Maine Medicaid costs above average

PORTLAND, Maine (AP) — In his relentless demands for steep Medicaid cuts, Gov. Paul LePage has said Maine spends far more per capita than other states on Medicaid and is high above the national average.

Whether you support or oppose LePage's cost-cutting proposals, he's right.

Maine had the nation's fifth-highest Medicaid coverage rate in fiscal year 2009, 27.8 percent, behind California, New Mexico, Louisiana and Vermont, according to the latest statistics for Maine from the Centers for Medicare and Medicaid Services. The national rate for the same period was 21 percent.

Maine's Medicaid expenses for that year amounted to $1,890 per resident. That's 61 percent higher than the national average of $1,173 per person, according to CMMS statistics.

LePage and others say those numbers show that Medicaid, which goes by the name MaineCare in Maine, is bloated and in need of slashing. If Maine's enrollment were at the national 21 percent rate, the state would have had about 276,000 people enrolled, 90,000 fewer than actually were.

"I ask all of you, where is the outrage?" LePage said in a recent letter to legislators. "Maine Medicaid programs have grown at an unsustainable rate, and spending is out of control."

Medicaid is a federal program administered by the states that serves as the country's primary health insurance program for low-income Americans. More than 66 million people were on Medicaid in 2010 at a cost of about $384 billion. About two-thirds of the costs were paid by the federal government, and one-third by the states.

LePage has proposed cutting $221 million in Medicaid spending in Maine to reduce a budget shortfall through mid-2013 and bring Maine closer in line to national averages on Medicaid funding and coverage rates.

The Legislature's budget committee has endorsed a proposal calling for $120 million in cuts to the budget, nearly all in MaineCare, for the current fiscal year that ends June 30 and addressing the rest of the shortfall later. Lawmakers are expected to give their approval to the budget this week after the proposal stalled in the Senate last week.

The governor, for his part, says while Medicaid coverage is helpful to those in need, the state simply can't afford the broad coverage it now offers.

Medicaid coverage and costs have grown fast in the past 15 years in Maine.

About 202,000 Mainers had Medicaid coverage in July 2002. By October 2011, that number had grown to more than 361,000 residents, according to the state Department of Health and Human Services.

But the growth didn't just happen willy-nilly — it was the result of deliberate steps by legislators aiming to increase health coverage for children, parents, the elderly and single poor people in hopes of creating a healthier state.

Expanded Medicaid coverage is one reason the state went from No. 16 a decade ago to No. 8 last year in the United Health Foundation's annual state-by-state health rankings, said Chris Hastedt, public policy director at the Maine Equal Justice Partners organization. It's also contributed to Maine having an uninsured rate of 10 percent, the sixth-lowest in the country in the Kaiser Family Foundation's annual ratings, she said.

"It was a very deliberate set of actions aimed at very specific goals," she said. "To a very large extent we've achieved those goals with important success for people who've been covered and for the people of Maine."

Former state Rep. Mike Saxl was among the legislators who pushed for increased Medicaid coverage of Maine children in 1996. That was followed in later years by additional measures to expand coverage to parents and childless adults and for prescription drugs for the elderly, he said.

At the time, expanding Medicaid was considered a smart move because every dollar in state funds leveraged at least $2 in federal money, he said. It was also viewed as a cost-saving measure since preventive medicine is cheaper than treating medical problems when they get to crisis stage, he said.

Medicaid is an important policy debate, but there are questions that deserve answers if the funding is going to be slashed, he said.

"How does somebody practically get coverage? Are we saying they want them to have uncompensated care at hospitals and doctor's offices? That's an option," he said. "Are we saying we want them to not have care? That's an option. Are we saying they should private insurance? That can be a good idea, but how are they going to afford that private insurance?"

Virtually every state over the years has expanded Medicaid coverage to some level beyond the core minimum requirements set by the federal government.

If Maine provided only the bare Medicaid coverage required by law, it would have just over 250,000 people on Medicaid rather than today's level of 360,000, state officials say.

