March 12, 2013

Consensus to expand Medicaid in Maine seen as likely

The governor's willingness to consider Medicaid expansion is noteworthy because of the deep opposition he expressed just a few months ago.

By Steve Mistler
Staff Writer

AUGUSTA — Republican Gov. Paul Le-Page and the Democratic-controlled Legislature appear to be moving toward a consensus that would expand Medicaid in Maine and end a month-long political standoff over debt payments to the state's hospitals.

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LePage signaled Monday that he's open to participating in the federal health care law's Medicaid expansion program, but will seek the "best deal for Mainers."

At the same time, Democratic legislative leaders released a plan to pay Maine hospitals the $484 million that they're owed.

LePage has been urging lawmakers to dedicate revenue from a new wholesale liquor contract to the hospital payments. But Democrats have not acted on his bill, making it clear that they want Medicaid expansion before they support the hospital reimbursements.

Monday's developments indicate that a path may be found that gives both sides what they want.

Hospitals would receive $186 million in back payments from the state, which would trigger another $298 million in payments from the federal government. That money would enable hospitals to fund renovation or expansion projects and add jobs.

The Medicaid expansion would make 55,000 more low-income people eligible for MaineCare, the state's version of Medicaid, according to an analysis by the Kaiser Family Health Foundation.

Those people would be "able-bodied" parents, and adults who have no children and earn as much as 133 percent of the federal poverty level -- just over $20,500 a year for a two-person household.

Adrienne Bennett, LePage's spokeswoman, said Monday that the administration will initiate discussions with the federal government over a Medicaid expansion. She said the governor will seek assurances that Maine is "getting a return on investment."

Bennett would not say what the administration wants in its deal. However, LePage has often lamented that Maine was penalized for increasing Medicaid eligibility voluntarily in 2003 because federal match funding has declined since then.

LePage's shift on Medicaid drew praise from Democratic legislators.

"We're pleased to see the governor is considering ways to increase health care coverage for Maine people while also saving the state significant taxpayer dollars," said House Speaker Mark Eves, D-North Berwick, in a prepared statement.

Eves was optimistic that Republicans and Democrats could reach an agreement on Medicaid expansion and a plan to repay Maine's hospitals, said his spokeswoman, Jodi Quintero.

Some of the coverage categories in the Medicaid expansion program would be 100 percent funded by the federal government from 2014 to 2016 under the Affordable Care Act. In subsequent years, reimbursements would gradually decline to 90 percent of the state's costs.

Bennett said other governors have been expanding Medicaid because "their states were far behind Maine in providing benefits."

Rep. Linda Sanborn, D-Gorham, has submitted a bill that proposes expanding Medicaid eligibility, but its details have not been published.

Jeff Austin, spokesman for the Maine Hospital Association, said the trade group for Maine's 39 hospitals is waiting to see Sanborn's bill before publicly committing to Medicaid expansion.

Although Medicaid expansion would likely drive down their costs by reducing charitable care, the hospitals would have been at odds with LePage had they lobbied for expansion. That might have jeopardized his support for paying off the hospital debt.

Republicans nationally have been urged to reject Medicaid expansion because it's in President Obama's Affordable Care Act.

However, several high-profile Republican governors have agreed to participate, in part because of the high reimbursement levels. In each of those states, hospital groups have backed expansion.

(Continued on page 2)

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Today's poll: Medicaid expansion

Should Gov. LePage allow Maine to partici­pate in the federal health care law's Medicaid expansion program?



View Results