An Act to Establish a Statewide Primary and Preventive Health Care Program
Maine Legislature, Session 121, LD 0585
Committee: Health and Human Services
Sponsors: TRAHAN, HALL, BUNKER, CUMMINGS, DUNLAP
Amends: 5 MRSA §12004-I, 22 MRSA §3174-D

Legislative Document 
No. 585 
H.P.448 
House of Representatives, February 11, 2003 
An Act to Establish a Statewide Primary and Preventive Health 
Care Program 
Reference to the Committee on Health and Human Services suggested and ordered printed. 
Presented by Representative TRAHAN of Waldoboro. 
Cosponsored by Senator HALL of Lincoln and 
7r/~/J7.~ 
MILLICENT M. MacFARLAND 
Clerk 
Representatives: BUNKER of Kossuth Township, CUMMINGS of Portland, DUNLAP of Old 
Town, McKEE of Wayne. 
Prin.ed on recycled paper 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1. 5 MRSA §12004-I, sub-§36-E is enacted to read: 
36-E. 
Statewide 
Human Services Primary and 
Preventative 
Health Care 
Program 
Advisory 
Committee 
Expenses 
for Members 
MRSA 
§3174-DD, 
sub-§4 
Sec. 2. 22 MRSA §3174-DD is enacted to read: 
§3174-DD. 
Statewide prima~ and preventive health care program 
1. 
Program established. 
There is established a statewide 
primary and preventive health care program, referred to in this 
section as 
the 
"program," 
to provide primary 
and preventive 
health care for residents of the State who lack health insurance 
and meet the requirements of subsection 2. 
2. 
Eligibility; enrollment. 
Primary and preventive health 
care benefits under the program are available to adults whose 
family income is above the eligibility level for MaineCare under 
section 
3174-G 
and 
below 
the 
maximum 
eligibility 
level 
established under paragraph A, c.S c.djusted under paragraph B, and 
subject to the requirements of paragraph C. 
If premiums are 
established 
for 
the 
program 
under 
rules 
adopted 
by 
the 
department, payment of the premium is required for enrollment and 
continued enrollment. 
A. 
The maximum eligibility level, subject to adjustment by 
the commissioner under paragraph B, is 300
0t> of the nonfarm 
income official poverty line. 
B. 
If the commissioner has determined the fiscal status of 
the program under subsection 6 and has determined that an 
adjustment in the 
maximum eligibility level is required 
under this paragraph, 
the 
commissioner shall adjust the 
maximum 
eligibility 
level 
in 
accordance 
with 
the 
requirements of this paragraph. 
(1) 
The adjustment must accomplish the purposes of the 
program set forth in subsection 1. 
(2) 
If program expenditures are reasonably anticipated 
by the commissioner to exceed the program budget, the 
commissioner shall lower the maximum eligibility level 
Page l-LR0050 (1) 
set in paragraph A to the extent necessary to bring the 
program within the program budget. 
(3) 
If program expenditures are reasonably anticipated 
by the commissioner to fall below the program budget, 
the commissioner shall raise the maximum eligibility 
level set in paragraph A to the extent necessary to 
provide coverage to as many persons as possible within 
the fiscal constraints of the program budget. 
(4) 
The 
commissioner shall give at least 
days' 
notice of the proposed change in maximum eligibility 
level 
to 
the 
joint 
standing 
committee 
of 
the 
Legislature having jurisdiction over appropriations and 
financial affairs and the joint standing committee of 
the Legislature having jurisdiction over health and 
human services matters. 
C. 
Subject to the other requirements in this subsection, a 
person who is resident in the State is eligible for the 
program unless that person: 
(1) 
Is eligible 
for 
coverage 
under 
the 
MaineCare 
program; 
(2) 
Is covered under a aroup health insurance plan or 
under health insurance, as defined in Section 2791 of 
the federal Public Health Service Act, 42 United States 
Code, Section 300gg(c) (Supp. 1997); or 
(3) 
Is eligible under Title 5, section 285 for health 
coverage 
under 
the 
state 
employee 
health 
insurance 
program as an individual or as a member of a family. 