But because of Medicaid's flexibility, the enrollment rates and costs are widely variable among states. While Maine provided some form of Medicaid coverage to 27.8 percent of residents in 2009, only 12.5 percent of New Hampshire residents were Medicaid recipients that same year. Maine and New Hampshire have roughly the same population, but Maine had about 200,000 more people on Medicaid than the Granite State.

California had the highest enrollment rate (30.2 percent), while Nevada had the lowest rate (10.9 percent), according to CMMS figures.

Generally speaking, most states through the years have broadened Medicaid coverage more for children than they have for adults, said Robin Rudowitz of the Kaiser Family Foundation in Washington. Maine has expanded coverage to adults more than most other states, she said.

But with the poor economy and revenue collections down, states the past couple of years have been implementing new Medicaid policies to cut spending.

The Kaiser Family Foundation said 47 states made cost-reduction Medicaid changes for fiscal year 2011.

For the current fiscal year, every state but North Dakota planned at least one policy change to contain Medicaid costs, Kaiser said last week in a midyear Medicaid budget update report. Forty-six states planned rate cuts or restrictions for health care providers and 18 states planned to reduce or restrict benefits. Four states, including Maine, planned eligibility reductions, but federal Medicaid officials have denied requests for enrollment procedure changes for Hawaii and Arizona.

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Comments

DONALD FERLAND's picture

How about instead of playing

How about instead of playing the blame game we look at bringing jobs to the state that will hire the people on state assistance??? If there are no jobs then people cannot get a job that offers health insurance. However, if people in government would look at solving the issues instead of putting a bandaid on it then maybe we would get somewhere. Slashing people of MaineCare results in multiple problems that will end up costing the state more in the long term. Long term solutions will not only improve the state's budgetary woes but it will also enable the people to be self sufficient and will stop some of the bickering that is going on in these blogs. It is not a Democratic or a Republican problem...it is a state problem and needs to be cured versus long term treatment plans.

Mike Lachance's picture

Tina, Taxes are too high in

Tina,

Taxes are too high in Maine. Period. Business Taxes. Payroll Taxes. Healthcare costs. This translates into businesses leaving Maine, and/or not hiring. It also precludes businesses from COMING here.

Taxes cannot be lowered with a DHHS budget that swamps every other expense on the boards. Lower the Medicaid/DHHS/Welfare budgets and you will open up the windows for lower taxes across the board, which will then open the doors for businesses to hire, stay and/or come to Maine... that will get the unemployed employed again....

Other than that I'm really not sure how you expect to cut the budget. Where? Who? It's clear that in Maine Welfare is the Sacred Cow of budget items. It cannot continue to be so.

DONALD FERLAND's picture

Mike, it is not just the DHHS

Mike, it is not just the DHHS budget that is causing problems. You are sounding more and more like someone that just doesn't want anyone to get assistance. My comment did not deny there is a problem in this state. But there are many areas that need to be changed...the size of the legislature, the transportation department, education, dhhs, msha, and probably many more that I can't even think of right now. I am saying that if the government found a way to bring jobs to Maine they could get many off the welfare rolls and save money. Yet they won't even work with the businesses that are hear to get people to work. The welfare rolls have thousands of people who have received job training but cannot get a job because they have no experience. What good is it doing the state to pay for the job training, the education, etc when businesses will not hire them? If you truly want to save money so that taxes can be lowered then why not look at this avenue? Maybe then the truly needy would be able to get their Maine Care coverage.

Mike Lachance's picture

QUOTE: "You are sounding more

QUOTE: "You are sounding more and more like someone that just doesn't want anyone to get assistance."

Your post lost all credibility at the second sentance.

Have you figured out that a Governor doesnt create jobs. Have you figured out that a Government doesn't create jobs. (unless you live in a totalitarian socialist State; which we dont) Moreover, a President and a Congress doesnt create jobs.

