LePage crashes DHHS deliberations: 'Get this done'

AUGUSTA — As lawmakers on the Legislature's budgetary committee grilled the chief of the Department of Health and Human Services on Friday on whether the state would receive federal waivers to make some of Gov. Paul LePage's proposed Medicaid reductions legal, a member of the audience was eager to talk. 

LePage. 

The governor raised his hand at least three times and requested to speak. After the final time, Appropriations Committee co-chairman, Sen. Richard Rosen, R-Bucksport, invited LePage to the interview table. 

During his forceful remarks, the governor reiterated the reasons lawmakers have to ratify his $221 million proposal to reduce Medicaid services.

LePage had given some of the reasons before, but not in this forum, not this way. 

What brought LePage to Appropriations was a letter from the federal Centers for Medicare & Medicaid Services which appeared to present a tall hurdle for $37 million of the governor's proposed cuts. The letter from CMS Director Cindy Mann indicated that the state might not obtain a waiver from the federal health care law to reduce Medicaid eligibility solely for budgetary purposes.

The letter concerned lawmakers on Appropriations, who are being asked to green-light some of LePage's Medicaid reductions, although proposals might not receive federal approval. 

The letter is also a concern for LePage, who is attempting to fill a $221 million budget gap at DHHS.

On Friday, the governor briefly discussed the CMS letter, saying he would personally make the case for the federal waiver to U.S. Health and Human Services Secretary Kathleen Sebelius. 

"If this (budget) is not approved by Feb. 1 and I don’t get on a plane on Feb. 2 and stay in Sebelius’ office, on April 1, the state of Maine will default," LePage said during more than seven minutes of remarks. "(Maine) will not have the money to pay the fourth-quarter 2012 Medicaid payments."

The governor said the cuts were required to keep state money flowing to schools and to keep nursing homes open. 

". . . I will be calling you back and asking you to give me the (General Purpose Aid to Education) money so that I don’t have to close nursing homes and we will probably have to close schools," said LePage, adding that he'd have to call the Legislature back into session before requesting education funding.

He added, "This is not normal politics. This is not rhetoric."

LePage said lawmakers were mistakenly addressing his budget proposal as a budget cut.

"It is not," the governor said. "It is (that) we are running out of money and this is the only way that I see to preserve the nursing homes."

He added, "Believe me, give me $221 million today, I go home, call it a day, business as usual." 

LePage said the Medicaid issue was brought to lawmakers last year in his biennial budget. However, he said, the Legislature did not approve his proposed reductions. 

"Well, the fact of the matter is we are spending at a much faster clip than we even thought," he said. "It’s taken us several months to recognize that we are blowing, or spending, an excess of $10 to $12 million a month more than we have. Add that up by 12 months, you’re at $125 million."

The governor stressed that Maine had been too generous with its Medicaid. He said the state pays "upwards of 200 percent over the federal poverty level for Medicaid" when other states "pay as low as 17 percent."

According to DHHS figures, the 200 percent statement turns out to be a generalization that represents two of the state's Medicaid offerings. Nonetheless, the state does exceed the federal poverty level in other programs.

"What we’ve done as a state has been very, very generous over the last decade," LePage said. "And that’s good. There were good times and we could afford it . . . We are not there any longer. We are not in the good times." 

The governor acknowledged that people would lose their health care if his proposal is ratified. However, he said, some would seek private insurance and others would take insurance through their employers. The latter individuals, he said, were discouraged from doing so because MaineCare provided a richer benefit that's funded by taxpayers.

"There isn’t enough money in Maine to feed the beast," LePage said.

The governor urged lawmakers to "get this done."

"I need to get (to) Washington and and try and sit with (Sebelius) and convince her that the game of being overly generous and the economy is such that they need to work with us," he said. 

LePage asked if lawmakers had questions. None did. Several appeared surprised that the governor had chosen to address the panel.

"I’ll answer any questions if you have any," LePage said, "otherwise I’m going downstairs to make a phone call to Secretary Sebelius."

