Maine should not expand its Medicaid program because it would add 124,000 recipients and increase its costs by $807 million over 10 years, says a consultant’s report released Friday by the LePage administration.

“This report highlights the fact that Maine’s General Fund is on track to be consumed by the MaineCare program,” said Gary Alexander of the Alexander Group. “Expanding eligibility for MaineCare to the able-bodied residents of working age will place at risk existing commitments Maine has to their traditional Medicaid recipients: those who are disabled and those who are elderly.”

Alexander indicated that there are opportunities to improve the program if the federal government gives the state more flexibility.

The former Pennsylvania welfare director, whose reforms in that state have been assailed by a Democratic program auditor, presented the first installment of his $925,000, taxpayer-funded study of Maine’s public assistance program Friday at the headquarters of the Department of Health and Human Services.

The administration received the report nearly four weeks ago but refused to release it until Friday, despite requests under the Freedom of Access Act from media outlets including the Portland Press Herald. Administration officials conceded that the report is a public document but said it is complex and Gov. Paul LePage wanted time to digest it before its release.

Attorney General Janet Mills, a Democrat, urged the administration this week to release the report or risk a court ruling that it was violating the law. LePage said Mills could “sue me” if she wanted the documents released.


The report is one of three that Alexander was scheduled to submit to the state last month under the terms of his contract. It’s not known whether he has delivered the others – an analysis of Maine’s welfare programs and an overhaul plan for Medicaid.

DHHS Commissioner Mary Mayhew ended Friday’s news conference before reporters could ask about the other reports. The Press Herald made a formal request to the DHHS on Thursday for any other reports submitted by Alexander, but the department has not said whether it has them.


Democratic lawmakers have characterized Alexander as a crony who was hired to bolster LePage’s controversial policy initiatives. Democratic leaders said his report would not be an independent study, but tailored to validate the governor’s goals.

Alexander would not respond to such criticism during his presentation Friday. Several times, Mayhew stepped in to answer questions that reporters tried to direct to Alexander. She raised her voice while criticizing reporters for not focusing on the report, which was released as the news conference began.

“This work is valuable,” Mayhew said of the report. “I’m not going to waste my time, the department’s time (talking about Alexander’s critics).”


But criticism followed quickly from outside groups and Democrats.

Sarah Gagne-Holmes, head of Maine Equal Justice Partners, an advocacy group for the poor, said she had yet to evaluate Alexander’s methodology but the cost projections are far above those produced by independent analysts.

“We know in the past the governor has used data to support his position,” she said. “From what little of the report that I’ve seen, I wouldn’t be surprised if this is the same thing. The (Legislature’s nonpartisan budget office) had very different numbers.”

She said, “Our (enrollment) growth rate is below the national trend. (Alexander) has a growth rate that’s well above the national trend.”

Alexander said his enrollment projection is higher because people would gravitate to Medicaid rather than pay for their own insurance. He also said, as Mayhew and the administration have said frequently, that Maine would be unwise to trust the federal government’s promises to fund Medicaid expansion under the Affordable Care Act.

“We cannot, with any level of comfort, rely on funding promises from the federal government,” said Mayhew, noting that reimbursement rates are always first to be cut during budget battles in Washington, D.C.



Friday’s presentation was preceded by weeks of controversy over Alexander’s record. On Monday, Eugene DePasquale, the auditor general of Pennsylvania, submitted an opinion column to the Press Herald urging Mainers to be wary of Alexander’s reform proposals.

DePasquale, a Democrat, described an audit that his office did on a contract Alexander signed while he was the state’s public welfare director. DePasquale said the contract, to pay home care workers, was mismanaged and late payments ultimately cost taxpayers $7 million.

Alexander resigned in Pennsylvania in February. Democrats there, including DePasquale, have suggested that the resignation was not voluntary.

In his report, Alexander suggested that Maine could improve MaineCare by getting more flexibility from the federal government to manage it. That was a reference to what is known as a global waiver, which the LePage administration has discussed. Such waivers give states more latitude in administering Medicaid programs. Alexander got a global waiver while he was the public welfare director in Rhode Island.

The waiver application began during the Bush administration and was later ratified by the Obama administration. The latter has yet to approve another global waiver, but it has expressed willingness to work with states that want more flexibility if they will expand Medicaid, a key component of the Affordable Care Act.



The expansion issue is expected to dominate the legislative session that started this week. Democratic lawmakers, who have made expansion a priority, were quick to respond Friday.

House Speaker Mark Eves, D-North Berwick, said in the Democrats’ weekly radio address that the report is a political tool to deny people health insurance.

“Governor LePage and his tea party allies will say and do anything to stop this common sense health care proposal from moving forward,” he said. “They’ve even paid an out-of-state tea party consultant to produce a report opposing it. The $1 million contract went to Gary Alexander, whose mismanagement and failed policies resulted in 89,000 children losing health care in Pennsylvania and cost taxpayers in that state $7 million.”

But Senate Minority Leader Mike Thibodeau, R-Winterport, said the study “made it even more evident that Maine cannot afford to go down the road of increasing the number of people who are dependent on welfare.”

He said, “If Medicaid is expanded, this program will quickly push out other functions of state government such as education, public safety, and long-term care for the elderly. These programs are already being threatened by budgetary constraints, and expansion would quickly accelerate that process.”


Lawmakers are considering a bill to add about 60,000 low-income Mainers to MaineCare through the Affordable Care Act. The Health and Human Services Committee plans a public hearing on a Medicaid expansion proposal Wednesday.

About 320,000 people are now enrolled in MaineCare.

Rep. Deborah Sanderson, R-Chelsea, said Friday that she expects Alexander to talk about his study next week.

LePage has said that Medicaid expansion would be too costly despite assurances from the federal government that it would fully fund expansion until 2016, before gradually drawing down to 90 percent reimbursement in 2020 and beyond.

Democrats say it makes moral and economic sense to accept the federal money and provide health care coverage to low-income Mainers.

Steve Mistler can be contacted at 791-6345 or at:

Twitter: @stevemistler

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