'It will have a real impact': LePage announces sweeping changes to MaineCare

AUGUSTA — The LePage administration on Tuesday unveiled a plan that could lead to sweeping structural changes in the state's Medicaid program while ending health care coverage for 65,000 people currently receiving it.

Paul LePage
Pat Wellenbach

Gov. Paul LePage pauses as he answers questions at a news conference at the State House in Augusta, Maine, on Tuesday, Dec. 6, 2011. LePage proposed tougher Medicaid eligibility standards as part of his plan to balance the budget. (AP Photo/Pat Wellenbach)

Gov. Paul LePage's plan is designed to plug a new $120 million shortfall in the budget of the Department of Health and Human Services. The plan the governor released Tuesday would result in a major overhaul of the state's MaineCare system and cut $220 million over the biennium.

LePage said the plan was designed to meet soaring enrollment in the system that is facing declining federal reimbursement. The administration said the cuts are targeted at optional services that go beyond federal standards.

Opposition to the plan was swift and forceful. Democrats and advocacy groups said the proposal was reckless and would result in only shifting MaineCare costs while increasing health care costs for everyone.

The administration estimated the proposal would remove 65,000 people from the system.

"This is a very, very difficult day for all of us," said DHHS Commissioner Mary Mayhew. "This will have a real impact on many people in this state."

Mayhew said the proposal was necessary to ween Maine off what the administration believes is a reliance on federal funding. LePage highlighted statistics showing that Medicaid represents 21 percent of all state funding, not quite double what it was in 1998.

The governor said the structural changes are needed; otherwise, the state would continue to see additional budget shortfalls at DHHS and "they're not letting me print money," he said.

Mayhew said Mainers must "end our unhealthy dependency on federal dollars."

LePage noted that Medicaid enrollment in the state has grown by 78 percent between 2000 and 2010, while Maine saw a 7 percent decrease in population. He also highlighted the state's increase in median age, from 38 in 2000 to 42.

"Not only are we getting older, we're getting poorer," said LePage, noting that Maine wages were below the national average.

Some of the proposals include axing the state reimbursement for health care for so-called childless adults and lowering reimbursement for independent providers of elderly and mental health care.

The latter, known as private, nonmedical institutions, often house elders who have lost or given up their homes but don't reside in nursing homes. Advocates for the poor and elderly said eliminating the PNMI subsidy could force recipients into nursing homes.

The administration has been reviewing the PNMI subsidy through a stakeholder commission. Cutting it would save $47 million and more than $100 million in federal match money.

The governor said the proposal was designed to protect the elderly and mentally ill and target cuts at people who had a better chance of getting off the system. He proposed cutting funding for childless adults, which would save about $37 million.

The proposal would eliminate health care funding for 19- and 20-year-olds.

The administration also proposed cutting dental, occupational and physical therapy, adult family care and other services, as well as limiting access to brand-name prescription drugs.

The plan also cuts by more than 50 percent state subsidies for a Fund for Healthy Maine, which allocates money for a national settlement with tobacco companies for smoking prevention, prenatal and young children's care, prescription drugs for the elderly and disabled, substance abuse prevention and treatment and school health programs.

The plan is included in a supplemental budget proposal that will be taken up by lawmakers when the Legislature convenes in January. It calls for cutting $120 million in fiscal year 2012 and another $101 million in 2013.

LePage hopes the plan will be adopted early in the session so the state can implement the changes in April and achieve maximum savings before federal reimbursement rates drop.

Several of the major provisions unveiled Tuesday were floated last year, but were spurned by lawmakers. Asked Tuesday if the Legislature had the political will to pass the plan, LePage said he was counting on it.

Opposition is expected to be fierce. Advocates for the poor said the cuts don't address the need for health care.

"This is a cost shift," said Ana Hicks of Maine Equal Justice Partners. "If this passes, we'll see these people pop up in emergency rooms and out in the streets."

Hicks said that while some MaineCare recipients would continue to receive benefits, rollbacks in drug and treatment plans would increase overall costs because recipients wouldn't receive the treatment they need and their conditions could worsen.

Rep. Peggy Rotundo, D-Lewiston, said Democrats still needed a concrete analysis to see what was driving the budget shortfall.

"(LePage) is proposing sweeping changes to MaineCare that will impact every family in this state," she said.

Republican leaders echoed LePage's concerns about the unsustainability of DHHS spending.

Senate President Kevin Raye, R-Perry, said, "You don't have to be a mathematical whiz to realize that explosive growth in MaineCare is unsustainable and that the chickens will come home to roost."

