The 130th Maine legislature made real progress on health care affordability for Mainers. Maine Center for Economic Policy supported several bills which increased eligibility for children and pregnant women, expanded dental coverage, made it cheaper and easier to get insurance on the individual market, improved prescription affordability, and set the stage for further progress in the next legislature.
Expansion of public coverage for children with low income
One of the most consequential changes is expanded eligibility and reduced costs for Maine’s CubCare program, which offers health care coverage to children with low income.1 Beginning in August, eligibility for the program will be increased from 208 percent of the federal poverty level to 308 percent. For example, the eligibility for a child living with one parent would increase from a household income of $38,085 per year to $56,395.
Additionally, the age eligibility will be raised so that 19- and 20-year-olds who meet the income threshold can participate. Finally, the legislation eliminates the monthly premiums program participants were required to pay and which research has shown deter people from enrolling without significantly impacting program costs.
As many as 40,000 children may be newly-eligible for the CubCare program under these changes, although actual new enrollment is estimated to be much smaller — around 6,000 children in the new eligibility groups are currently uninsured completely. The elimination of premiums will benefit another 5,000 children currently enrolled in the program.2
The timing of the implementation of these changes depends on rulemaking from Maine’s Department of Health and Human Services and, for premium elimination, approval from the federal government. They should take effect later this year.
Dental coverage for 190,000 adults in the MaineCare program
Beginning later this year, adults enrolled in the MaineCare program will for the first time have access to comprehensive dental services (children’s dental services are already covered). This initiative was introduced in several bills in 2021 and ultimately included in the 2021 supplemental budget. Lack of adequate dental care is a severe health problem for many Mainers with low income. More than a third of Mainers with household incomes below $20,000 a year haven’t seen a dentist in at least five years. And this lack of preventative care has a real cost — Mainers in this income bracket are twice as likely to have had a tooth extracted as Mainers with middle income Mainers with household incomes over $75,000.3
Approximately 190,000 adults 21 or older currently enrolled in MaineCare should be eligible for the new benefit.4
The new coverage is scheduled to take effect by July 1, 2022.
Extended postpartum care in MaineCare
The MaineCare program was further improved by the extension of postpartum benefits from the previous 60 days to 12 months. Research increasingly finds that new mothers face physical and mental health challenges in the year after giving birth. Lack of health care coverage is one reason the United States has such a high rate of maternal mortality. Extending Medicaid coverage for a full year will provide new mothers more security in the months following a birth and help address these problems. LD 265 increases the length of postpartum coverage in stages:
- 6 months starting January 1, 2022
- 9 months starting July 1, 2022
- 12 months starting July 1, 2023
The extended coverage would phase out at the end of 2026 unless the legislature chooses to extend it.
Coverage for immigrant children and pregnant women
The final major change to the MaineCare program is the restoration of coverage to some Mainers with uncertain immigration status who were previously covered until the program was terminated by Governor LePage. Without access to comprehensive health care coverage, refugees, asylum-seekers, and other immigrants often find it financially impossible to afford the care they need. While LD 718 had sought to restore coverage to all immigrants, a compromise in 2021 ultimately resulted in coverage for children under 21 and pregnant and postpartum women as part of the 2021 supplemental budget.
This coverage goes into effect July 1, 2022.
New website to purchase subsidized insurance
In 2021, Maine launched a new website to help Mainers enroll in health insurance programs created by the Affordable Care Act. The site includes features not available at Healthcare.gov, including the ability to search for certain health care providers or plans covering specific prescriptions. The new website is the first step in establishing an independent health insurance exchange for the state of Maine, allowing the state more authority to regulate plans sold on the platform.
Easier enrollment for individual plans
Another effort to make it easier to enroll in subsidized or free health insurance passed the legislature as LD 1390. Beginning in 2023, Mainers will be able to check a box on their income tax return asking the state to help them determine their eligibility for financial assistance with health care. Maine Revenue Services will send this information to the state’s health care marketplace which will determine whether people qualify for free coverage under the MaineCare program or subsidized insurance under the Affordable Care Act. State agencies will then help people enroll in those programs. This approach was pioneered in Maryland, and in the first year, thousands of Marylanders signed up for Medicaid or subsidized insurance. Black Marylanders and those under 35, who are among the hardest groups to reach, were especially likely to enroll through this system.
Improved affordability in rural Maine
Steps were taken to make insurance more affordable for Mainers living in more rural parts of the state, particularly Down East and in Aroostook County. Health insurers are allowed to charge higher premiums for Mainers living in different parts of the state. The cheapest insurance is available for people living in Cumberland and York Counties while the most expensive is for residents of Aroostook, Hancock, and Washington Counties. While this practice, known as “geographic rating,” can allow insurers to account for higher hospital costs in rural parts of the state, it further exacerbates income disparities. Under the current system, some of the poorest areas of the state are faced with the highest insurance costs.
Currently, insurers can charge 1.5 times as much for plans issued in Aroostook County compared to those in Cumberland County. Under LD 1331, that differential will be reduced to 1.25 times for plans beginning on January 1, 2024. While specific impacts on premiums will depend on decisions made by insurance companies, the result should be lower premiums in rural Maine and slightly higher premiums in southern counties.
Insulin safety net
Last year, LD 673 was passed to ensure all Mainers have access to one emergency 30-day supply of insulin every 12 months if they are unable to afford the medicine otherwise. This builds on a 2020 law capping insulin copays for Mainers with insurance at $35 for a 30-day supply.
The emergency insulin supply law came into effect March 1, 2022.
Office of Affordable Health Care
To continue improving access to health care, the legislature authorized the creation of an Office of Affordable Health Care in 2021. In 2022, further powers were approved for the office, which is currently hiring its first executive director. The office is charged with analyzing trends in health care costs in the state and proposing evidence-based policies to reduce costs. The new mandates include increasing public coverage through MaineCare, creating a Medicaid buy-in program, and creating a public option plan for the marketplace.
Prescription drug cost accountability
Efforts continued to make prescription drugs more affordable for Mainers by comparing prices paid in Maine to those paid for the same drugs in Canada. The Maine Health Data Organization, along with the Prescription Drug Affordability Board and Office of Affordable Health Care, will collaborate to compare prices for the 100 costliest prescriptions and the 100 most commonly prescribed medications in the state. Beginning in 2023, the state will produce an annual report showing the potential savings if prescription prices in Maine were capped at those paid in Canada.
Laying the groundwork for family and medical leave
Progress continues to be made toward a statewide paid family and medical leave program. A commission established last year met several times to consider the best way to design and deliver a program and contracted an actuarial study to determine costs. The 2022 supplemental budget authorized funds for the commission to continue meeting into 2022 and to report back to the next legislature.
Notes:
[1] This initiative was initially LD 372, and ultimately included as part CCC of the 2022 supplemental budget.
[2] US Census Bureau, American Community Survey, 2019 public-use microdata.
[3] US Centers for Disease Control, Behavioral Risk Factors Surveillance Survey, 2016 data (most recent year with oral health questions). Retrieved with the Web-Enabled Analysis Tool, https://nccd.cdc.gov/weat/
[4] Maine Office of Program and Fiscal Review, MaineCare enrollment data, December 2021. https://legislature.maine.gov/doc/7994
