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Maine GOP Lawmakers' Medicaid Expansion Plan Faces Uphill Fight
02/25/2014   Reported By: Patty B. Wight

A compromise plan to expand Medicaid in Maine is on the table. Two Republican lawmakers drafted the proposal that would move the state's Medicaid program to a managed care model, in a bid to contain costs and appease Republicans opposed to expanding the program. But as Patty Wight reports, the plan doesn't seem to be convincing key GOP lawmakers to embrace expansion.

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Wilson, Saviello, Katz

Republican Sens. Roger Katz (above right) and Tom Saviello (above left) spent six months drafting their Medicaid expansion compromise. It essentially combines two bills the Legislature is already considering: one to expand Medicaid, the other, to move Medicaid to a so-called "managed care" model.

"By combining the two bills, we're giving almost everyone something that they're not going to like, and in divided government, that's the only way you can get things done," Katz says. "We're trying to thread the needle."

Under the proposed managed care plan, Maine would contract with four companies - including at least one non-profit - to manage the state's Medicaid program. The state would pay a flat fee per patient instead of the current model of paying per appointment or procedure. And the contract would require a minimum 5 percent reduction in the overall cost of the Medicaid program.

Republican Sen. Tom Saviello says it's more than a win-win. "Because this is a three-way winner: It cut costs, reduces the costs; it provides health care to the individuals that really need it; and it provides employment opportunities."

That's because if Maine expands Medicaid, the federal government covers 100 percent of the cost - about $1 million a day - for the first three years, then tapers to 90 percent by 2020. Some of that money, says Saviello, would go toward hiring more health care providers.

The compromise also calls for hiring more fraud investigators and using savings to eliminate a waiting list for Medicaid services for the developmentally disabled.

The initial reaction from Democrats is temperate. "We've been skeptical in the recent past of managed care as a concept," says Democratic House Speaker Mark Eves. "But if this something that gets us one step closer to insuring 70,000 Mainers, it's something that we're obviously going to looking very closely at. But I think it's too early to tell what kind of broad support this Republican proposal is going to have."

Forty-five other states' Medicaid programs use managed care, but not all of them have saved money. Eves says it's all in how it's implemented.

"There is a way to do managed care that does save state dollars, but it's done in an appropriate way," Eves says, "and that's through better care coordination and care management."

While Democrats are open to the expansion compromise if not fully embracing it, Republicans, like House Minority Leader Ken Fredette, aren't budging on the issue. "This is Medicaid expansion. That's all it is. They've dressed it up to make it look a little different."

Fredette says managed care may be a good idea, but tacking Medicaid expansion onto the bill is not. "It's going to be a very small amount of people that are going to be supportive of this, and at the end of the day, we will sustain the governor's veto and stop Medicaid expansion," Fredette says.

In a pre-recorded radio address, Maine Department of Health and Human Services Commissioner Mary Mayhew said efforts to contain spending in Medicaid should focus on existing needs.

"Government cannot be all things to all people, and we must put our most vulnerable citizens' needs first and ensure that state government is effectively prioritizing our limited resources in the best interests of the future of this state," she said in the address.

Republican Sen. Roger Katz knows the proposed compromise to Medicaid expansion faces a battle. But he's optimistic that enough Republicans will be swayed.

"It shouldn't be as partisan an issue as it is," he says. "Eight or nine other Republican governors around the country, including some very conservative ones, have concluded this is good for their state. We think it's good for Maine, particularly if we can get these reforms in how the department handles the program."

The Health and Human Services Committee will consider the compromise Wednesday afternoon.

Photo:  Patty Wight


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