House Majority Whip Andre Cushing, R-Hampden, said lawmakers had no choice but to address the problem now.

"It's not going to get better if we kick the can down the road," he said. "Either we address the issue now or we deal with a greater problem next year."

Although much broader in its reach, LePage's plan bears some resemblance to a proposal Gov. John Baldacci unveiled in 2004 to address a $127 million shortfall by cutting funding for some optional DHHS programs. The cuts drew massive public backlash as 1,500 people flocked to the Augusta Civic Center for public hearings.

Hearings on the LePage plan are expected to begin next week.

It's unclear what will happen if Democrats balk and thwart the passage of a two-thirds DHHS supplemental budget. Republican leaders on Tuesday diverted questions about their willingness to pass a majority budget.

"We're still looking for that (two-thirds budget) solution," Cushing said. "If we're going to institute these changes, we need to work collaboratively. You know, this isn't a Republican versus Democrat issue. This is a fundamental problem that other states are facing."

smistler@sunjournal.com

LePagedhhssupplemental

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Comments

Joe Morin's picture

Wow

Years and years and years of irresponsible state govt. has lead to the startling facts presented and the sobering truth. Lepage is looking to fix things in Maine not get re-elected. I assumed he would continue to ignore it and kick the can for the next Gov... but he isn't. The only guy with the intestinal fortitude to do HIS job knowing he will be crucified. OSTERITY Folks!!!! News flash! The rest of the world is doing it!

Nathan Schultz's picture

It takes effort and resources

It takes effort and resources to develop medical equipment, medicine, medical facilities and medical personnel. For some reason people think they are entitled to benifit from the investment of effort and resources of others for no reason other than it exists so why shouldnt they have it.
I can understand the state providing basic medical care like setting a broken bone or antibiotics to fight a simple infection. For people to feel entitled to things like CAT Scans, MRI's, dialisis, organ replacements, or any other advancement that came about through other peoples effort and investment is rediculous. Where do people think these advancements would come from if there was no expectation of a return for investment or effort?
When the government subsidizes anything it causes that thing to have lower quality at a higher price.
One suggestion for saving money would be for the state to only provide care that has been available for more than 15 years which would allow people basic care without breaking the bank.

Cris Johnson's picture

LePage MaineCare Proposals

There is a considerable difference between necessary spending to fulfill government's obligations to its citizenry and "wasteful spending."

This phrase has been getting quite a lot of air-time in the past year and it's time to call a halt to it.

When governments have to power to gather the revenues they need to provide the services they were created to provide, failure to do so is the highest order of deceit they can impose upon the electorate.

Paul LePage and his self-serving description of Maine as a state lacking the financial resources to address it's own problems without slashing public services is outrageous.

Mark Elliott's picture

Our government wasn't created

Our government wasn't created to support us......

 's picture

OK...

Now that that's out of the way, let's find some more poor people on whose backs we can balance the budget.

FRANK EARLEY's picture

There is help out there

When I suddenly found myself with no health insurance,being totally disabled with a ton of medical issues. After I got done throwing things all over the house (didn't see my cats for a week). I went to work.
You don't need DHHS or Mainecare. If you know where to look,help is out there.
I once had a college professor tell me, its not that you know the answere, I'ts your ability to find those answeres.
Most hospitals offer some sort of help,and I don't mean er's, there really very good about it. also call around to pharmasutical companies as alot of them offer help and in some cases free medications. Its not a cureall but it some of the help thats out there. The more you look the more you'll find

ANTHONY NAZAR's picture

Gotta cut, cut cut...

If Maine required the big boxes to either provide health insurance for all their employees or pay a per uninsured employee surtax so that Mainecare could do it, the taxpayer might have more money to spend on cheap plastic *&# made in China. The cost of MaineCare could go down forcing LePage to get honest and admit that all he wants to do is eliminate programs that help "the little people."

CLAIRE GAMACHE's picture

Cutting waste

There is a difference between cutting waste and cutting programs without actually finding out if there is waste. Just because a program is expensive does not mean it is wasteful. Does anybody know where the inexpensive medical care is? I am all for cutting out fraud and waste but I don't see that happening. I just see someone with a desire to eliminate a program using the fraud and waste excuse without any real effort to find out where the fraud and waste is. I also see someone who has no clue what is going on using a hatchet where a scalpel is called for. In the end the cost in money and lives will show this to be a stupid approach. I'm hoping our legislature has more sense.

