BRUNSWICK — Rejecting billions of federal dollars available to cover more low-income Mainers because MaineCare is “too expensive” holds the uninsured hostage to program inefficiency. Maine can cover more people and reduce the program’s costs. And we don’t need a wholesale restructuring of the program to do so.

Some say MaineCare should “look more like the national average,” yet from 2007 to 2012, MaineCare’s annual enrollment growth was far below national averages. Adults, the target population for expansion, comprised 28 percent of MaineCare 2010 enrollment but accounted for only 10 percent of costs. There are better ways to lower costs than limiting enrollment.

Maine has higher disability rates among low-income people, and we are older than the nation. Those populations, who are particularly costly to serve, dominate MaineCare enrollment. Persons with disabilities account for 20 percent of MaineCare enrollees but half of spending.

MaineCare spending per person is 7 percent higher than the national average.

High health care costs drive spending for both commercial payers and MaineCare. But most MaineCare spending is on long-term care and services for persons with disabilities – services often provided, not by traditional health providers, but by organizations whose primary source of revenue is MaineCare. As the primary payer of those agencies, MaineCare has more capacity to address their costs.

Among states that have closed institutions like the former Pineland Center, Maine ranks No. 1 in per-person spending on those with intellectual and developmental disabilities – no state spends more.


The Human Services Research Institute reports that Maine serves some people with intellectual and developmental disabilities who are relatively less impaired, yet they receive a costly array of services, regardless of their level of need.

No state has more persons eligible for both Medicare and Medicaid – some of the most costly users of health services – yet Maine did not participate in a federal pilot project designed to improve care and lower costs.

Maine is one of only eight states nationwide without risk-based managed care, programs that have made Medicaid budgets more predictable

It’s important to make “apples to apples” comparisons about just what the cost of MaineCare is.

States spend 35 percent of budgets on K-12 education, and only 19.3 percent on Medicaid. Medicaid spending only looks bigger when federal funds are included. But those federal funds are an infusion into Maine’s economy and cover the costs of the poor – who will still get sick and whose costs will be paid for in higher health insurance premiums if there weren’t MaineCare.

The Maine Department of Health and Human Services is actively working to address the program’s cost challenges. A grant restructures MaineCare service delivery and payment. The state assured the federal government that $472 million in Medicaid savings will be in place in three years.


To bring our high costs more in line with other states, the DHHS is assessing persons with intellectual and developmental disabilities in order to develop appropriate, individualized services. This will generate savings that can pay for those now on waiting lists.

The DHHS’ Emergency Department Collaborative saved $8 million by providing team-based care to frequent users of the Emergency Department. It is the basis for a new initiative addressing high-cost enrollees.

Health homes – in which a single provider or a team of providers becomes accountable for the care of a person with multiple chronic illnesses – are in place to better manage care. And MaineCare’s version of managed care is under way.

Collectively, these efforts make Maine a leader in improving Medicaid efficiency and effectiveness. Still more can be done to reduce costs, particularly of people eligible for both Medicare and Medicaid and through stronger program management.

The tools to make MaineCare sustainable are already available. Costs do need to be controlled, and solid work is under way. In accepting federal funds to cover more low-income adults, Maine has more than two years with full federal funding during which to achieve program efficiencies and real savings before we have to pay one dime for those newly eligible.

Some say we need to redesign MaineCare in order to achieve savings. Promises of savings from program overhaul are just that – promises. But people in need cannot wait for promises.

The cost of MaineCare services exceeds national averages. By supporting and expanding the ongoing hard work of cost containment, we can afford to expand coverage to low-income adults now, knowing a better managed MaineCare program will yield long-term sustainability.

— Special to the Press Herald

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