February 26

New MaineCare expansion plan seeks consensus in Augusta

A key Republican says his proposal is bipartisan, covers 60,000 more people, provides an economic boost, takes advantage of federal funding and includes cost controls through managed care.

By Steve Mistler smistler@pressherald.com
Staff Writer

AUGUSTA — A key Republican senator released a proposal Tuesday to expand Maine’s Medicaid program to more than 60,000 low-income residents and establish a managed care system for all 320,000 beneficiaries of the $2.5 billion program in an effort to control costs.

click image to enlarge

Assistant Senate Republican Leader Roger Katz, right, and Sen. Thomas Saviello, discuss details of their proposal to expand Medicaid under the Affordable Care Act while implementing other significant changes to the program, Tuesday, Feb. 25, 2014, at the State House in Augusta, Maine. The expansion would be paired with a plan to implement managed care in the Medicaid program to try to curb costs. (AP Photo/Robert F. Bukaty)

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The proposal, sponsored by Assistant Senate Minority Leader Roger Katz, R-Augusta, could reshape a partisan debate that has raged for more than a year. Katz’s idea is the result of a six-month effort to build support for expanding the publicly funded health insurance program, which has provoked fierce ideological and philosophical opposition among Republicans over its results and costs.

Katz said the state has proven incapable of managing its Medicaid program, called MaineCare, the way it’s now structured, “regardless of which party is running it.” He said his plan would enable the state to overhaul the program while taking advantage of federal funding for expansion through the Affordable Care Act.

Katz’s plan was submitted in the form of an amendment to a managed care bill he submitted in the last legislative session and that lawmakers held over to the current session. The Legislature’s Health and Human Services Committee will take up the proposal Wednesday.

MaineCare expansion would extend health insurance to an estimated 60,000 to 70,000 adults who have no children and earn as much as 133 percent of the federal poverty level – just over $15,558 a year for an individual – while providing an economic boost to hospitals and health care providers. Katz said the sustainability of the program is on the line.

“It’s a broken system,” he said. “At the same time, expansion could offer a major economic boost. We are forgoing almost a million dollars a day (in federal funding) by not participating in the Medicaid expansion.”

Under the managed care approach, the state would drop its fee-for-service structure, which now pays hospitals and health care providers for every visit and procedure. In its place would be a system that creates a limited network of doctors and hospitals for MaineCare patients. The cost of the treatments provided in the network would be set by a third-party managing company that would be paid a set fee by the state.

The Medicaid expansion would expire after three years if the Legislature didn’t reauthorize it – after an independent review of its health impacts and costs. Coverage for those people also would end if the federal government reneged on its promise to fully fund expansion for three years, then gradually reduce its compensation to 90 percent of costs by 2020.

Katz’s proposal includes provisions to boost efforts to:

Root out Medicaid fraud among providers and consumers.

Make reforms that would help eliminate a waiting list for about 3,000 developmentally disabled people.

Study ways to move people off Medicaid through better employment opportunities.


The amendment is Katz’s second attempt to build bipartisan consensus for Medicaid expansion, a top priority for Democrats in Maine and in other states. It has been a leading issue for Eves, the House speaker, who took the symbolic step of allowing Katz’s proposal to move ahead of his expansion bill.

“We view the proposal as a step forward in months of debate over how to ensure more families can have access to a family doctor,” said Eves. “Our priority has always been focused on lifesaving health care for 70,000 Maine people. While we have been skeptical of managed care programs in the past, we look forward to hearing the details of the Republican proposal. We will want to make sure that the emphasis is on quality treatment, not simply denying care.”

(Continued on page 2)

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