The only people who can create jobs are Businesses. I qualify this by stating that Govt jobs do not contribute to the bottom line of a capitalistic society. Reducing Govt jobs, however has the opposite effect of reducing private sector jobs; conversely, increasing private sector jobs often has the opposite effect of increasing Govt jobs.

Therefore, the only jobs the govt can create are the ones that hurt our economy.

What the Govt needs to do is stop perpetuating the lie that businesses dont pay as much taxes as individuals, and actually lower taxes on businesses, both big and small. This goes for Maine and the Nation. The tax burden on Businesses in the US is at the top tier of all developed nations in the world. The competitive disadvantages that US businesses have in the global marketplace is insane. For US businesses to compete effectively today will require a) lower corporate taxes and b) a level playing field for imports and exports on-par with foreign competitors.

You want the Govt to create jobs? Good luck. You want to fix the problems that are preventing US companies from hiring and growing? ...Address the above (2) points.

If we are going to lower corporate taxes than the State budget MUST be rolled back at least 15 years. Thats not a fantastic pipe dream, but it sure gets those recieving State assistance all riled up.

Tough choices. Eliminate welfare? no.

DONALD FERLAND's picture

And Mike, you are

And Mike, you are consistently saying to come up with solutions and stop getting upset and ranting....I offered other examples of where to cut and you say I lost all credibility because of one sentence....you have no credibility if you will not even have a discussion that proposes other ideas that do not agree with your own. You have all the answers...NOT....you have a clue....ON SOME THINGS BUT NOT OTHERS. Sorry I don't have time to research all your past comments to prove this statement as it is now time for me to do my thing and stop worrying about people who are not willing to listen to others....

My point....DHHS pays for job training and education for recipients....There are no jobs here....Why are we wasting the money to train and educate people....Gee sounds like a place to make cuts....DUH

DONALD FERLAND's picture

And one more thing Mike, It

And one more thing Mike, It was Governor LePage who campaigned on bringing jobs to Maine....another lie or another misstatement or another misinterpretation. You can't defend him both ways...either government cannot bring jobs and he is a liar or government can bring jobs and you contradict yourself!!!!!

Mike Lachance's picture

UGH. LePage is making huge

UGH. LePage is making huge efforts to back-fill the financial and economic SKINKHOLE the DEMS left us all. To do that takes guts and backbone. Unfortunately, Tina, it seems to take a REPUBLICAN to do these things. Since the Dems and the RINOS wont go near ANY of these issues.

Its too bad there are no Dems with answers, or even Dems with the will to make decisions that affect there welfare-bound voter base... you see, take money from the voter base and you get no votes.... and that, Tina, is why Dems cannot fix Maine.

So, LePage IS doing what needs to be done. And think about this... he's almost single-handedly putting ALL These issues ON THE TABEL because now, finally, after decades, good-intentioned folks like you are actually talking about fiscal responsibility, sound economics and smart government. All things that should have been a part of the discussion under Dem controlled Blaine House, Dem controlled house and a dem controlled senate.

Its crystal clear. LePage IS upholding his promise. This is step one.

GARY SAVARD's picture

However you want to cut it,

However you want to cut it, Tony, Maine doesn't have the money to fund all of these programs, period. Face it, there is no more of other peoples' money for Augusta liberals to spend . That is painful, but it is the truth. Some facts can be twisted, but not all, as hard as you might try. Painful yes, but avoidable, no.

