The LePage administration is seeking federal permission to change the eligibility rules for MaineCare, the state version of Medicaid. If approved, able-bodied adults would have to meet work requirements and chip in on their health care.
State officials say the changes would make the program financially stable and help enrollees become self-sufficient. But at a public comment hearing in Portland on Wednesday, those opposed say the changes will cut access to health care, which contradicts the real purpose of Medicaid.
Department of Health and Human Services Commissioner Mary Mayhew described the overarching goal behind the waiver Maine is seeking.
“So that we can promote independence, self-sufficiency, that welfare programs don’t become a trap,” she said.
One major way the state seeks to do that is to require able-bodied adults ages 19-64 to work or perform community service about 20 hours a week, or lose coverage. Chris Hastedt of Maine Equal Justice Partners calls it the most dangerous part of the waiver.
“It’s really not a work requirement at all. It’s a penalty for not being able to find a job, if you can’t find one,” she says.
It’s modeled after a similar state requirement implemented in 2014 for food stamps. Hastedt says since then, hundreds of people have been disqualified from that program, despite having health conditions that prevent them from working.
Fifty-six-year-old Judy Bullard worries that this new proposal would result in her being disqualified from MaineCare, which helps her get treatment for epilepsy.
“Someone looks at me, and it looks like I’m able-bodied. I have an invisible disability, and nobody looks at me and knows I have a disability until I have a seizure. And there are a lot of other people out there like me,” she says. “It’s just wrong for a caseworker to make an assumption that I have the ability go out and work without really knowing more about me.”
Hastedt says other states have applied for similar work-requirement waivers and have been denied.
“And the reason for that, is it’s contrary of the purpose of the Medicaid Act, which is to help people who can’t afford health care get basic health care,” she says.
Aside from the work requirement, Mayhew also wants MaineCare recipients to contribute to their health care. Enrollees would pay for missed appointments, they’d be charged $20 if they go to an emergency room and aren’t admitted as a patient, and they’d also pay monthly premiums.
“To prepare individuals for certainly the cost associated with care, but also the cost-sharing that exists with employer-sponsored coverage and in the commercial health insurance market,” she says.
The idea may make sense in theory, says independent health policy consultant Mitchell Stein. But he says evidence from other states that have required Medicaid premium payments, including Michigan, Iowa and Arkansas, proves otherwise.
“It just doesn’t work. You end up getting people delinquent on premiums. Being eliminated from the program, accruing more debt for the premium they can’t pay, and the state spending a lot of money to try to collect this and not taking in very much. Certainly taking in much less than the premium collected,” he says.
Stein says these changes would save the state money, but only because they discourage eligible people from enrolling in MaineCare.
Judy Newell knows firsthand the value of having coverage. When she qualified a few years ago, she says that she was able to see a primary care physician who detected breast cancer.
“I’m still on chemo. I’ve been on chemo for almost 3 years now — a lot of surgery. But I would not even have known, and I would not be standing here today, if I did not receive MaineCare when I did,” she says.
Newell says she’s worried for others who may become ineligible if the waiver proposals are put into place.
Stein says he doesn’t see how Maine’s proposals fulfill the purpose of federal waivers, which are to improve care and reduce costs.
“I have to say this waiver is designed to be vindictive. It is taking advantage of an application process designed to run the program more efficiently, and using that to get people off the program. It’s not saving money effectively, it’s not improving the program. It’s eliminating benefits,” he says.
But Mayhew says the changes would strengthen a safety net program that’s been hemorrhaging red ink for decades.
Another public hearing on the waiver is scheduled for Thursday in Augusta. DHHS will accept public comments through May 25, and must document how those comments were considered in its final application to the federal government.
