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.
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."