Maine Medicaid patients face losses under budget cuts

PORTLAND — Tricia Clark will keep her fingers crossed when the Legislature reconvenes this week and takes up a budget plan that calls for sharp cuts in Medicaid and health care spending.

Robert F. Bukaty/The Associated Press

Jean Greenleaf, 73, checks her medication at her home in Winthrop on Friday. Greenleaf receives funding for the drugs she takes for diabetes, cholesterol, a stomach disorder and depression, but will likely lose coverage for hospital visits under proposed cuts by Gov. Paul LePage.

Clark, 19, stands to lose out when the Legislature votes on a plan to slash spending on Medicaid and a slew of other programs ranging from mental health assistance and school grants to dental care, drug abuse treatment and prescription drugs.

Clark is one of nearly 7,000 young adults who will lose Medicaid coverage if the Legislature approves a proposal to eliminate 19- and 20-year-olds from the state's Medicaid program, which goes by the name MaineCare in Maine.

That's a tough pill to swallow for Clark, who lives in a studio apartment in Portland, makes a low wage as a kitchen assistant and dishwasher, and is still getting on her feet after being homeless for six months last year.

Without Medicaid coverage, she'll have to cover the costs for her primary care physician and therapist, which she says she can't afford.

"What's shocking to me is that medical coverage seems like a bare essential — and I can't believe they're taking that away," she said.

In his effort to cut state spending, Gov. Paul LePage proposed revamping the state's Medicaid program and eliminating other services and programs administered by the Department of Health and Human Services. Medicaid is a federal program administered by the states that serves as the country's primary health insurance program for low-income Americans.

Supporters of the cuts say that welfare spending is unsustainable and that Maine provides Medicaid coverage to 35 percent more of the population that the national average. The latest proposed cuts, which must be approved by the full Legislature, will help close an $83 million budget shortfall at the health department.

Last month, the Legislature approved a first round of sharp Medicaid cuts.

Lawmakers froze enrollment in Medicaid for childless adults, meaning that none of the 14,000 or so who now receive benefits will be denied, but that no new enrollees will be allowed. (There's a waiting list of more than 18,000 for the program.) Legislators also eliminated coverage for parents with incomes between 133 percent and 200 percent of the federal poverty level, casting nearly 12,000 people off coverage.

This week, the Legislature is taking up a budget with additional proposals that, if approved, will cut more people off Medicaid and other health care programs.

Those proposals include eliminating Medicaid coverage for parents with incomes between 100 and 133 percent of the poverty level, as well low-income 19- and 20-year-olds.

LePage's original proposal also eliminated prescription drug coverage for the elderly and disabled by doing away with the Medicare Saving Program and the Drugs for the Elderly program. The Legislature's Appropriations Committee, though, approved a plan last week that merely cuts those programs rather than eliminating them altogether.

Other proposals on the table include reducing funding for the state's Head Start programs; eliminating or reducing funding for dental, vision, chiropractic, occupational therapy, smoking cessation and physical therapy services; and reducing or eliminating Fund for a Healthy Maine programs, which receive Maine's annual tobacco settlement payments and distribute them for school grants, child care, dental, immunization and other programs.

Opponents of the cuts say not only do the proposals hurt the neediest and most vulnerable residents, but they're also illegal under federal Medicaid rules.

Rep. Mark Eves, the ranking Democrat on the Health and Human Services Committee, said it's "completely irresponsible" to move forward with some of the proposals knowing that the Secretary of Health and Human Services Kathleen Sebelius will deny many the cuts. He also doesn't think Mainers have much of a stomach for taking prescription drugs away from the elderly and the poor.

"I think people inherently understand and sympathize with the need for seniors with disabilities to continue taking their medication," Eves said.

But supporters of the cuts say tough times call for tough measures. The state will be asking for waivers from the federal government for some of the proposal, said Stefanie Nadeau, the head of MaineCare Services.

In the meantime, Tricia Clark isn't the only one hoping the Legislature doesn't approve all the cuts.

Jean Greenleaf, 73, of Winthrop, originally stood to lose funding for the drugs she takes for diabetes, cholesterol, a stomach disorder and depression under LePage's original budget proposal. It appears her prescription drug coverage will be saved under the Appropriations Committee's compromise, but she's likely to lose coverage for hospital visits, which would expose her to more than $1,200 in payments that are now covered.