D. 
Notwithstanding changes in the maximum eligibility level 
determined 
under 
paragraphs 
A 
and 
B, 
the 
following 
requirements apply to enrollment and eligibility: 
(1) 
A program participant must 
be enrolled for 
a 
12-month enrollment period. Prior to the end of each 
12-month 
enrollment 
period 
the 
department 
shall 
redetermine eligibility for continuing coverage; and 
{ 2) 
P~rsons Qf higher family income may nQt be covered 
unl~§s 
p~r§ons 
of 
lower 
fgmily 
inl:;;om~ 
are 
also 
cov~red. 
Thi§ 
subparagraph 
may 
nQt 
b~ applied 
to 
gisqyglify 
g 
person 
during 
th~ 12-month 
~nrollm~nt 
p~riQg. 
A 
p~rson of 
high~r family 
inl:;;Qme 
mgy 
be 
gi§qyglified gt the 
end 
Qf 
th~ 12 month enrollment 
period if the 
commissioner has 
lowered 
the 
maximum 
eligibility level under paragraph B. 
E. 
A person whose 
family 
income meets 
the eligibility 
requirements at the time of enrollment and increases to 
disqualify the person at the end of the 12-month enrollment 
period may purchase coverage under the program for a period 
of up to 18 months at a 
premium level that is revenue 
neutral and that covers the cost of the benefit and 
a 
contribution toward administrative costs no greater than the 
maximum level allowable under COBRA. 
The department shall 
adopt rules to implement this paragraph. 
3. 
Program 
administration: 
benefit 
design. 
With 
the 
exception of premium payments under subsection 5 and any other 
requirements 
imposed under this section, 
the program must be 
coordinated 
and 
integrated 
with 
the 
MaineCare 
program 
and 
administered with it in one administrative structure within the 
department. with the same enrollment and eligibility processes 
and 
outreach. 
The 
department 
shall 
adopt 
and 
promote 
a 
simplified eligibility form and eligibility process. 
In order to 
maximize 
the 
use 
of 
federal 
and 
other 
nons tate 
funds, 
the 
delivery of primary and preventive health care services must be 
coordinated with the delivery of those services in other health 
care programs 
and settings 1n this State, 
including without 
limitation 
rural 
health 
clinics, 
federally 
qualified 
health 
centers, 
federally 
qualified 
look-alikes 
and 
Indian 
health 
services. 
The program must use, but is not limited to, the same 
benefit de1iyery system as 
the MaineCare program and provide 
benefits through the same health plans, contracting process and 
providers. 
4. 
Advisor:y committee. 
The department shall convene 
an 
advisory committee, as established in Title 5, section 12004-1, 
subsection 36-E, to provide advice regarding benefit design and 
primary and preventive health care services to be covered by the 
program. 
The 
advisory 
committee, 
which 
may 
not 
exceed 
members, 
must 
include 
consumers, 
providers 
of 
health 
care 
services, carriers licensed under Title 24 and Title 24-A, and 
representatives of Indian health care services. 
Members of the 
advisory committee not otherwise reimbursed for expenses may be 
reimbursed for expenses by the department. 
5. 
Consumer 
copayments 
and 
premium 
payments. 
In 
consultation with 
the 
advisory 
committee 
formed 
pursuant 
to 
subsection 4, 
the 
department 
may 
charge 
reasonable 
consumer 
copayments and premiums for primary and preventive health care 
services 
under 
the program. 
If the department 
adopts 
rules 
establishing premiums 
for 
the 
program, 
the 
department 
shall 
include a provision waiving premiums for good cause. 
6. 
Quarterly determination of fiscal status; reports. 
