While Gov. Baldacci and the Legislature focus much attention on bonds, K-12 education funding and so-called tax reform, the crisis brewing in Maine’s Medicaid program has received little attention.

Consider these four sobering facts:

• State spending on Medicaid is up almost $180 million during the governor’s first two years in office. That’s 33 percent growth. Gov. Baldacci has presided over the largest Medicaid spending increase in the state’s history.

• Medicaid enrollment climbed by more than 34,000 (15 percent) to over 260,000 in that same time period. Now more than one in every five Mainers is on Medicaid.

• While Medicaid has expanded by 15 percent, the growth of jobs in Maine has inched up just 1.4 percent through November 2004, according to the Maine Department of Labor. Maine is at a historic moment. We have the largest-ever number of people working and the largest-ever population on Medicaid.

• Taken together, Maine Medicaid is growing 1,077 percent faster than Maine jobs. Dramatic Medicaid growth is unsustainable when the underlining tax base – people with jobs, earning incomes and paying taxes – is not growing accordingly. Additionally, shouldn’t Medicaid, the public health care safety net, be shrinking as more people are going to work?

Most astonishingly, at the same time as this Medicaid spending and enrollment explosion, the Baldacci administration is expanding Medicaid eligibility.

As part of the governor’s Dirigo Health reform law, Maine Medicaid was set to expand in April 2005 to two additional categories of adults: childless adults (those with no disabilities and no minor dependents) earning between 100 and 125 percent of poverty, and parents (those with minor children) earning between 150 and 200 percent of poverty. Combined, the Legislature’s Fiscal Office estimated that this could bring up to 78,000 more people onto Maine Medicaid.

However, last month, the governor announced that the childless adult expansion would be indefinitely postponed. Maine is just one of a handful of states that provides Medicaid coverage in the first place to this population. Remember, these are adults with no disabilities and no dependents. The first childless-adult Medicaid expansion began in October 2002 and was supposed to cover fewer than 16,000 adults at or below the poverty level, when fully phased in. As of last week, 24,000 people had enrolled in the program. Since this Medicaid waiver has a cap on federal funds available and the state is set to spend beyond the cap again this year, the governor decided that this Medicaid expansion would not proceed as planned.

Sadly, the administration and Legislature should own up to the financial problems within Medicaid and take the necessary steps to shore up the program and ensure that the most needy and vulnerable can receive adequate services.

Instead, the governor has been touting the pending Medicaid expansion to parents earning between 150 and 200 percent of poverty. For a family of four, that means parents earning up to $38,700 a year would be eligible for Medicaid. A family of five could earn up to $45,200. For a reality check, the median household income in Maine in 2003, the last year figures are available from the U.S. Census Bureau, was $37,600. The governor estimated that 12,000 more adults could enroll in Medicaid as a result of this expansion. The Legislature’s Fiscal Office estimates that number could be up to 52,000.

The Legislature and the governor need to ask some difficult questions and find real solutions to solve the Maine Medicaid crisis.

• Does it make sense to anyone that Maine could afford to provide Medicaid coverage to parents earning more than the median income?

• Is it fair and equitable that Maine should provide Medicaid coverage to a family of four earning $38,700 but not to their elderly parents earning just $13,000 a year?

• Does it makes sense to expand Maine Medicaid in April at the same time that the governor is proposing $88 million in cuts in Medicaid services for disabled and mentally ill children and adults?

• How should the Medicaid safety net be reformed to ensure that it will sustainable, particularly as Maine, the third-oldest state in the nation, ages?

Maine Medicaid should be an adequate, meaningful health care safety net to the truly needy and disabled. It should not be the health insurance plan for middle-class Mainers.

Tarren Bragdon is the director of health reform initiatives for the Maine Heritage Policy Center and the author of the MedicaidWatch report, available at mainepolicy.org. He can be reached at:

tbragdon@mainepolicy.org.

Copy the Story Link