That's a lot of money for Greenleaf, a widow who brings in $1,175 a month in Social Security and another $150 to $200 a month from office cleaning jobs. There's little money left over after she pays $400 a month on the mortgage of her Winthrop home, electricity, phone, food and, in the cold-weather months, oil for heat.

"I think it's kind of cruel to do this to the elderly, especially those who can't work," said Greenleaf. "I've been worried to death about my pills. And there are a lot of people a lot worse off than I am."

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Comments

Jeff Johnson's picture

Priorities

Everyone deserves luxuries. Luxuries that they can afford, after they've paid for their necessities. Would you argue that food, shelter, clothing, and health care are necessities?

Do I know poor people? I happened to live on the other side of the fence from one of Lewiston's biggest projects. Subsidised housing. Housing that you and I are paying for with our tax dollars. Do you know what I see on the other side of the fence? Satellite dishes outside almost every upstairs window. The glow of huge televisions in the downstairs windows. Everyone going outside to smoke on their porches, because they can't smoke inside.

Let's do some math: $6/pack for smokes. a pack-a-day smoker is $2,200/year. A big television: at least $1,350. That's if you don't rent from Aaron's or Color Tile... that would be $50/week. Satelite/Cable is at least, $120/month or $1,440 a year.

Guess what... I just found $5,000 that I could live without in my budget. $5,000/year would surely get me on my way to paying some medical bills. Or rent.

Many peoples priorities are backwards. They're worring about cell phone bills and car payments instead of rent and medical bills.

JOHN PAINTER's picture

Choices

It was unfortunate that the Legislature could not find grounds to make a collaborative change to the state budget as it previously seems to have done.  However the changes proposed, appear to me to be both legal (providing the state properly notified CMS of the intent and receives permission), and prudent given the dire predicament MaineCare is in.  That might change depending on how the US Supreme Court rules on the legality of the Affordable Care Act.

It is unclear why the press seems to under report the troubles Maine is experiencing with the federal government over our state Medicaid plan.  Understanding that may help our citizens and Legislature work together to address the problems we have in a way that has the least harmful impact on all Mainers.  Readers can go to materials being posted by DHHS  http://www.maine.gov/dhhs/oms/provider/pnmi/citations.shtml 

Most immediately concerning is the mature woman who is worried about affording her medications.  It is unclear in the article why she does not have Medicare and most importantly Medicare Part D.  She would also qualify for QUIMBY that covers co-pays, deductables etc in Medicare, which would cover her medications.  The article mentions she experiences depression, if it is major depression she may qualify for full MaineCare with the income indicated. 

Regarding the young woman in the story, though in a tough situation, many people are in that boat.  I was without insurance for some time when I was that age too.   She fits into an age cohort that is the most healthy and capable of self care, childless adults without a disability are not a Medicaid required category and fall under optional coverage, the state can opt not to cover. It's important to note she would not lose MaineCare if she has a qualifying disability.   Also she can apply for Dirigo Choice which has a deep sliding scale available.

Depending on how the Supreme Court rules on the Affordable Care Act, many of more could lose MaineCare, or many more could be added.  Either way there will be a cost, both human and fiscal, our state much like the nation needs more informed discussion and debate on the matter.

Re: Beneifts

"Goodness... It would be terrible if those who 'cant afford' medical care had to give up their cell phones, cable/satellite service, and cigarettes.

Yup, I'm sure that a few of you will comment and say, "I don't have those luxuries!!" But you all know as well as I that the vast majority of people in this situation aren't willing to sacrifice their conveniences for necessities. "

Stop generalizing. Do you know any truly poor people? If you do, do they really have all those 'luxuries' as you claim they all do?

I truly doubt that. Such "luxuries" that they can't have any, at all? None? They have to suffer and endure this life without any? Gee whiz, nice of everyone to deem what a luxury is.

This state has such a poor track record of creating jobs and attracting businesses that there are a lot of people who are unemployed and poor, because they can't get a job-there are few out there.

When you're poor you become one of the invisible-you don't matter to anyone except yourself. Whatever you try to achieve/do in your life becomes a matter of moral judgement for everyone who claims they have your best interests at heart, and then when you protest, you're told to 'shut up and take what we give you."

In other words, beggars can't be choosers, even when it comes to existing/surviving. Guess we should all go and die quietly in a corner somewhere and stop inconveniencing the rest of you. That way you won't have to worry about us.

Douglas Mac antSaior's picture

Yep, pretty much. I'll wait.

