Governor Paul LePage’s proposal for harsh changes in the state’s Medicaid program, known as MaineCare, would restrict access to health care for many low-income Mainers. Maine is one of 19 states that haven’t adopted the Affordable Care Act’s (ACA’s) Medicaid expansion, leaving most poor adults without a coverage option. The governor’s proposal would make it harder for low-income parents and adults with significant health conditions who do qualify for Medicaid to stay enrolled.
The proposal would limit Medicaid coverage to three months in a 36-month period for beneficiaries who aren’t working or engaged in a work-related activity, impose cost-sharing and monthly premiums on most adult beneficiaries no matter how low their incomes are, and impose an asset test on all adult beneficiaries, further restricting eligibility.
Many Mainers have submitted comments opposing the proposal, which requires approval by the federal Centers for Medicare & Medicaid Services. Several comments reflect the fears of individuals with disabilities and their families. The wife of a disabled veteran wrote:
My husband is a disabled veteran and receives his medical care through the Veterans Administration, but our son (who turned three in July) and I are covered by MaineCare. . . . Arbitrary time-limits on receiving benefits, and adding work requirements, are detrimental to families suffering these circumstances. . . . MaineCare enables me to stay healthy, care for my family, and remain productive in our community.”
Other commenters emphasized the hardship the proposal would impose on Mainers struggling with mental health and substance use disorders, such as opioid addiction. Maine’s rate of drug overdose deaths rose by 26 percent in 2015 alone. Limiting access to MaineCare for people with behavioral health conditions could significantly harm those who rely on the program for treatment.
Imposing time limits on people receiving family planning services and HIV-related care through special MaineCare programs would also prove harmful. As one health care provider wrote:
I am a board-certified Obstetrician and Gynecologist providing care at a community hospital in York, Maine. . . . The proposed changes to Maine’s Medicaid Section 1115 waiver would make it less accessible, and thereby harm the health of many of my patients. . . . Most Medicaid recipients who can work outside the home already do, and for those who do not, it is usually because of a major impediment or caregiving responsibilities. These requirements disproportionately harm low-income women, who more likely to provide informal and undervalued caregiving to family members, including spouses and parents, and are therefore less likely to work outside the home.”
Similarly, another provider in Northern Maine explained that the proposal doesn’t take into account the challenges facing many MaineCare beneficiaries:
As a Clinical Psychologist in Maine who works with many families on MaineCare, I believe that Gov. LePage’s proposal … does not consider the realities of Maine. Maine is a large rural state with very little public transportation and few supportive services for parents and children. . . . Finding a job with a flexible work schedule, obtaining childcare, arranging transportation to work and childcare (not covered by MaineCare), and paying the cost of childcare (also not covered by MaineCare) are often impossible for Mainers on MaineCare. Please reject Maine’s 1115 Medicaid Waiver.”
More broadly, the LePage proposal would effectively punish those who can’t work or pay premiums by taking away their access to care. One commenter reflected on this disdain for MaineCare beneficiaries, writing: “Just listening and reading about the way the poor and low income are being presented is a misleading untruth. Please protect us from this abuse. I beg and pray you hear my words.”
If Maine’s leaders truly want to help low-income Mainers climb out of poverty, further restricting their access to needed care isn’t the answer. Instead, Maine should adopt the Medicaid expansion, which would improve access to the health care services that support employment and economic mobility. One Mainer said it best:
To impose a work mandate before people are able to be treated for illnesses and recover is makes no sense. Expand Medicaid to this population first.”
[Editor’s Note: For further information, see the comments submitted to HHS on Maine’s Medicaid waiver proposal.)