May 1, 2013

U.S. pledge on Medicaid sparks clash in Maine

Democrats say the clarification on federal funding paves the way for expansion in Maine, but LePage officials say it falls short.

By Kevin Miller
Staff Writer

WASHINGTON — Maine Democrats clashed with the LePage administration over Medicaid on Tuesday after federal officials signaled that Washington would likely pay all initial costs to cover an additional 10,500 low-income Mainers.

Democrats saw the letters from U.S. health and human services officials as another reason why Maine should go along with the Medicaid expansion in the federal Affordable Care Act.

The question of who would pay "was really the question that people were waiting to hear the answer to," said House Speaker Mark Eves, D-North Berwick. "Now that we have that answer, we can move forward with confidence knowing what the costs would be to the state."

But LePage administration officials said Washington has yet to respond to Maine's request for a special deal that would have the federal government cover all of Maine's expansion costs for an additional seven years.

"There are too many unanswered questions," said Adrienne Bennett, spokeswoman for Republican Gov. Paul LePage. "Expansion is going to cost the state as much as $100 million in a few years."

On Tuesday, Health and Human Services Secretary Kathleen Sebelius sent a letter to LePage saying that states will receive "the highest available match rate available under the law" as part of the expansion in the Affordable Care Act.

While Sebelius said her department still needs a detailed analysis from Maine, preliminary information suggests that the federal government would pay 100 percent of the cost to cover 10,500 adults without children.

The letter did not address an additional 45,000 adults -- mostly parents earning as much as 133 percent of the federal poverty level -- who would be covered by the expansion.

Many states will be reimbursed 100 percent of the cost of the expanded Medicaid coverage for three years, and 90 percent after that.

But questions emerged about whether the federal government would cover all costs for the 10,500 childless adults in Maine because the state has provided at least partial coverage to them since 2009.

Whether expansion would cost or save Maine money has been a topic of spirited debate. The LePage administration says it would ultimately cost Maine taxpayers, but an analysis by the Kaiser Family Foundation projected that Maine will save $690 million over the next decade if it accepts the federal dollars. 

On Tuesday, Democratic leaders in the Maine Legislature seized on the letters from Sebelius and another federal official, saying that issue has been settled.

"We need to address one of the most challenging issues facing Maine people and that's the affordability of health care," Senate President Justin Alfond, D-Portland, said in a prepared statement. "This is an opportunity to make sure more people can get the health care they need. It is the right thing to do and the financially wise thing to do."

While the LePage administration has expressed a willingness to participate in the expansion, the governor has said he wants the best deal from the federal government. LePage has told the Obama administration that Maine will consider participating if the federal government pays the full cost of the expansion for 10 years, rather than the three years included in the law.

Mary Mayhew, commissioner of Maine's Department of Health and Human Services, estimated that expanding Medicaid would cost the state an additional $100 million after the federal support drops to 90 percent in three years. With Maine already struggling to meet demand from its current recipients -- as evidenced by recurring budget shortfalls -- the state cannot afford to pay to expand coverage, she said.

(Continued on page 2)

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