AUGUSTA — Gov. Paul LePage’s administration is again seeking to reform Maine’s Medicaid system, MaineCare, and sees a new opportunity under the Trump administration.

Among the changes is a request by LePage and Health and Human Services Commissioner Mary Mayhew to charge MaineCare recipients monthly premiums and co-pays for services if it is determined they have an ability to earn an income.

Mayhew said the governor believes Trump will look more favorably on waivers Maine has previously sought but were rejected under former President Obama.

“We believe that President Trump and the incoming executive leadership in Washington present Maine and other reform-minded states with a unique opportunity to reshape the Medicaid program to best fit the needs of their citizens,” Mayhew said in a statement. “That means expecting able-bodied adults to work, contribute to the cost of their coverage, and pay a small fee if they miss an appointment in exchange for taxpayer-funded health insurance. Like our other welfare programs, Medicaid should be a temporary hand up, not a lifetime benefit for an able-bodied adult.”

Other changes being sought by Maine under the waivers include work requirements, a time limit on benefits and asset tests.

Mayhew’s renewed request lines up with what Trump’s nominee to lead the federal Department of Health and Human Services says he would like to see done nationwide. Dr. Tom Price, a member of Congress from Georgia, supports providing block grants to states and said he believes the state of Indiana, which requires co-pays and premiums for Medicaid recipients, has the right model.

Indiana, under then-Republican Gov. Mike Pence, held off expanding Medicaid under the Affordable Care Act until it could enact a state law requiring some financial participation by recipients.

In general, states led by Republican governors or states where Republicans hold majorities in the Legislature have begun to renew their prior requests for waivers on their Medicaid programs.

Last week, Gov. Robert Bentley of Alabama, a Republican, said he hoped the Trump administration will allow states to charge Medicaid premiums and set new enrollment requirements, The Associated Press reported. Alabama requested a waiver to be able to charge premiums to Medicaid recipients in January.

The requested changes also line up with what House Speaker Paul Ryan has proposed as reforms to state and federally funded Medicaid programs.

LePage’s administration has been relatively successful in changing components of the state’s welfare system in recent years, including putting in place work requirements for those accepting food benefits under the Supplemental Nutrition Assistance Program, previously known as food stamps, as well as changing eligibility requirements for Medicaid. About 270,000 Mainers are on MaineCare. Roughly 350,000 were on the program when LePage took office in 2011, Mayhew said in her letter to Price.

LePage’s current budget also looks to further restrict welfare benefits in Maine by reducing the maximum time a family could receive state and federally funded Temporary Assistance to Needy Families cash benefits, from 60 months to 36. About 12,000 Maine families could be affected by that change, while another 20,000 Mainers could lose their health care coverage under a proposal by LePage to tighten eligibility requirements for MaineCare by lowering the amount parents with children can earn and still qualify.

Democratic lawmakers, including Dr. Patricia Hymanson, a state representative from York and co-chair of the Legislature’s Health and Human Services committee, have said that cutting off Medicaid for low-income parents is “cruel” and helps keep families trapped in poverty.

In her release Thursday, Mayhew touted the administration’s reductions in welfare costs, noting the state’s overall budget has benefited by a new stability in the DHHS budget, which makes up about one-third of all state spending.

“Our programs are on firm financial footing, so instead of dealing with a crisis, we can carefully evaluate how to best use taxpayer money,” Mayhew said. “We are able to ensure Maine’s programs prioritize their intended beneficiaries – our poor children, our elderly and our disabled. This focus will help build a better future for our communities and our state.”

Mayhew said Maine will be requesting the changes via a section 1115b Medicaid waiver in the coming days.

“In planning for Maine’s future, our focus needs to remain fixed on the disabled and elderly in our state,” she said. “To make serving them properly a reality, we need a commitment from the federal government that we can tailor our program to best serve our state.”

These so-called “skin-in-the-game” provisions also have been floated in the Maine Legislature, including as recently as last year, when a pair of Senate Republicans teamed with Democrats to advance a bill, with a one-vote margin, that would expand Medicaid in Maine under the ACA but would have required some limited co-pays. The bill eventually died between the House and Senate when the Legislature adjourned in 2016, But the bill faced a likely veto from LePage, who had five times successfully vetoed bills to expand Medicaid in Maine.

According to a January report from the Kaiser Family Foundation, a national nonprofit that studies health care policy, 39 states charge parents of children in the Childrens Health Insurance Program some fees, and 23 of the 32 states that have expanded Medicaid charge cost-sharing for adults in the expansion. Six states have received waivers to charge premiums or monthly contributions for adults on Medicaid.

Mayhew’s announcement comes just one day after a group of advocates for Medicaid expansion in Maine turned in more than 67,000 signatures to the Secretary of State in hopes of getting a question on the November ballot.

Previous support for Medicaid expansion in the Legislature has included some Republicans, including Sens. Roger Katz of Augusta and Tom Saviello of Wilton.

Thursday, during his weekly appearance on WGAN’s radio talk show in Portland, LePage said his goal was to preserve government health care programs for the most needy Mainers and not for those who can work and pay part of their own health care costs.

“We are not, we are not trying to get people off Medicaid,” LePage told show hosts Matt Gagnon and Spencer Thibodeau. “In fact, if you are disabled, you are mentally ill or you’re elderly, I’m the first one in line to get you on. The people that we are trying to target are the people who are 19 to 50, that are able-bodied, that have no disabilities, that refuse to go to work. I say, ‘You go to work.'”

LePage then repeated a message he has stated previously that even those working full-time for the minimum wage, now at $9 an hour, would be eligible to purchase health insurance from the federal exchange set up under the ACA. “So there should be no more uninsured in the state of Maine,” he said.

LePage did not mention that he has opposed both the ACA and increasing Maine’s minimum wage, which voters in November supported.

Rep. Drew Gattine, D-Westbrook, the former House chairman of the Legislature’s Health and Human Services Committee, disagreed. He said other states that received federal waivers to add co-payments or premiums were granted them because they were expanding their programs to cover more individuals, not so they could limit access further.

LePage’s administration is asking for waivers as a way to remove more people from the system, Gattine said.

“This department continues to be obsessed with finding ways to take access to health care away from low-income people,” Gattine said. He said LePage has vetoed bills to expand Medicaid in Maine that included many of the provisions LePage is now seeking with the federal waivers, except the administration is asking for the waivers without expanded coverage for additional low-income Mainers.

“We’ve already got tens of thousands fewer people on our MaineCare program than we did when this governor took office,” Gattine said. “At what point is enough enough?”

Scott Thistle can be contacted at 791-6330 or at:

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Correction: This article was updated at 12:06 p.m. on January 27, 2017 to correct the number of Mainers on MaineCare and the proposed reduction of the maximum time a family could receive Temporary Assistance to Needy Families cash benefits.