It remains to be seen whether lawmakers will be heartened by the governor's promise to try to persuade Sebelius to grant the Medicaid waivers. Prior to his remarks, Maine DHHS Commissioner Mary Mayhew cautioned lawmakers about drawing conclusions from the letter.

"This response from CMS is not helpful, nor is it based on a formal proposal," said Mayhew, adding that state officials had been working with the Attorney General's Office to gauge whether the state had a chance to obtain the waivers from the Affordable Care Act.

Mayhew said the health care law's Maintenance of Effort provision was tying the state's hands in addressing its Medicaid budget. She said the federal government should be persuaded to grant an MOE waiver, given a shortfall that threatened its entire Medicaid program. 

Mayhew also noted that the state would seek assistance from its congressional delegation to obtain the waivers. 

U.S. Rep. Chellie Pingree, D-Maine, recently said the waivers appeared unlikely. 

U.S. Sen. Susan Collins, R-Maine, in a written statement Friday, stopped short of endorsing the MOE waiver, saying it was "imperative for the federal Department of Health and Human Services to work closely with the state to maintain the safety net that protects our most vulnerable citizens."

U.S. Sen. Olympia Snowe, R-Maine, went further.

She highlighted an amendment she helped secure in the federal health care law that would mirror what the governor is trying to do with childless adults on MaineCare. 

Snowe said the amendment was trying to fix an inequality in which states with low eligibility didn't have to make the same tough budget decisions as states like Maine with higher eligibility. 

She said that if the federal waiver is granted to lower the eligibility for childless adults from 200 percent above poverty level to 133 percent, Maine "would still have income thresholds for parent coverage that would be higher than 40 other states."

She added, "Indeed, 17 states have coverage only up to 50 percent of poverty, with five states covering only up to 30 percent."

Snowe said the government must continue to help those most greatly affected by the economy.

"At the same time," she said, "there are tremendous fiscal challenges confronting the state, including those resulting from the rising costs of MaineCare."

smistler@sunjournal.com

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Comments

Ed McCaffrey's picture

I'm so happy that our RINO senator has spoken

Snowe said "The government must continue to help those most greatly affected by the economy."
Those most greatly affected by the economy should not include those who are unwilling to work a job that they consider "menial", or those who think that they deserve 80 weeks of unemployment because they happened to work for 15 weeks at a ski mountain. There are all kinds of jobs out there at minimum wage working for farms, as well as those in groundskeeping and Mcdonalds, Wal-Mart and numerous other places.
I know people right now who should have run out of unemployment months ago who are still collecting because the jobs they have been offered pay less than what they were making at their old jobs. OH WELL people!!! Times have changed and I for one don't like the idea of my tax money going to pay somebody to sit on their ass because they can't make as much money as they used to.
Adapt or die. The same goes for medicare/caid. The TRULY needy, such as non insured elderly, MR adults (not children with working parents), Really disabled people (no arms, blind and deaf, those with gona-herpe-syphi-laids)
you know the people I mean!!! are the ones who should be covered by govt insurance.
We have become such an entitlement centerd society that we no longer know how to survive without govt aid. The Constitution does not guarantee any of this to Americans, and the Declaration of Independence, stated that all men are entitled to the "pursuit" of happiness. It wasn't guaranteed either.

JOHN PAINTER's picture

The tyranny of the status quo versus care of the most vulnerable

While it should be clear to anyone familiar with Medicaid CMS never issues "waivers" to reduce eligibility - that's contrary to the Social Security Act, it is evidently not clear to many in our Legislature or DHHS that CMS can in certain circumstances approve exemptions from the MOE requirements of the ACA. This was made very clear last year.

