December 23, 2011

Pingree sees barriers to Medicaid cuts

Legislator questions Gov. LePage’s confidence on federal waiver

By Susan M. Cover
State House Bureau

AUGUSTA — It would be tough for Maine to win federal approval for the cuts to MaineCare that Gov. Paul LePage has proposed, said U.S. Rep. Chellie Pingree.

“It will be more difficult for the state to procure the waiver than the governor is suggesting,” Pingree said in an interview Wednesday. “I don’t think it is a slam dunk that the state, no matter what action the Legislature takes ... will automatically get approval for waivers.”

On Tuesday, LePage said he is “absolutely confident” that Maine will get the federal waivers he is seeking to help it reduce costs and address a $221 million shortfall in its Department of Health and Human Services. LePage said he believes that the federal government will work with the state because it does not want Maine to “go bankrupt or broke.”

Maine’s members of Congress aren’t yet expressing such confidence.

Pingree, a Democrat who represents Maine’s 1st Congressional District, is the only one who is ready to say that Maine would have trouble getting federal approval for the cuts the Republican governor seeks. The other three are waiting to see how much, if any, of LePage’s proposed cuts get adopted by the Legislature.

The budget-balancing proposals need federal approval, to allow Maine to deviate from “maintenance of effort” requirements. As part of the federal Affordable Care Act, states must maintain programs at levels no more restrictive than those that were in effect in March 2010. But states can ask for waivers.

If the federal government doesn’t approve waivers for Maine, LePage or the Legislature will have to look at other areas in the DHHS, or the entire state budget, to cut spending.

LePage and Republican legislators have said they want to solve the DHHS deficit within the DHHS.

Democrats have said the entire state budget should be considered.

Combined, the waivers would save the state an estimated $23 million in general fund spending over the next 18 months. That does not include about $12 million in tobacco settlement money that LePage is proposing to redirect to MaineCare from a program that helps elderly people pay for prescriptions.

LePage says U.S. Health and Human Services Secretary Kathleen Sebelius told him he needs legislative approval before he requests waivers.

Pingree said she has not been in contact with LePage or the federal department about the issue. She said she is watching to see whether the Maine Legislature approves all or part of LePage’s proposals.

The proposals would reduce or eliminate coverage through the Medicare Savings Program, which helps the elderly pay for prescription drugs, tighten eligibility requirements for parents to be in MaineCare, and end MaineCare coverage for 19- and 20-year-olds.

MaineCare is the state’s version of Medicaid.

The federal government might not look favorably on the request to cut the Medicare Savings Program, according to a letter Pingree received in September about a related waiver issue. Sebelius indicated that her department told the LePage administration in May that “the maintenance of effort provisions in the Affordable Care Act would apply.”

Republican Sen. Olympia Snowe did not say whether she thinks Maine could get the waivers, and did not address the specific cuts proposed by LePage.

She said via email, “I will work with the governor and the state Legislature as they develop and submit their specific proposals to the secretary of health and human services to secure fiscal relief while maintaining access to care for those most in need.”

Republican Sen. Susan Collins also made no prediction about the state’s chances for a waiver. She did not say whether she agrees with the proposed cuts, but said the state and federal governments should cooperate during the budget crunch to maintain a safety net for low-income Mainers.

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