Jenn O'Neil's picture

It's so easy to look at

It's so easy to look at numbers on paper and forget that those figures are associated with real live human beings. At what point do you tell someone that it's just too bad if they are sick,injured,or in need of medication but we can't help you.Too bad if you can't afford it, or are already working 2 jobs to keep the lights on.Too bad that you don't happen to have popped out several kids . Too bad if you try every day to better your situation but just can't get anywhere. This constant referral to people receiving benefits as "lazy" is just ignorant. And guess what? Programs that serve the elderly/mentally ill/disabled are already working with nothing. What's left? I have a hard time believing there is no place else to cut except within the poorest population.

Mark Elliott's picture

This isn't the only place the

This isn't the only place the state is cutting Jenn........we have to cut all over, and we are.

 's picture

It's about time someone is

It's about time someone is addressing this problem. there is so much corruption and abuse in the system. I support this 100%. I think the state of maine is a big attraction I know it is in the top 10 for welfare, medicaid, food stamps and handout that can be given. I know someone who gets foodstamps and still goes to food bank for food. also talk with some cashiers and they say some people have thousands of dollars on their card. you can always tell their baskets are always over flowing. mine is a hand basket I am grateful I am independent of these programs

 's picture

Maine Care Costs The Biggest Waste

One word METHADONE The way it is set up now methadone users have unlimited time to stay on this program The state of Maine needs to take a real hard look at this so called sham of a program.

If an addict has a desire to clean up why not limit this program to one year and if during this year the addict fails a urine test BAM out the door.

Lets ask these so called "clinics" for proof that there are addicts that are on methadone that work.

The numbers do not lie between the free rides 7 days a week and the total costs these clinics are billing Maine Care why would any clinic release an addict from treatment? They wouldnt want to shoot Santa Claus would they?!!

So there it is want to save the state money limit the time an addict gets the free high daily and let them get jobs and for once in their lives contribute.

Kind of makes one wonder how much money these clinics have contributed to politicans maybe?

Jennifer Chretien's picture

I have an honest question

I have an honest question about the methadone programs. Do the people getting methadone required to attend any other type of rehab program. If the issues that lead to the drug use in the first place are not addressed then methadone alone will not work. I realize this is an added expense but I think it would be more successful than methadone alone. The treatment offered needs to be something that is going to work otherwise why bother?

 's picture

Insurance

As long as we have an open door to the world without a limit on how many we can possibly take in and support its not just medical coverage that is going to go broke. Instead of finding out why ins. rates are so high why don't we find out why everything from pills to surgeries cost more than an average car. You spend 10 mins. in a drs. office and see what it costs you. Pills seemed to be priced on how important it is that you have them. We have got to decide if we are gonna take care of our own or the world. You can only cut a pie in so many pieces. Go on any given day to the emergency room. First Alert or Dept. of Human Services and tell me what you see. The whole system sucks and it don't start with the little guy losing his/her assistance. It starts with why is it so high in the first place. At one time some went to Canada to get the drugs cheaper but who do you think did the research and passed on the information for free so their drugs became more affordable? You put all federal officials starting in Washington on SS and Medicare and you will see this fixed in a hurry. In the meantime that "wide open door" to the world must close.

Jennifer Chretien's picture

I have to agree, like I said

I have to agree, like I said in my comment this isn't a simple black and white issue.

ERNEST LABBE's picture

To see (hear) the waste

in Maincare just listen to dispatches to ambulances. They are routingly dispatched for such things sudden onset of wrist pain, possible broken arm things that a five dollar taxi ride would accomplish for the same price as a $750.00 ambulance ride. Listen close because these calls are 90% Mainecare covered calls. Am I against helping people no, however I am against wasting money. Cut the waste.

Jennifer Chretien's picture

Are we spending beyond our

Are we spending beyond our means without a doubt. Tough decisions have to be made and for some more than others those decisions will make things harder than they already are. The black and white thinking that I'm reading here is mind boggling. Not everyone who receives mainecare is simply looking for something for nothing. I'm willing to bet many people really don't want to need help, they would rather be able to provide for themselves, that is not always possible. For all the holier than thou folks who have never been in need consider yourself lucky and stop looking down on people whose situations you know nothing about. Things do have to change our current system is clearly unsustainable but these cuts will effect real people. People who may not be able to pay for uncovered services and prescriptions. People who can't afford to acquire debt for those services and will not get them as a result. This will be detrimental to their well being. The alternative I think will be an increase in ER visits because people know they can't be turned away. I don't have the answers but I know it is not as simple as most people want it to be.