FRANK EARLEY's picture

This is just an observation, don't jump all over me

LePage is upset that way to many low income people are signing up for medicaid. His solution is to deny these people health and other coverages.Over the years, on more than one occasion I decided to just quit. stop trucking and making good money with full benefits. I went out and tried to find work which would allow me to be home every day at some point.
I wasn't alone. Many drivers I new, did the same thing at some point or other. There was just one problem. Employers in the L/A area new they didn't have to pay anything or offer benefits, Back in the eighties there was a large work force, most of whom had at the most high school diplomas, workers were disposable. How many of you have been told ,if you don't like it go home, there's plenty more where you came from.
I couldn't find a livable wage anywhere, and I had a college degree. This same problem existed in the trucking industry as well. At least with the trucking companies it came back to bite them in the ass.
After deregulation in the seventies, there were trucking companies popping up everywhere. There were more drivers than jobs. Eventually experienced drivers got sick of the constant harassment, and retired including myself. I got another degree and was able to find a decent job with benefits. Now all these companies can get are driving school graduates, and once they get the trucks out of the ditches and pay the increased insurance, experienced drivers suddenly started getting respect. Two months after I retired I was offered six figures to go to work for a large national company as an instructor, I turned it down.
Now the real root of the medicaid problem. LePage is right, there are way to many people who need help. The problem, as far as I'm concerned, isn't too many people needing help. It the fact that the State Of Maine has created an entire generation of grossly underpaid people. People who never had the opportunity to advance their education because they were just trying to exist. Now that's come back to bite the state in the ass. Le Page must have seen this and probably contributed to this problem at Mardens. I don't see a whole lot of people leaving mardens with a nest egg to live on, security and the ability to purchase health insurance. No they could be in their seventies and they'll be looking for another job.
That is what this whole state is about going from one job to the next. Is it any wonder that their only chance of help is from the same state that put them in the situation there in now.
I don't see a solution to this problem, other than to offer a livable wage. I don't see that happening, but until it does. The only help is the state. I feel LePage is looking at the wrong end of the problem. Again just an observation.

ANTHONY NAZAR's picture

Dig a bit deeper

Before lining up the firing squads to do away with the less than desirables as seen by the MHPC, let's pull out a couple of other stats - like per capita personal income, poverty level, and overall tax burden.

On the last - despite shrieks from the right, the United States ranks 46th in the world, not 1st as Grover Norquist would have you believe. On the poverty level, Maine does rank better than Arizona, but consider that a significant part of Arizona's population receives BIA support - no small thing. On the first, income level, we're right there beside such economic paradises as Mississippi and Alabama, but we have to buy fuel to stay warm for 5 moths of the year.

So, yes, we seem to be just handing out fists ful of cash to the lazy as Lance and his smamy crew want you to believe, but there are other factors - like when a part time, no bennies, job at a big box is cause for a igh five with the wife and that job is subsidized by the State of Maine through MaineCare and the Feds through SNAP.

Of course, that doesn't fit LePage's demagoguery, so it's swept under the rug.

Please make sure your brain is in gear before putting fingers to the keyboard.

Randall Pond's picture

I agree with you but, make

I agree with you but, make you use Spellcheck before submitting your story as well. Your part about the Part Time no Bennies line has a miss spelling in it.

Lauren Hebert's picture

NO CHOICE; HAVE TO FIX

We have no choice. It MUST be fixed. Yeah cut the governor's salary... and that will save a pittance; purely for show. But we must address the realities. The prior administration has said it is proud to have expanded coverage, as it gave uninsured people insurance. I heard them say it out loud in an interview recently. But that is them spending money (yours) that we just do not have in our economy. I am a health care provider and I see the system collapsing every day. Patients who need ongoing treatment are allowed only two treatment sessions, where we typically provide eight to ten sessions (phyical therapy). Rationing is already here. I live that fact daily turing away patients who need more than the ration allows. Ask any physical therapist to confirm what I say. We can cut every conservative's favorite program, eliminate legislators' salaries (do you realize how little that is, purely a token allowance) and tax the stuffing out of every rich person in Maine (there are what, a dozen of them? They don't live here; too many taxes) and we do not come close to fixing the problem. But what few understand is the fact that ACA (Obamacare) forces states to greatly increase their medicaid coverage over the next 2-3 years, almost doubling enrollment. Yes the feds pay for part of that for two years, but maine people end up paying it, with money we do not have. The ACA forces socialized medicne on us and shifts the cost to the states via vastly expanded medicaid coverage mandates that soon go into effect. That is why Sebelius won't allow waivers. Medicaid is the ghetto of healthcare and it is coming for you one way or another

Mark Brennick's picture

Why would Lepage want to

Why would Lepage want to listen to MS. Sebelius? She works for a goverment that's in debt for 15 trillion dollars.I don't believe their 'experts' have any valuable information.They have a bigger mess to take care of.

