LePage administration moves toward stricter Medicaid rules

Maine will ask President Donald Trump’s administration to let it further rein in the state’s Medicaid program, announcing on Tuesday that the Department of Health and Human Services will have a comment period and two public hearings in May ahead of a formal request.

The move was no surprise: Gov. Paul LePage’s administration announced its plan in January to ask the Republican president to grant several changes to MaineCare, the state’s version of Medicaid, the federal low-income health care program.

MaineCare has long been targeted by LePage, whose administration has touted culling 67,000 from the program between 2011 and 2015. The Republican governor has also vetoed Medicaid expansion under the Affordable Care Act five times.

Maine will vote on a citizen’s initiative that would force the state to expand in November and these changes are seen as a way to undercut that effort.

They include:

A system of premiums and co-payments. Able-bodied adults will have to pay tiered monthly premiums based on income. If they don’t pay, they will be booted from the program. Maine also wants to require $20 co-pays for unnecessary emergency room use and allow doctors to charge MaineCare patients for missed appointments. These changes are aimed at increasing accountability for patients. A 2016 report from the progressive FamiliesUSA said five states charge monthly fees in Medicaid, but it said they were often unaffordable and led to thousands being dropped from the program.
Making MaineCare enrollees subject to work or service requirements. Able-bodied enrollees, with some exceptions, will have to work at least 20 hours per week or volunteer for 24 hours per week, similar to work requirements instituted in Maine’s food stamp program in 2014.
An asset test. LePage instituted a $5,000 asset limit in the food stamp program with several exceptions and his administration wants the same in Medicaid.

The LePage administration is expected to submit the request after a 30-day public comment period from April 25 to May 25 and two public hearings in Portland on May 17 and Augusta on May 18.