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Wednesday January 04, 2012 | 01:59 PM

A Maine program launched by the federal health care reform law that helps consumers figure out their coverage options and appeal decisions by insurance companies to deny claims is imperiled by congressional gridlock.

The $150,000 grant awarded Maine by the Department of Health and Human Services was only supposed to have to last until this past fall.

But the Augusta-based non-profit Consumers for Affordable Health Care is trying to squeeze the funding to keep its Maine Health Insurance Consumer Assistance Program, which it runs for the state, going until March.

The organization is headed to Washington later this month to talk to Maine lawmakers about ways to come up with more money.

But Mia Poliquin Pross says she is afraid that no more funding will be available until next year, leaving a program adrift that she says has already helped six people recover about $35,500 in denied benefits, with three other cases pending in various stages. Those cases haven’t gone to court; the program has succeeded in appealing directly to insurance companies via the companies' internal appeals process without having to go the litigation route.

“We are facing a gap (in funding) as of March,” Poliquin Pross said. “We will continue to do the best we can with the resources we have,” including by applying for private grants.

The money was part of nearly $30 million given out to states after the 2010 Affordable Care Act was signed into law, the Washington Post has reported, a story which mentioned Maine's program.

But the grants authorized by the health care reform law have to be approved each year as part of the congressional appropriations process, and when Congress could only pass a catch-all 2012 spending bill near the end of the year that merely continued funding for existing programs.

Poliquin Pross and other advocates say they are afraid no more money can be handed out for the consumer assistance programs – which in the case of Maine includes a telephone help line to answer a wide range of questions and an attorney dedicated to aiding with claim appeals – until the 2013 spending bills are approved near the end of this year.

Consumers for Affordable Care used the grant money to build on an existing telephone help line, but it had not previously been able to dedicate an attorney to aid in claims appeals.

“Before we got the grant we weren’t able to take on appeals on a regular basis,” Poliquin Pross said.

Poliquin Pross said that insurance companies have put the number to the program’s help line in their explanation of benefits forms, and she is afraid the calls for advice and help will keep coming in even after the money needed to keep the program going full force runs out.

“We will operate the help line but we may not be able to take on the appeals and help people with their insurance issues,” she said.

Some advocates have said federal money allocated to Maine and other states to start up another aspect of the health care reform law, state-run insurance exchanges supposed to start up in 2014, could be used to fill the funding gap. But Poliquin Pross said she isn’t optimistic that federal regulators will allow that to happen, and notes that Maine already is finalizing plans for what to do with that money.

Maine lawmakers say the program should be funded, though they didn’t say how the gap could be filled. The House comes back from its holiday recess Jan. 17, the Senate not until Jan. 23.

"Senator Snowe believes that consumer assistance programs have value in helping people navigate the health care maze, and members of the senator’s staff will be meeting with representatives from the Maine Health Insurance Consumer Assistance Program on this issue later this month to see how we might be able to assist,” said Chris Averill, a Snowe spokesman. “With the challenge and necessity of reducing our unsustainable federal deficits and debt, discretionary spending has been cut by $31 billion compared to last year’s levels, and our responsibility is to see that needs are met while we also chart a course toward fiscal responsibility.”

Rep. Chellie Pingree, D-1st District, said that the consumer assistance program is an example of why she believes the health care reform law, which is headed for a Supreme Court showdown this year, should move forward.

The program has “provided real value to Maine people in helping them stand up to insurance companies that don’t always have their best interests in mind,” Pingree said in a statement. “I’ll continue to support funding so this program can continue to operate in Maine and am hopeful that it will continue to be funded by Congress.”


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Kevin Miller is Washington bureau chief for the Portland Press Herald and MaineToday Media. He has worked as a journalist in Maine for 6 ½ years, covering the environment, politics and the State House. Before arriving in Maine, he wrote about politics, government and education for newspapers in Virginia and Maryland.
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