Yep, pretty much. I'll wait.

Jeff Johnson's picture

Benefits

Goodness... It would be terrible if those who 'cant afford' medical care had to give up their cell phones, cable/satellite service, and cigarettes.

Yup, I'm sure that a few of you will comment and say, "I don't have those luxuries!!" But you all know as well as I that the vast majority of people in this situation aren't willing to sacrifice their conveniences for necessities.

Health care is not guaranteed under the constitution. It's not an entitlement. It's not the government's job to keep you healthy... it's a social service, and social services get cut when budgets fail.

Douglas Mac antSaior's picture

The truth is, paid insurance

The truth is, paid insurance is getting worse and worse each year. Why should free insurance get any better? All you people who willingly have given up liberty for comfort as the quote goes...deserve neither.

Betty Davies's picture

Following the example of a bully

Maine's Republican leaders are following the example of Gov. LePage. A bully, he would never dream of going after the strong (so he gives tax breaks to millionaires and billionaires).

Nope. It's the weak--impoverished people and the disabled, elderly, and chidlren--who are the Republicans' favorite targets.

A matter of life and death

Those who propose such severe cuts to the Maine Care program have never used it, and have never needed to.

They aren't the people it was intended for. They will never need it, because they're the ones who can afford to pay for their own insurance.

They have absolutely no idea how this will affect the people it helps, have no interest in how it will affect them and could not care less about the end results of their 'budget cutting'.

All they care about is the dollar sign in front of the program-not the people it helps.

It's obvious that nobody in the legislature has a conscience, and they've never heard of such an idea.

It's shameful that all that matters to them is that they've saved a bit of money-not lives.

It would really be helpful if the state looked into their own spending habits.

Stop putting the blame of the budget on the backs of your poorest residents!

JOHN PAINTER's picture

Mary, I'm not certain the

Mary, I'm not certain the Legislature is uncaring. I think both Sen. Crave and Rep. Rotundo are very much so. What I am concerned about is whether all citizens have enough information to discuss and debate the challenges confronting us to give helpful feed back to our elected officials.

I think the individuals highlighted in this article have some options, and not certain why no one at DHHS is assisting, though there are certainly people who have more limited options.  Theres currently an absence of discussion, outlining of what our states DHHS system really should look like, and what should it do.

There is little doubt in my mind or history books that before the Social Security Act of 1935 and its offspring, the Medicare and Medicaid Amendments of 1965, that life was too frequently miserable for the elderly, or if one was unfortunate enough to be disabled, or an impoverished child how nightmarish life could be. There was no ability to pursue happiness.  Congress and FDR did not think Social Security would fix all the nations problems, but they did believe it could help, and from what I see as a helping professional does indeed smooth out the vicissitudes of life.  

What I find concerning is the lack of serious discussion of what we want, as a nation or as a state.  I also am concerned that there has been so much generational distance from American life before the Great Depression, that the harsh realities of age, illness, and impoverished childhood without Social Security, Medicare and Medicaid has faded from our collective conscious.

I wonder if as a state, let alone nation, we have the desire to look at the advantages for all of us created by our Social Security system and the desire to sacrifice at all levels to fix what is not working.

JOHN PAINTER's picture

Let me clarify that, by "very

Let me clarify that, by "very much so" I mean they are caring, I think the vast majority of Maines Legislature is.

Sandra Coulombe's picture

And yet most who back these

And yet most who back these cuts claim to be Christian and yet in Mathews are the following words of Jesus:
41Then shall he say also unto them on the left hand, Depart from me, ye cursed, into everlasting fire, prepared for the devil and his angels: 42For I was an hungred, and ye gave me no meat: I was thirsty, and ye gave me no drink: 43I was a stranger, and ye took me not in: naked, and ye clothed me not: sick, and in prison, and ye visited me not. 44Then shall they also answer him, saying, Lord, when saw we thee an hungred, or athirst, or a stranger, or naked, or sick, or in prison, and did not minister unto thee? 45Then shall he answer them, saying, Verily I say unto you, Inasmuch as ye did it not to one of the least of these, ye did it not to me. 46And these shall go away into everlasting punishment: but the righteous into life eternal.

It is a shame more who claim to be Christian don't bother to even try to live by the teachings of their own divinity.

Jeff Johnson's picture

Christians

I'm sorry... I see nothing in the article mentioning Christians or Christianism, or Christianity?

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