Initial Medicaid Implementation: Maine initially implemented its Medicaid program in July of 1966. Like many other states, initially Maine did not take up the option to offer care to the medically indigent. Maine’s Medicaid program has largely been focused on responding to the needs of rural residents. The state, aside from the Portland area, is primarily rural and lower income which makes access a greater concern for many Mainers.
Key Medicaid Political Issues: Maine has had experience with expanding coverage prior to the passage of the Affordable Care Act. In 2003 the state expanded MaineCare through a program called Dirigo Health that was financed through a cigarette taxes. Critics have argued that the expansion of the benefit did not significantly change the insurance rate however this period was accompanied by a recession and a decreasing reliance on paper products, a major economic center of the state, both of which would have increased the uninsurance rate had the safety net of MaineCare not existed. The policy included an insurance product available to small businesses, the self-employed, and individuals. The plan also allowed other large purchases to support joint purchasing agreements that would strengthen the bargaining power of the state’s program. The program ended due to a combination of fiscal and political pressures in the state. The state faced significant budgetary pressures as the recession hit the state and the Medicaid program experienced payment delays which led to political calls to end the program. Governor LePage ended key portions of the program after taking office in 2011 including the policy that provided coverage to adults without dependents. LePage has advocated for further reductions in the Medicaid program through additional eligibility requirements, reductions in eligibility limits for parents and elderly individuals and a termination of coverage for 19 and 20 year olds that the state had previously covered.
Medicaid Expansion Implementation: The Maine Legislature voted to expand Medicaid six times, all of which were vetoed by Governor LePage. Over the period of these votes (2012-2016) the legislature switched from Democratic control of the Senate to Republican control while Democrats maintained control of the House. In November of 2016 voters in Maine approved Medicaid expansion through a veto-proof ballot initiative with 59 percent of the vote. LePage refused to implement the Medicaid expansion and was sued by the state to submit an expansion application. The Court ruled that the state had to expand coverage by a certain date but the governor did not implement Medicaid expansion still. Upon losing appeal the governor finally submitted an application for expansion but asked the federal Centers for Medicare and Medicaid Services (CMS) to not approve the application. At the same time the state had submitted an 1115 waiver application in 2017 to institute work requirements and time limits for the existing Medicaid adult population. Both the waiver application and the state plan amendment that would expand coverage are still under review at the federal CMS. While the 1115 waiver can be rejected or significantly amended based on policy decisions of the administration, it is less clear that the administration would be able to reject the expansion application except for on grounds that it does not meet the legal standard or the state has asked for policy outside of federal law.
General facts about Maine Medicaid:
Medicaid program name: Medicaid
CHIP Program name: MaineCare
Separate or combined CHIP: Combination
Medicaid Enrollment: 261,000 (2018 estimate)
Total Medicaid Spending: $2.6 billion (2016 estimate)
Share of total population covered by Medicaid: 21%
Share of Children covered by Medicaid: 44% (estimate)
Share of Medicaid that is Children and Adults: 60%
Share of Spending on Elderly and people with disabilities: 68%
Share of Nursing Facility Residents covered by Medicaid: 66% (estimate)
Expansion state: Yes* (Governor refuses to implement)
Number of people in expansion: N/A
Work Requirement: No* (Waiver under consideration)