FRANK EARLEY's picture

been there

Mark, just a short note. I am totally disabled,with an incurable medical problem.
On Jan 1st 2011 I lost all my health insurance without warning.I had to pay my own medical bills as well as prescriptions for almost a full year until I finally got new insurance. I know what its like, I've been there

P.S.
I have nothing to do with Mainecare

Mark Elliott's picture

This isn't about who deserves

This isn't about who deserves insurance or who doesn't. It's about whether or not Maine can afford to foot the bill anymore. When the bill is larger than the paycheck it's time to reduce the bills.

 's picture

I agree...

with Ronald R....this is another reason we need a nationalized healthcare plan in which all American citizens would fall under - including members of Congress and State governments.
To radically cut the MaineCare program as suggested will send those people swarming into ER's where they cannot be refused care and where they can't pay the high cost so it will end up in debt collection. The hospitals will be forced to raise their costs to help off-set their loss (called cost-shifting), and insurance premiums will be raised and deductibles increased because they can't keep up with rising costs. It's a never ending circle of our current healthcare dilemma.

We are a state with increasing aged population and low income, unskilled labor force. We have to face this head on - as many rural states are finding. Many of our kids who have gone to college can't find employment in this state and have had to move "away" so the hopes pinned on them have not come to fruition. Mark E. is correct in that someone has to jump into the pool.

 's picture

make the hard decisions

I would bet that Rep. Rotundo solution is to go back to not paying hospitals and health providers, raising taxes while adding more debt with increased borrowing from Peter to pay Paul The problem is black and white, the FEDERAL SHARE IS REDUCED,$100,000,000 in CUTS MUST BE MADE TO BALANCE THE BUDGET! THE STATE HAS NO MONEY. 80% of revenue is spent on Education and Welfare, so I would suggest that instead of wasting energy, sending groups of people in funny shirts to Augusta protestesting what must be done, that Marg Rotundo do her job, make the tough decisions the people expect her to make, help change Maine from a Welfare state to a state that can pay the bills without adding to the burden our children will have to pay for. Mainers simply cannot afford to pay for everything for everybody.

FRANK EARLEY's picture

Mainecare

Once again our illustrious govenor has jumped into the swimming pool, but forgot to fill it.
I've seen the problems with "Mainecare" coming full speed from day one. It was not well thought out back then, and everyone is paying for it now.
I feel that what needs to be done is a surgical disection of the whole program. I agree with the higher copays and generic drugs only, If a person is paying copays and can't afford the whole amount at once, he's more likly to set up a payment plan with the medical facility. An emergency room visit won't result in anything.
I can almost guarentee there are many thousands of dollars that can be saved in administative costs. A responsible review of medical spending would also result in millions of dollars of savings. Unfoutunatly it will take time, time the govenor doesn't seem to have.
When the first person dies because they lost thier health insurance. We'll all have to ask ourselves, was it worth it. I think you know what the answere to that question is.

Mark Elliott's picture

Someone HAD to get into the

Someone HAD to get into the pool, empty or not. Our last "leader" sure as hell didn't have the courage to do it, LePage does. All those cuts you are describing will surely upset people just as well. How will you explain your reasoning to those people when that happens?

Point is, no matter where we cut, there will be a certain amount of upset from various groups. Are you willing to do your part in absorbing some cuts?

GARY SAVARD's picture

Well said Mark. This is what

Well said Mark. This is what happens when you put off the inevitable until the last minute of the last hour on the clock.

Mark Elliott's picture

actually Robert, that 7% was

actually Robert, that 7% was a DECREASE in population.....this is the "can that got kicked down the road" by democrat "leadership" in the past forcing us to make drastic changes now. We've already dilly dallied on it long enough. The resistance is perfectly normal to any change. Those that reap the benefits of programs being cut will scream because they feel they are losing something that is theirs. Hence the term "entitled". But you know darn well, with our governments overspending the way they are now, we all, you and I included, stand to lose much much more down the the road if we don't get it under control.

My wife works in social services so I am sure I will be affected in the near future as well and I am ok with that because I know we must make tough changes now in order to advance later. I am taking steps now so that any changes that come my way will be as painless as possible to my family.

Mark Elliott's picture

Damn newspaper writers! Can't

Damn newspaper writers! Can't trust any of em anymore..... LOL

Mark Elliott's picture

on another note Robert, a few

on another note Robert, a few years back we all had a chance, the "entitled included, to force Maine's government to spend within our means when we voted on TABOR (2 or 3 times I think). We, the people of the state, refused to pass it. The chickens have now come home to roost........

RONALD RIML's picture

And yet

Another argument for "National Health Care"

All LePage will accomplish is to shift those who need care from one program to another 'provider' ER's, etc... - so watch insurance rates go up.

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