AUGUSTA — A state-funded study on the impact of a Medicaid expansion was modified substantially from its first to final draft, according to a Bangor Daily News and Sun Journal review of multiple revision documents.

Late on Friday, the Maine Department of Health and Human Services released three earlier versions of the Rhode Island-based Alexander Group’s feasibility study on Medicaid expansion. The release followed the newspapers’ requests for the documents under Maine’s Freedom of Access Act.

While the draft reports were produced, neither the governor’s office nor DHHS has fulfilled a secondary request for copies of communications between the state and the Alexander Group regarding the three revisions to the study that took place between Dec. 16, when the first draft was submitted to the state, and Jan. 10, when the final report was released to the public.

Another request seeking that data was sent to state officials on Monday. State offices were closed in observance of Martin Luther King Jr. Day.

The first and final drafts of the report show that changes were made — some cosmetic, some substantial — that saw the report grow from 95 to 131 pages.

Much of the report’s growth from first to last draft can be explained by the addition of several expansion scenarios, which outline a spectrum of possibilities if Maine expands.

While the numbers in the report and its final projections and conclusions remain relatively similar, changes included subtle revisions in rhetoric and small formulaic changes that might have yielded larger changes in conclusions.

For example, the original version of the report said MaineCare enrollment — even without expansion — would grow from 285,416 today to more than 370,000 in 2014. The final version added about 35,0000 to that figure, saying enrollment would grow to 406,100 in 10 years.

That may be because the Alexander Group did not originally include in its analysis roughly 45,000 Mainers who now receive partial benefits under MaineCare. Subsequent versions of the report did, which may explain why enrollment growth predictions in the final draft were higher than in the original.

The document appears to have been edited to present a more detached analysis of the Medicaid expansion equations. The most politically charged passages were softened or removed outright; sections outlining poor health care outcomes for those enrolled in Medicaid were trimmed or stricken, as were segments and a related appendix outlining the political breakdown of Medicaid expansion, noting “there appears to be a partisan pattern on how states are deciding to expand.”

An initial version even suggested that considering expansion at all was a waste of time.

Alexander originally wrote that, given the current level of spending on MaineCare, “there seems to be little point in talking about the expansion scenario that significantly increases costs and accelerates the cost growth rate.”

That passage was removed in the final report.

Other language changes in the report de-emphasize forecasts that might have questioned efforts by Republican Gov. Paul LePage to create jobs and grow the state’s economy.

The first draft calls the dramatic increase in Maine’s poverty rate described in the report as “phenomenal.” The final report referred to the increased poverty rate as simply “one causal factor” driving Medicaid growth.

The projected growth in the number of Mainers living under the federal poverty limit is important because it drives the increase in residents expected to receive Medicaid benefits if the program is expanded.

Alexander’s critics have said his projection of rapid growth in the poverty rate is unrealistic.

The conclusion on both the first and final draft emphasizes “state-based” solutions to the problems facing Medicaid, with the federal government granting more flexibility to states through Medicaid waivers.

The revisions also show the scope of involvement by DHHS Commissioner Mary Mayhew and members of her staff. In the first draft, contract administrator Sam Adolphsen, who previously worked for the conservative Maine Heritage Policy Center, was thanked along with Mayhew for his efforts.

The final version thanked Mayhew and her entire staff, and made clear the impact the department had on the study it had itself commissioned. It said the report incorporated not only information provided by the department, but some recommendations as well.

The overall projected cost of a Medicaid expansion in Maine was also reduced slightly from the first draft to the last.

In many respects, the final draft of the report can be considered to be less political than the first version. Also removed from the first report was a section that detailed negative health outcomes for states that had previously expanded Medicaid.

The overall projected cost of a Medicaid expansion in Maine was also reduced slightly from the first draft to the last.

The report distributed on Jan. 10 is the first part of a five-part study of Maine welfare programs that was authorized under a nearly $1 million, no-bid contract between DHHS and the Alexander Group. The group is headed by Gary Alexander, the former commissioner of the Department of Public Welfare in Pennsylvania.

Democrats in Maine and in states where Alexander has previously worked have panned the consultant as an ideologue. In Maine, they’ve called him a “crony” hired by LePage to validate the governor’s stance against Medicaid expansion.

Republicans, including LePage, have called Alexander one of the best consultants in the country, and have chastised Democrats for dismissing his report out of hand.

The remaining four parts of the Alexander Group’s analysis of welfare programs in Maine had varying target dates between Dec. 20, 2013, and May 15, 2014, but a spokesman for DHHS said those deadlines have been extended.

“The department is focused on ensuring that quality work is done to assess the needs of the program and make sure that our programs are operating efficiently and effectively,” DHHS spokesman John Martins wrote in an email.  “No new target date for completion has been set, but progress is being made and the department looks forward to benefiting from the completed analysis in the coming weeks.”

Martins also noted that 40 percent of payment to the Alexander Group would be withheld until the required work has been completed.

sthistle@sunjournal.com

Maine Medicaid Expansion Report-AG-2013De16 (1)

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Maine Medicaid Expansion Report, Jan. 10