Maine’s Department of Health and Human Services is facing a $120 million deficit, a gaping and largely unanticipated financial hole that must be filled if taxpayers hope to avoid funding yet another supplemental budget for this agency.

According to DHHS Commissioner Mary Mayhew, the agency is now going through a thorough review to restructure and streamline delivery of services. It’s a review that, according to Mayhew, will create efficiencies and trim waste.

Good.

However, the review is not close to complete and its result is unknown. And, the simple reality is that adjustments to program administration will not come close to meeting the budget deficit. The department will have to cut programs and services, and it will start by whittling Medicaid.

Mayhew said one of the guidelines will be to measure Maine’s benefit package against what is required by federal law. Maine’s benefits exceed those requirements, a situation created over a period of years as in-state programs and services were expanded and eligibility guidelines were adjusted.

For instance, in 2002, DHHS added a new class of Medicaid eligibility for low-income adults who do not have children; 2,846 clients immediately enrolled for benefits.

Four months later, that number had jumped to 10,036 and has consistently remained between 10,000 and 22,000 each month since. In October, there were 18,819 adults receiving service, which is about 5 percent of all Medicaid clients.

According to Gov. Paul LePage, that program now costs Maine taxpayers something close to $20 million a year.

Using that spending estimate, Mainers pay $1.6 million a month to insure these childless adults, or close to $89 per person each month, which is a pretty reasonable cost for medical coverage.

On Monday, the Associated Press reported that Gov. LePage is expected to announce that, as part of his plan to resolve the DHHS deficit, Medicaid services for these low-income adults will end.

In talking about that possibility last week, Mayhew said that she hoped these adults would pursue individual medical insurance policies to maintain continuity of coverage. But, that is unlikely. These adults qualify for Medicaid because they are already living on the financial edge, and to think that they would have the cash to pay premiums for private insurance is just not realistic.

The more likely scenario is that these uninsured adults will seek medical care at the most expensive sites — our state’s emergency rooms. And, without the ability to pay, the cost of their care will be pushed off on businesses and the privately insured.

So, Maine people are going to pay for their care anyway.

What may also happen is that these adults who would no longer qualify for care as individuals may consider having children in order to qualify for family coverage, bringing the burden for the parent and child’s combined care back to DHHS.

Cutting an entire class of Medicaid clients to help meet the budget deficit might make sense on a balance sheet, there is no real savings because those costs will just be loaded on taxpayers  and insurance rate payers in another form.

In addition to aligning state benefits with federal requirements, another measure DHHS may consider in trimming services is comparing public services to those offered under private insurance.

One example is that Medicaid pays for transportation to medical appointments. Private insurance does not, and those patients are expected to get themselves to their appointments and are entitled to claim mileage credit on their income tax returns. Shouldn’t Medicaid patients do the same?

Just because insurance is publicly funded does not mean it should be more extravagant than available in the private sector. Right?

While we appreciate and support the governor’s position to trim DHHS instead of grabbing funding from other agencies to resolve the DHHS deficit, it just doesn’t make sense to eliminate an entire class of Medicaid clients and set them adrift to fend for their own medical care when the end result will not create any real savings.

Instead, we need sensible, surgical cuts across the agency’s entire roster of services and then focused attention paid to controlling costs, quashing fraud and protecting the public’s money.

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The opinions expressed in this column reflect the views of the ownership and editorial board.

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