Wednesday, December 11, 2013
By Kevin Miller firstname.lastname@example.org
Washington Bureau Chief
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.
Mayhew said Sebelius' letter did not address that issue, which will be key to the LePage administration's decision.
Mayhew said it also remains unclear to her department how Maine would be reimbursed, since the state previously offered more generous Medicaid coverage than the federal government required.
"It's why we wrote the letter (to Sebelius), to better understand what they are willing to do to work with Maine," said Mayhew, who will meet with top officials in Washington this week to discuss the issue.
In her letter to LePage, Sebelius pledged to continue working with the administration on the issue, but did not address the 10-year request. "I remain committed to working with you to consider all available options for ensuring the sustainability of your Medicaid programs," Sebelius wrote.
Democratic leaders had received their own letter from the head of the Centers for Medicare and Medicaid Services, Cindy Mann.
That letter, combined with Sebelius' note to LePage, constitute a "game changer," they said.
Democratic U.S. Rep. Chellie Pingree of Maine also called on LePage to expand Medicaid.
"Those federal funds come from taxpayers in Maine and around the country," Pingree said in a prepared statement. "So if we turn the funding down, Maine people will be subsidizing Medicaid expansion in other states and not getting anything in return. It just doesn't make sense."
Pingree is married to S. Donald Sussman, majority share owner of MaineToday Media, publisher of the Portland Press Herald.
Maine's political debate over expanding Medicaid is tied to a debate in the Legislature about paying more than $484 million in Medicaid reimbursements owed to hospitals.
Democratic leaders have linked the two by saying they will back the LePage administration's high-priority hospital reimbursement plan if the governor agrees to expand Medicaid. They say the reimbursement plan is moving forward, but the two issues are tied because care for the uninsured is driving up health care costs.
That has been scorned by Republicans in the Legislature and the LePage administration, who accused Democrats of threatening to scuttle the reimbursement plan.
"The Republican caucus, I think, flatly will not go along with coupling the hospital debt with Medicaid expansion," said Rep. Kenneth Fredette, R-Newport.
He said LePage would veto any coupled bill and, without Republican support, Democrats would not be able to override the veto.
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