The direction to each of the states Medicaid Directors was:

"Yes. Under section 1902(gg)(3) of the Act, as added by the Affordable Care Act, during the period January 1, 2011 through December 31, 2013, if the State submits a certification to the Secretary that it has or projects a budget deficit for the current or following State fiscal year, the Medicaid MOE provision does not apply for certain adults during that year. (See Q4 about the interaction with the Recovery Act MOE provision.) Specifically, this exception to the MOE provision may be applied to adults who are not eligible for coverage on the basis of pregnancy or disability and whose incomes are above 133 percent of the Federal poverty level (FPL). (See Q5 for more details on the specific options available to States.)
It is important to note that, while the MOE would not apply, the State would need to submit a Medicaid State plan amendment (or amendment to a waiver/demonstration under section 1115 of the Social Security Act, as appropriate) to implement any reduction in eligibility."

This is the full link to the memo from CMS http://www.cms.gov/smdl/downloads/SMD11001.pdf so that you can get a sense of the context.

I hope that the current debate over words "waivers" versus "exemptions" in Augusta quickly boils away so that we can address both a deficit in our MaineCare program and current directive from CMS to amend our state Medicaid plan within 90 days (starting this past December 23) or face severe repercussions due to several factors not mentioned in this current debate for some reason.

FRANK EARLEY's picture

Just by the tone of his address

Sounds like he's in the middle of a mental breakdown

observations

I think it is a lot worse than people know and if the captain of a ship is showing signs of panic you better brace for the iceberg.

Audrey Alcala's picture

Great job Lepage...you want

Great job Lepage...you want the lawmakers to make these changes become
legal so they can happen? Isn't it bad enough you are going to affect those in great need? I'm so thankful I knew enough not to vote for you!

CLAIRE GAMACHE's picture

Maine is not broke

You cannot make a credible statement that Maine is broke and at the same time give a $3,000 tax break to the wealthiest 6,000 mainers. You cannot claim that Maine cannot afford medical care for the sick and schools for the kids and at the same time create new departments and file frivolous lawsuits. I suppose the governor thinks he can go yell at Sebilious and scare her into violating federal laws. Somehow that is one charm offensive I doubt will be successful. On the other hand maybe he could go yell at the Republicans in congress who consistently block any programs that would create jobs or in any way stimulate the economy in order to gain political advantage.

Kevin Saisi's picture

Hummm....

I didn't know that legislative committees allowed public participation by non-members. Perhaps I should show up and put in my two cents. It seems that if they allowed him to speak just because he is the governor, it may be a case of violation of the separation of powers. It would be interesting to see his behavior investigated as to its legality/ethics.

DONALD FERLAND's picture

Here is my question....if the

Here is my question....if the proposed cuts are enacted by the legislature and Maine does NOT get the waiver, where does that leave us? Will we lose federal funds? Will we have to pay anything to the federal government?

The track record of the federal government granting the waiver is NOT favorable. I believe before any legislative action is taken we need to look at these concerns. Losing federal money will make an even bigger problem. Having to pay back the federal government will also create a bigger problem. And I, for one, would like to know what will happen if the waiver is not granted.

I do not like Lepage. I do not like what he is trying to do. However, I do see that some things need to change (whether this is the right thing to do or not remains to be seen) but I do not think our representatives should make a decision without ALL the facts...and I mean the truth, not the interpretation, not the misstatements, not the bully pulpit....the truth, the whole truth, and nothing but the whole truth.

open your eyes

This has been going on for decades then dumped in his lap, this would be the same outcome for anyone placed in that seat. Maine is broke and it is not the fault of any governor newly elected.

teamwork

You know what Dan, i am a Mainecare provider and with the constant cutbacks
and closing of needed services i see people struggling, clients as well as providers. I care deeply about people and give free care daily to those who can not afford it. I do not see the value of fighting over who is a BULLY,REPUBLICAN, A DECENT MAINER,DEMOCRAT ETC..ETC. We need to ban together to get this mess resolved rather than point fingers and use energies on SHOOTING THE MESSENGER. Our budget is depleted and there is more going out than coming in,rather than slam everyone why don't you share ideas,solutions,hope, teamwork....

not new

yes i do not agree with the tax cut to the rich but i do not believe this deficit is caused by that tax cut last session, this mess has been in the works for years and covered up for years.

