Friday, December 6, 2013
AUGUSTA — The federal government on Wednesday awarded $1.4 million to 19 Maine health centers to help them sign up state residents for health insurance under the Affordable Care Act. The grants included $74,000 for Portland's Health Care for the Homeless clinic and $73,000 for the Portland Community Health Clinic.
For the homeless clinic, the grant is a mixed blessing.
The good news is that it received the grant. But it can't currently spend the money, officials said.
Because the clinic deals exclusively with homeless Mainers, most of whose incomes fall below the federal poverty line, its only realistic option under the Affordable Care Act would be to use the grant money to help its clients sign up for free Medicaid coverage.
But although the act provided federal funding for Maine to expand Medicaid to cover more people, the state chose not to, and few of the clinic's clients would qualify under existing eligibility rules. And the way the act was written would leave most of them ineligible for federal subsidies for more expensive insurance – most couldn't afford it anyway.
Julie Sullivan, Portland's public health director, described the clinic's situation as a Catch-22.
"We were prepared to sit down with people and help them enroll," she said. "But there's no way we can do that now."
Sullivan said officials will likely ask the U.S. Department of Health and Human Services if the clinic can delay spending the money while waiting to see if Maine reverses course and expands its Medicaid program – known as MaineCare – next year.
Sullivan said the grant program was set up under the assumption that all states would expand their Medicaid enrollments, as originally called for under the Affordable Care Act. But a 2012 U.S. Supreme Court decision allowed states to opt out of the Medicaid expansion.
Gov. Paul LePage vetoed a bill that would have expanded MaineCare coverage, leaving the Portland homeless clinic with no options for spending the grant money to help its clients get insurance coverage.
"They didn't foresee that Maine would do what Maine is going to do," Sullivan said.
Cutbacks to Medicaid set to begin at the end of this year will trim about 10,500 people off the rolls, including homeless individuals who don't have children.
Anyone earning up to 100 percent of the federal poverty level is not eligible for federal subsidies to buy coverage under insurance exchanges to be established under the Affordable Care Act. The act was written to assume the poorest of the uninsured would be covered by the Medicaid expansions.
Sullivan said in addition to problems with the grant, the homeless clinic is bracing for a $300,000 to $400,000 cut in its $1.6 million budget, because Medicaid reimbursements from the state are being slashed. She said the clinic is weighing its options, and reducing operating hours is a possibility.
Unlike the homeless clinic, The Portland Community Health Center, a nonprofit that serves low-income residents, will be able to use its grant money, because it will primarily be helping people buy health insurance on the insurance exchanges starting Oct. 1, said Laura Gottfried, the center's chief program officer.
Gottfried said the center will hire one full-time and one part-time employee to find eligible people and help them enroll. Families with income between 100 percent and 400 percent of the federal poverty level will be eligible for federal subsidies to help them buy insurance if their employers don't offer plans.
"It will be a big effort," Gottfried said. "Part of our strategy is to go on-site to a number of social service agencies to reach as many people as we can, rather than just expecting people to come to us."
U.S. Health and Human Services Secretary Kathleen Sebelius announced the grants Wednesday. About $150 million will be given out nationally as part of the administration's effort to ease the process of signing up uninsured people for coverage, which takes effect Jan. 1.
The department says the $1.4 million given to Maine will allow health centers to hire 25 more workers to help more than 18,000 people get health insurance coverage. Mainers can go to the health centers to learn about their coverage options under new insurance exchanges, Medicaid and the Children's Health Insurance Program.
Joe Lawlor can be reached at 791-6376 or at: