Friday, April 18, 2014
A frequent mantra is repeated in the media and halls of the State House by Gov. Paul LePage, administration officials and their supporters: They oppose Medicaid expansion until an estimated 3,000 vulnerable people on waiting lists are served.
Let’s understand two important facts: first, expansion would have no negative impact upon these individuals. Second, the administration, despite these protests, has done very little to help this priority population over the past three years.
The people referred to most often are individuals with developmental disabilities and autistic disorders. All the people in these vulnerable groups already receive Medicaid (MaineCare in Maine) or have other coverage for the medical care they need. Accepting federal funds to cover 70,000 more people would not jeopardize that.
A recent report from the Department of Health and Human Services indicates about 1,300 people with developmental disabilities and autistic disorders are on waiting lists for community-based waiver services. They are waiting not for medical care but for additional supports to help them reside in their homes or group homes and continue in community work environments. These additional supports include employment training, case management, transition-to-adulthood programs and family support services.
To be sure, these wrap-around services for people with developmental disabilities are important and expensive. Pulling all these individuals off the waiting lists would require an estimated $35 million of Maine tax money, matched by many millions more of federal Medicaid funds.
Extending MaineCare to 70,000 people, however, would not drain funds away from the waiting lists. The funds earmarked for MaineCare expansion can be used only for expansion, not for covering nonmedical waiver services. And the expansion would be paid for 100 percent by federal dollars in the initial years.
Moreover, if this is such a priority population to the LePage administration and legislative allies, where is their urgency? Let’s look at recent budgets. In 2011, when Republicans controlled the House, the Senate and the Blaine House (the most opportune time for a new priority initiative). they could have put new funds in the budget to address waiting lists. They did not. In 2012, the governor’s budget again had no new funds for waiting lists and actually cut funds for home support services. In 2013, the Legislature put some new increases in place to reduce waiting lists. This is certainly an erratic funding trajectory for such supposedly high priority populations.
It’s promising that about $10 million in new funds was committed in 2013. This now places Maine at the maximum number of people that can be served under the current waivers from the federal government. Waivers can be expanded by a simple application to the Centers for Medicaid and Medicare. The major factor limiting the numbers served is the amount of general fund dollars Maine commits to this group.
The governor, his legislative supporters and DHHS say there just is no money to do more. The administration, however, has shown it can be bold when it wants to, having directed $433 million into income and estate tax breaks, $183.5 million into hospital payments, and even $1 million into one controversial Medicaid study.
Let’s take these vulnerable individuals out of the political crossfire. More resources are needed for them, no question. However, leadership and innovation also are required to re-envision support, such as broadening the department’s modest efforts at the use of monitoring technologies and expanded forms of home supports. New initiatives such as health homes and accountable care communities could benefit these individuals as well as other MaineCare members.
If there is truly the will to help these vulnerable populations, the ways are well within our grasp.Lisa Miller, Somerville, is a former member of the House of Representatives, serving on the Committees of Health and Human Services and Appropriations and Financial Affairs.