Future of MaineCare remains uncertain even after lawmakers fill deficit

By Billy Kobin, Bangor Daily News Staff

Cori Cantrell and her two children have used MaineCare for several years, relying on it for everything from surgeries to ear infections or stitches after a basketball hoop fell on one youngster’s head.

Cantrell, 32, who lives in the Penobscot County town of Exeter, values the “peace of mind” the health insurance program for low-income children and adults offers Wyatt, 8, Amelia, 6, and herself.

Cantrell, who works in a nursing home, and her family represent the human side of what is at stake for the future of the state’s Medicaid program after lawmakers squabbled for weeks before finally agreeing to fund its $118 million deficit.

The Democratic-controlled Legislature passed the plan without Republican votes needed for the money to become available immediately, forcing the state to pause or cap certain payments to health providers and hospitals until June, when the new budget patching the MaineCare shortfall will take effect.

Amid those delayed payments, MaineGeneral Medical Center in Augusta announced last month it is laying off 100 employees and blamed the temporary cuts to state reimbursements.

“For our children, that is our future, and I think it is important for us to invest in them and keep them healthy,” Cantrell said.

The funding headaches come after years of political battles preceding the COVID-19 pandemic and disagreements between parties over enrollment, work requirements and other checks on eligibility, with the battles ramping up federally under President Donald Trump and in a Republican-controlled Congress that advocates worry may eye Medicaid cuts to pay for trillions of dollars in tax cuts backed by Trump.

MaineCare, the state’s version of the Medicaid program that serves low-income children and adults under the age of 65, has grown from serving around 260,000 residents in the middle of 2018 to more than 400,000, per state figures presented to lawmakers. Department of Health and Human Services spokesperson Lindsay Hammes did not have year-over-year data but said the latest figures from December indicated 392,030 Mainers were enrolled in Medicaid, the Children’s Health Insurance Program and other categories.

Gov. Janet Mills, a Democrat who expanded MaineCare after winning election in 2018, first urged lawmakers in early January to immediately fix the $118 million MaineCare shortfall, with Finance Commissioner Kirsten Figueroa attributing it to growing enrollment, increasing use of MaineCare services since the COVID-19 pandemic and rising costs due to inflation and workforce challenges.

Figueroa told lawmakers that while any one of those factors would not pose budget issues on their own, the combination of them created “a perfect storm” that would cause havoc.

Mills pitched a short-term budget to patch up MaineCare. After GOP appropriators initially backed the plan in February, the minority party turned on it, though most House Republicans and Democrats supported a compromise that would have included a review of any waste, fraud and abuse in the health insurance program for low-income kids and adults. 

Still, that bipartisan effort failed to gain the two-thirds support to take effect immediately when all but two Senate Republicans — Rick Bennett of Oxford and Marianne Moore of Washington — voted against it, citing a desire for MaineCare work requirements and other spending checks. Democrats then pivoted to passing an $11.3 billion budget last month without Republican votes, meaning the one-time MaineCare funding and payments would not reach hospitals and health providers until 90 days later, or in June. 

Republicans have pointed to the MaineCare enrollment figures and cost overruns as a problem caused by Mills and her party. Sen. Joe Martin, R-Rumford, summed up his party’s view in a March newsletter that said Mills “has aggressively expanded Medicaid in Maine without a clear plan to pay for it.”

“Instead of implementing responsible limits or ensuring only the truly needy receive benefits, she opened the floodgates — leading to the crisis we see today,” Martin wrote of Mills.

But Senate President Mattie Daughtry, D-Brunswick, pointed to Maine’s uninsured rate dropping from 8 percent in 2019 to 5.7 percent in 2021, the largest decline among states in that time. 

“When people are able to access affordable health care, it is better for the workforce and better for the economy,” Daughtry said.

Former Gov. Paul LePage repeatedly vetoed bills to have Maine join other New England states in expanding it under former President Barack Obama’s Affordable Care Act, with the Republican governor holding out after roughly 59 percent of Maine voters approved a 2017 referendum that extended MaineCare to about 70,000 more residents with incomes between 101 percent to 138 percent of the federal poverty level at the time.

Mills succeeded LePage in 2018 and swiftly implemented the MaineCare expansion while also pulling the state out of LePage’s move approved by President Donald Trump’s first administration to require many MaineCare recipients to work 80 hours per month. Trump, who returned to office in January, may revive the work requirement fight.

“We’re not talking about something radical here,” Senate Minority Leader Trey Stewart, R-Presque Isle, said of his work requirement pitch.

Citing the 2017 referendum, Maine Equal Justice policy advocate Alex Carter pushed back on complaints about the size of the health care program, saying “more people becoming eligible and utilizing MaineCare is a good thing.”

“This is not a ‘nice to have.’ This is an essential health service,” Carter said.

Maine is hardly alone in experiencing challenges with its version of Medicaid, which serves more than one in five people in the U.S. and accounts for nearly a fifth of the nation’s health care spending. The Kaiser Family Foundation found nearly half of states have recently reported Medicaid funding challenges amid increasing pressures or fiscal uncertainty.
The MaineCare funding debates will likely return, as Democrats only included money to fill the shortfall for one year. Rep. Drew Gattine, D-Westbrook, who co-chairs the Legislature’s budget committee, cited rumblings about what Trump and Congress may do with Medicaid.

“I know we throw around this word ‘uncertainty’ a lot, but I just keep coming back to it,” Gattine said. “I have no idea what they’re actually going to get through Congress.”