Lawmakers endorse bipartisan deal on immediate DHHS shortfall

AUGUSTA — Weeks of intense backroom negotiations, work sessions and partisan distractions over a funding shortfall at the Department of Health and Human Services have subsided, at least for now. 

Next comes the hard part for Republican leaders: selling the compromise to Gov. Paul LePage and his loyalists in the conservative caucus. 

Lawmakers on the Legislature's budget-writing Appropriations Committee voted unanimously early Wednesday morning on a deal that will close a $120 million budget gap for fiscal year 2012, while avoiding some of the more difficult cuts to the state's MaineCare program that were proposed by LePage. 

Democrats heralded the deal, saying it preserved health care for thousands of low-income Mainers, including veterans and the state's most vulnerable residents.

Republicans championed lawmakers' ability to reach a bipartisan compromise that allowed the state to pay its bills while improving on LePage's initial proposal.

House Majority Whip Andre Cushing, R-Hampden, said neither party was thrilled with the deal. However, he said, the plan solved the immediate funding crisis while moving toward the governor's call for structural remedies that will avoid repeated shortfalls in the state Medicaid system. 

Cushing said the compromise also struck a balance between providing health care for the most needy and weaning some Mainers from the system.

The deal came amid the governor's call for Republicans to use their majority to ratify his initial plan. That proposal, introduced in December, would have eliminated health coverage for 65,000 Mainers. 

On Tuesday, LePage told the Sun Journal he might actively campaign against Republicans who didn't support his budget proposal. The governor on Wednesday repeated that statement at a public forum in Skowhegan at which he announced his education proposals. 

Some of the governor's cuts are still on the table and included in the proposed fiscal year 2013 budget. The Appropriations Committee will begin work on that proposal Thursday. 

The 2012 budget that the committee finalized at around 1:30 a.m. Wednesday will go to the Legislature for votes and possible amendments. 

The compromise includes a deal on two of the most controversial items, the so-called non-categoricals — childless adults — and the eligibility threshold for parents of children on MaineCare. 

The agreement caps funding for non-categoricals at $40 million and freezes enrollment through attrition.

Sixty percent of childless adults are 35 or older; 43 percent are 45 or older; and 47 percent have serious medical conditions, such as cancer and diabetes. Recipients of the public health insurance must earn at or below 100 percent of the federal poverty level, which is $10,890 a year for one person.

Also under the deal, parents of children on MaineCare must earn less than 133 percent of the federal poverty level to be eligible. The threshold is currently 200 percent. The deal would align eligibility with the minimum eligibility threshold of the Affordable Care Act, which goes into effect in 2014. 

“We had to pass this budget to keep the lights on, make sure seniors get their medicine, and ensure nurses and health workers continue to get paid,” Rep. Peggy Rotundo, D-Lewiston, the ranking House Democrat on the Appropriations Committee, said in a written statement. “We had few choices to resolve the immediate budget problem.”

Rotundo noted that the proposal restored cuts in outpatient Medicaid funding to the state's hospitals. The provision, she said, would equal about $5.3 million when combined with a federal match.

House Speaker Rep. Robert Nutting, R-Oakland, said Wednesday he was hopeful he and other leaders could sell the deal to LePage.

"It is our hope that once we strike a deal in Appropriations, we will be able to demonstrate to the governor and his supporters that the deal we were able to construct is preferable to the one he seems to be most interested in," Nutting said.

A majority budget would not go into effect until 90 days after passage, meaning lawmakers would have to make it retroactive. 

A budget with two-thirds support of lawmakers can be treated as emergency legislation and go into effect immediately after it's signed by the governor. 

The governor has said lawmakers must settle the budget by April 1 or DHHS would not be able to pay its bills.

Nutting, in a written statement, was hopeful that lawmakers would ratify the deal. 

"The governor gave us a solid framework for this supplemental budget to restructure many programs administered by the Department of Health and Human Services," Nutting said.

LePage on Wednesday distributed a letter to lawmakers urging them to not allow Medicaid to "cannibalize state government." The letter contained many of the statistics the governor says show that the state is overly reliant on Medicaid.

Rep. Jeffrey Timberlake, R-Turner, a member of the conservative caucus, said he didn't like everything in the compromise proposal, but he wouldn't hold up passage of the plan. 

Progressive advocacy groups said they weren't happy with the plan. 

Ben Chin, political engagement director for the Maine People's Alliance, said the Appropriation Committee's budget proposal was "callous, cruel and counter to the values of the people of Maine." 

"Today, the Appropriations Committee of the Maine Legislature announced a budget plan for 2012 that eliminates all health care for more than 14,000 Mainers and cuts important preventive care measures for hundreds of thousands more," Chin said. "It also allows for more possible cuts in the yet-unresolved budget for 2013."

On the other side of the political spectrum, Lance Dutson of the Maine Heritage Policy Center, described the committee compromise as "an outrageous dereliction" of the mandate that accompanied Republicans' Augusta takeover in 2010.

Dutson was particularly irked by the budget provision that would halt the scheduled drawdown of the Dirigo Health insurance assessment to sustain Medicaid programs. Dutson likened the proposal to a tax. Dirigo Health is the state's affordable health care program.

The Legislature could ratify the agreement as early as next week.

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JOHN PAINTER's picture

I agree with rescinding the

I agree with rescinding the tax break in this instance, however it will not be enough because our problems with the Centers for Medicare and Medicaid (CMS) is over how our state Medicaid Plan is written and how we have been running our Medicaid program (MaineCare) since the last renewal. To clear a path out of the MaineCare woods will require DHHS rewriting our state plan, and apprising the Legislature so that its fully aware of what our plan allows us to do. We have not really fixed the PNMI issue, there are still PNMI's with over 15 people (theres one with 40 + people in the County) around the state which is a clear violation of both federal and state law, Maine also "bundles" rates for a number of it's MaineCare services, something CMS has expressly warned us about not doing - at least without very detailed descriptions maintained by provider agencies what service and who is providing it in the bundled rates, and several other issues.

Furthermore, by 2014 when the Affordable Care Act (ACA) kicks in, a provision in the ACA expands the income limit to 133% of the federal poverty level. That means 10's of thousands more Mainers will qualify for regular MaineCare - I do not see anyone trying to develop the system now to manage that.

There are ways to manage the mess we have with MaineCare, both major parties cooperating is a good start, but it will take more - the Executive branch, I think, will need move beyond saying "No" to "How shall we".

 's picture


Legislators making bipartisan progress despite their Governor.


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