Mark Brennick's picture

Why would Lepage want to

Why would Lepage want to listen to MS. Sebelius? She works for a goverment that's in debt for 15 trillion dollars.I don't believe their 'experts' have any valuable information.They have a bigger mess to take care of.

Bob Stone's picture

Nope, Not Due To Enrollment

Last week, Peggy Rotundo said, in this newspaper, that the problem was not due to enrollment.

Nice try, Peggy. Got another whopper for us?

Note that when Peggy went to Augusta, Medicaid enrollment was about 200,000 souls. It is now 361,000 souls.

Nope, no problem with enrollment. Soak the rich and all problems will be solved.

Betty Davies's picture

Where are the jobs?

LePage campaigned on a promise to bring jobs to Maine. If Maine had increased its employment rate, more people would now have health insurance covered by employers, and would not need MaineCare.

Instead, Maine has been hemorrhaging jobs.

LePage has tried erecting a sign at the border, taking down a pro-worker mural, and proclaiming that Maine is a major welfare state with an economy in shambles. He's trying to slash healthcare, to ensure that any workers any company might consider hiring will have chronic health problems.

For some reason, LePage's tactics haven't caused potential employers to flock to Maine.

How about, instead of getting rid of MaineCare, we (figuratively) "slash a bloated" governor?

Bob Stone's picture

How about understanding the facts

The people that the governor proposed "slashing" have an average age of 41, are male, and don't have any kids. They can get health care through their employers, but would rather have the taxpayers of the state of Maine give them FREE care. Only saps pay for health care. Why not get it for FREE?

Peggy and Margaret are not telling you this.

Fred Stone's picture

Betty

I think if you looked at the facts you would see that this was inherited, and personally I applaud him for his effort to control it.

Betty Davies's picture

LePage's inability to create jobs was perhaps "inherited"

And he doesn't seem to be able to do a thing about it... Except bluster.

Jason Theriault's picture

Not gonna work.

As a story earlier said, the top 5% of MaineCare recipients make up almost half of the expenditures. And these are the people who require constant care or they will die. SO either you cut back on them, and people start dying, or you will have to cut other programs to the bone to see any serious reduction.

I don't know if there is a way to win here.

Ron Dexter's picture

Finger in the Proverbial Dike

How about finding solutions to the causes, instead of trying to patch it from the results side?

CLAIRE GAMACHE's picture

And yet

When Ms Sebelius offers to give him ways to cut his costs that will not put him in violation of federal laws, he is not interested. It may be that some trimming needs to be done but it needs to be done with an eye towards the particular needs of the Maine population (most of which are elderly and without children in the house) and in a humane way not with an idealogical hatchet.

Mike Lachance's picture

"idealogical

"idealogical hatchet"????
What the heck do you think has been going on in Maine for the last 45 years?
One big liberal idealogical hatchet job. Its what got us here in the first place.
LePage is trying to stop the hatchet job... the hatchet thats been hacking away at the TAXPAYER's INCOME for decades.

GARY SAVARD's picture

We should have a low

We should have a low uninsured rate... more Mainers are on publicly funded healthcare than people in 45 other states by percentage. I agree that this didn't just happen willy nilly, we can thank Baldacci and company for dumping this crap on our heads. The fact that it is not affordable and can't be sustained has no bearing on this issue whatsoever, though, according to the democrats who supported the expansion of this mess. Say what you want about Paul Lepage, I admire the man for having the courage to face the issues head on. In the past, it was just so much easier to play the old shell game with the bills than to face reality.

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