Maine: Single-Payer Program

Maine: Single-Payer Program

Upshot

  • L.D. 1608, would establish the MaineCare for All Program, which would provide health care coverage to all residents of the states.

  • The program would be implemented in four phases. Coverage would be expanded to different income eligibility groups within the state, starting with individuals with incomes above 138 percent FPL but below 200 percent FPL and ending with individuals with incomes above 400 percent FPL.

  • The bill primarily relies on the Department of Health and Human Services and the MaineCare for All Implementation Task Force for designing and implementing the program. The Task Force would have been required to submit recommended legislation by January 15, 2022 to fully implement the MaineCare Program.

  • During Maine’s two-year session, the bill underwent several work sessions. However, the Committee vote to advance the bill was split and the bill eventually died in Committee. Three Democratic members of the Committee joined the four Republican members to defeat the bill.

Background

Maine transitioned to a state-based Marketplace and offered standardized health plans in fall 2021. This helped contribute to a 10 percent increase in enrollment in 2022. Three insurers offered Marketplace plans in 2022 and a fourth is joining for 2023. The Marketplace also features a merged risk pool for individual and small group plans and the state will implement an easy-enrollment program beginning in 2024. For the 2022 coverage period, approximately 66,000 residents enrolled in Marketplace plans.

Maine has also succeeded in implementing other reforms aimed at improving access and affordability throughout the state. Since taking office, Gov. Janet Mills issued an executive order to expand Medicaid and signed the Made for Maine Health Coverage Act in 2020, which reduced the OOP costs of common medical visits. Recently, the state received CMS approval for a section 1332 reinsurance waiver for the individual and small employer markets through 2027.

Summary

The legislation aims to expand MaineCare, the state’s Medicaid program, to all residents of the state by 2025. The program would include the following features:

  • Benefits: The Departments of Health and Human Services, Labor, and Professional and Financial Regulation (the Departments) would be required to design a program to provide the coverage of the services that mirror the EHB categories.

  • Payment for Services: The Departments would also design payment rates for covered health services. The program would be required to pay a “reasonable amount” charged for medically necessary emergency health care services and fair rates of compensation with participating providers and organized delivery systems that are commensurate to the services rendered.

  • Implementation: The bill would require that the MaineCare Program be implemented in the following four phases over three years:

  • MaineCare for All Implementation Task Force: The bill calls for the establishment of the MaineCare for All Implementation Task Force that is responsible for overseeing and implementing the program. The Task Force would have been required to submit recommended legislation by January 15, 2022 to fully implement the MaineCare Program and would have had to include the following provisions:

    • A transfer of responsibility for administering the MaineCare program and CHIP from the Department of Health and Human Services to the MaineCare for All Program and; a transfer of responsibility for administering any other state of federal health program to the MaineCare for All Program. This transference aligns all existing health benefits under the MaineCare for All Program.

    • Apply for all waivers necessary to transfer health care funding from the federal government to the MaineCare for All Program;

    • Establish an ongoing revenue stream to adequately fund the program; and

    • Establish a rate board to oversee the true cost of providing care for all state residents.