendar year 2016 through increased administrative costs and for some parents who would gain eligibility, according to a report by Manatt Health Solutions commissioned by the Maine Health Access Foundation. At the same time, the state would see savings and revenues of $43.9 million for a net savings of $26.7 million.

“States are seeing real benefits including savings – savings Maine would also achieve by using federal funds to replace state funded only programs in the area of mental health and substance abuse, cancer treatment, corrections and other state funded programs,” Ann Woloson, a policy analyst with the Augusta-based nonprofit Maine Equal Justice Partners testified at the hearing.

But Maine Department of Health and Human Services (DHHS) Commissioner Mary C. Mayhew believes the savings won’t materialize at all. She testified at the Statehouse hearing that MaineCare expansion would end up costing the general fund $53 million in the upcoming two-year budget, then $107 million in 2018-2019 and $140 million in 2020-2021. Her department cites a report by the Foundation for Government Accountability (FGA) that found Medicaid enrollment figures far exceeded projections, leaving them obligated to fund more than they first anticipated.

It’s happened before in Maine. In 2001, state officials projected 11,000 childless adults would enroll in MaineCare, but 25,000 had enrolled within two years, leading to a doubling of MaineCare’s share of the state budget and caps on enrollment and waiting lists.

“Medicaid ate our budget alive. It crowded out funding for schools, for transportation, for environmental efforts. It’s just unsustainable,” said Maine DHHS spokesman David Sorensen. “When you expand Medicaid, ultimately, invariably, you always see more people enrolled than you expect. You always see more of a cost than you expect. It’s just the way it is.”

The Manatt report does not consider the long-term impact of expanding Medicaid, which makes it “a completely useless study for us,” Sorensen added.

Expansion states where data was available have already far exceeded the enrollment estimates for the year 2022 in a 2012 report by the Urban Institute and the Kaiser Family Foundation, the FGA report found. Connecticut enrollment, for instance, was 177,068 in December 2014, 18 percent above the estimate of 150,000.

New Hampshire lawmakers cut funding to continue Medicaid expansion after it expires in 2016 from Gov. Maggie Hassan’s proposed budget.