Long time in the works

I have worked through many cutbacks and closing of necessary services never knowing if we would have our jobs the next day. When you are faced with job loss due to DHHS cutbacks, you know that this budget mess has been shifted for years as one day you will lose your job and clients will lose their services but then the next day it will continue for a while well that tells me this crisis has been going for years and someone has only shifted the cost and never took the appropriate action to resolve the crisis, sweeping it under the rug has not fixed the problem. Although i do not agree with all of the governors actions i do feel he is the only one willing to address this head on and take the wrath to do what is necessary for the survival of Maine, then rebuild the services that were cut so harshly but first we need to get our heads above water then with the appropriate steps we will all emerge out of the water completely.

NONE

None, that is why i have worked many years in human services and provided free services and even paid for clients medications that were cut without notice. I have a 65,000 school loan and give out more of my paycheck than i keep to people in need so please do not think i do not care or do my fair share or feel the effects of the CUTBACKS... I have been through Hell with the cutbacks and lost a lot including my business and office but i am not bitter i am still out there servicing my clients to assist them in these scary times... I only wish that the citizens of Maine would team up and stop the fighting on who sucks and who does not... I bet the people who do the most complaining have not sacrificed or lost a fraction of what i or my clients have...Use your energy to resolve as it would serve us all in a positive way...

DONALD FERLAND's picture

Brenda, while I see that the

Brenda, while I see that the program needs fixing, I still would like to know more facts. What will happen if they pass this in Augusta and the feds do not give us a waiver? Will we lose more federal money? Will we have to pay the federal government more money? These are questions that need to be answered truthfully before they do anything in Augusta. I also agree with Dan to some extent. The tax break needs to be rescinded. If the state is in that dire a straight then now is not the time to lose revenue of any kind. These cuts will also affect my family and I see the need to fix the program, but I cannot see fixing it on the backs of the poor unless we know what the end result is going to be. With the climate in Washington, I do not see a waiver coming so my biggest fear is that they will pass the cuts in Augusta and we will end up in trouble with Washington and it will cause a bigger financial mess then we already have. And then the Governor will want to take even more from the poor, the elderly, the disabled, and the children. That is what we cannot allow.

JOHN PAINTER's picture

Tina, We are already having

Tina,

We are already having "trouble with Washington" / Ceneters for Medicare and Medicaid Services (CMS) for a number of issues including the PNMI issue which is not resolved, bundled rate services, credentials of providers Maine has approved and not approved in its state plan, and several other serious things. Maine currently has 60 days to provide a written correction plan to CMS to correct these and other issues, failure to do so would, according to CMS regional head Richard McGreal result in stiff sanctions e.g. closer scrutiny, claw back of funds, etc. This would not go well for Maine, we tend to have very sloppy Medicaid program, I doubt the Feds want to look unless they are forced too such as ongoing rule violations.

I believe currently the LePage Administration and Legislature are misunderstanding Title XIX rules mixing Federal statute up with the Affordable Care Act (ACA), which is cerainly a bear to read but which is fairly clear that it can with state certification of hardship, exempt the Maintenance Of Effort (MOE) requirement under the ACA.

This is the full link to the memo from CMS to state Medicaid Directors which includes the circumstances states must face, and process and extent of exemption from MOE read at this
link http://www.cms.gov/smdl/downloads/SMD11001.pdf so that you can get a sense of the context.

I'm hopeful that our elected officials will pull things together, since not doing so risks much more that $200 million.

DONALD FERLAND's picture

All your language about the

All your language about the government is great, but why can't anyone just put it in plain English....if we do NOT get granted the waiver then what is it going to cost us? Is this the only way to go? And as to your last statement.....if they go this way and we do not get the waiver then we certainly are going to need to find much more than $200 million!!!!!!

We need ALL the facts that truthfully detail exactly what is going to happen in each instance.

