FOR IMMEDIATE RELEASE: Friday, March 15, 2019

MEDIA CONTACT: Julie Rabinowitz, Director of Policy and Communication, 207-292-2722 ext. 102, Julie@mainepbp.com

AUGUSTA—Maine lawmakers need to know the real costs of the Mills Administration’s Medicaid Expansion.

“Understanding who is enrolling in Medicaid expansion is extremely important for the budget as well as what is happening in relation to Maine’s uninsured. Lawmakers in Augusta need the real costs to craft a realistic and balanced budget,” stated Julie Rabinowitz, director of policy and communication for Maine People Before Politics.

As of Friday, March 8, Maine’s Department of Health and Human Services announced that it has enrolled more than 10,075 people under Medicaid expansion. DHHS should report to the Health and Human Services Committee and the Appropriations and Financial Affairs Committee essential data on these new enrollees. 

Whether new enrollees were eligible for Medicaid expansion when the state expanded in the early 2000s determines their federal reimbursement rate. Individuals who were eligible under the prior expansion are now only eligible for the current FMAP reimbursement of 64.52 percent this federal fiscal year and decreasing to 63.80 percent in federal FY2020. The new enrollees are eligible for the Affordable Care Act’s federal reimbursement at the highest rate, 93 percent in 2019 and 90 percent in 2020 and thereafter.

Advocates of expansion argued that almost all individuals who would enroll in expanded Medicaid would be eligible for the highest reimbursement rates, although the LePage administration estimated that the number eligible for the higher match would only be about 60 percent. Enrollee data DHHS now has will end this speculation as to costs.

DHHS should compile and share the following with lawmakers immediately and provide updates as more individuals are enrolled:

• The number of individuals qualifying for the highest reimbursement rate and for the current FMAP.
• A determination whether enrollees’ coverage is retroactive to July 2; if so, healthcare providers may submit all bills incurred by an enrollee back to that date to DHHS for payment.
• The types of services enrollees are accessing; for example, the percentage of individuals accessing rehabilitation services for opioid use.
• Financial details regarding the number of providers that have submitted claims as of July 2, the total cost incurred for those services, and the types of services.
• Whether providers are being notified that enrollees’ prior and even current costs may not be eligible for the federal match because the SPA has not yet been approved.
• The number of individuals who have given up private health insurance (either employer-provided or purchased by the individual) prior to enrolling in Medicaid expansion.
• The number of new enrollees who did or would have qualified for subsidies on the exchange and what their monthly cost would have been if they had not enrolled in Medicaid expansion. 

Past estimates have pegged the average Medicaid beneficiary’s annual cost to the program at $7,000. This puts the average annual cost of the 10,000 people enrolled to date at $70 million dollars.