JOHN PAINTER's picture

If we don't get an exemption

If we don't get an exemption from the MOE, it will cost us $200 million or so, the projected deficit for DHHS, as we are evidently using 4th quarter funds to cover into April.

The exemption from MOE is not the only way to go, we could cut other state agencies, like education and any of the other state agencies - though there could be unanticipated problems and costs down the road for cutting them. We could raise taxes. There are options, though all of them have consequences and don't necessarily address the real issue. I do not envy anyone in the Legislature right now.

I don't think the real issue is about waivers or extensions, or money, specifically. I think the real issue is there isn't a real vision, direction or organization of DHHS, other than to cut costs. The risk right now, is that we have a fairly new administration which is playing catch up and doesn't quite comprehend the problems it has inhereted, and when it does figure something out is so callous in presentation of the problem that no one can see the forest for the trees.

DONALD FERLAND's picture

Well then, thank you for your

Well then, thank you for your putting it in plain English. In my opinion EVERYTHING should be put on the table including the governor's precious tax cut and we start taking step to tighten everyones belt. DHHS has been cut for years,and yet the problem still exists....lets start by cutting the administrators and their salaries.....education is already down to bear bones so lets only deal with cutting administrative things there. DOT....the roads suck anyway and the bridges are falling apart so what are they doing with their money?????? Investigations for a witch hunt.....come on now get over it....the treasurer of this state should be doing some serious budgeting instead of worrying about a department that actually has money.......duh

JOHN PAINTER's picture

Personally I think Maine has

Personally I think Maine has a lot of potential, that's why I moved back, though my wife (who is a naturalized citizen) found it very hard at first to give up the more robust economic and cultural life in other urban areas. Having grown up lobstering, I was prepared, though having lived outside of the state and country for several years I had to readjust too.

Maine has for many decades thought of itself primarily as "vacation land" for others, and not enough as gateway to Canada, Europe and the information age. Unfortunately when we have attempted interesting things; Dirigo Choice it has been far beyond our economy of scale; or the laptop initiative - too focused on the particular machines and not STEM education to make them do helpful things, to be viable in the short, let alone long run, though we have the core necessities to develop into a more economically and culturally robust state. For that I am hopeful, I've always felt Mainers know how to get things done - maybe not so pretty but we make it happen.

Our infrastructure like roads and bridges are in rough shape, like most of the other country, I agree with you that's a drag on people and our economy.

maybe this is why ?

Tina, while i am not one who knows the answers, i do know that at the state level they are committed to dole out different packages to different departments. If DHHS is in dire straights its because that dept has overspent,mis-used allotted funds or keeps growing to exceed their capacity. I do not think they can take back a tax break that was part of an original overall state/federal budget plan. Fed money also has to be used in the dept that it was requested for so it is not cold hearted people saying let every one die it is regulations of the money that we either follow through with the intended plan for that fund or risk loosing all future funding. With very little people working and paying into the system the programs would fold due to the balance between the wage earners and the recipients. Maine can not afford to maintain the current level of inkind services and would STOP in its tracks without these harsh actions unfolding. I do believe this is serious and necessary to stabilize. I despise the word cutback and have felt the realities over the past 10 years, seen many leading Agencies downsize,fold altogether,have many professional colleagues not working and have myself scrambled for work. I am not qualified to extend clarity or inside truths but i have lived and observed this matter many times over so this is just my observations.

DONALD FERLAND's picture

Sorry Brenda if you thought I

Sorry Brenda if you thought I was asking you to answer the questions. That was not my intent. My intent was to point out that those are the questions we all should be asking before we get in more trouble with the federal government. I think the answers to the questions may help guide us in coming up with tolerable solutions for all. Or at least that is my hope.

HOPE

No i just felt compelled to share my thoughts on the matter but in no way want to come across as someone who knows. I am a critical thinker who is seeking answers too. I have learned that every coin has two sides and we get more work done by working together rather than against each other. I think we share the same hope !

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