On a 
quarterly basis, 
the commissioner shall determine 
the fiscal 
status of the program, determine whether an adjustment in maximum 
eligibility level is required under subsection 2, paragraph Band 
report to the joint standing committee of the Legislature having 
jurisdiction over appropriations and financial affairs and the 
joint standing committee of the Legislature having jurisdiction 
over health and human services matters on enrollment, utilization 
and costs of the program. 
7. 
Provisions applicable to federally recognized Indian 
tribes. 
After 
consultation with federally 
recognized 
Indian 
nations, 
tribes 
or 
bands 
of 
Indians 
in 
the 
State, 
'the 
commissioner 
shall 
adopt 
rules 
regarding 
eligibility 
and 
participation of persons who are members of a nation, tribe or 
band, consistent with Title 30, section 6211, in order to best 
achieve the goal of providing access to primary and preventive 
health care while maximizing the use of federal funding. 
8. 
Resource guide. 
The program must post on the Internet a 
resource guide to primary and preventive health care services for 
use by consumers and providers of health care services. 
9. 
Health weeks. 
Twice per year the program must undertake 
a 
health 
week 
promotional 
campaign 
to 
provide 
free 
health 
screening services and encouraoe enrollment in the program. 
10. 
Rulemakinq. 
The 
department 
shall 
adopt 
rules 
in 
accordance with Title 5, 
chapter 375 as required to implement 
this section. 
Rules 
adopted pursuant to this subsection are 
routine technical rules 
as defined by Title 5, 
chapter 
375, 
subchapter 2-A. 
Sec. 3. Public hearings. 
In performing its duties under the 
Maine Revised Statutes, Title 22, section 3l74-DD, subsection 4, 
between October L 
2003 and the date that the statewide primary 
and preventive health care proqram, 
established in Title 22, 
section 3174-DD, 
subsection 1, 
begins providing services, 
the 
statewide preventive and health care program advisory committee 
shall convene 4 public hearings, one of which must be held 
III 
York 
County, 
Cumberland County, 
Oxford County or Androscoggin 
County, one of which must be held in Franklin County, Kennebec 
County, Lincoln County, 
Sagadahoc County, 
Knox County or Waldo 
County, one of which must be held in Aroostook County, Penobscot 
County, Somerset County or Piscataquis County and one of which 
must be held in Washington County or Hancock County. 
of 
Sec. 4. Waiver application. 
Human 
Services 
shall 
By January L 
submit 
an 
2004 the Department 
application 
for 
a 
waiver 
under 
the 
federal 
Medicaid 
program 
to 
the 
federal 
Department of Health and Human Services, Centers for Medicare and 
Medicaid 
Services. 
The 
waiver 
application 
must 
propose 
a 
statewide 
primary 
and 
preventive 
health 
care 
program 
in 
accordance with the provisions of the Maine Revised Statutes, 
Title 22, section 3174-DD. 
Sec. 5. Effective date. 
This Act takes effect October 15, 2003, 
except that primary and preventive health care coverage under 
that section of this Act that enacts the Maine Revised Statutes, 
Title 22, section 3174-DD takes effect 90 days after notification 
to the Department of Human Services that the waiver application 
submitted pursuant to this Act has been approved. 
SUMMARY 
This bill establishes a 
statewide primary and preventive 
health care program, a Medicaid waiver program to serve children 
and adults with family incomes up to 300% of the federal poverty 
level, 
subject 
to 
adjustment 
by 
the 
Commissioner 
of 
Human 
Services in order to maximize coverage and prevent overspending 
by the program. 
The program will include an Internet resource 
guide and health weeks twice per year to promote good health and 
encourage enrollment in the program. 
The program includes an 
advisory committee to advise the Department of Human Services on 
consumer 
copayments 
and 
premiums. 
The 
bill 
requires 
administration of the program 
~:,_, 
be coordinated and integrated 
with the MaineCare program. 
The bill requires 4 public hearings 
on a statewide basis prior to the operation of the program. 
The 
bill requires quarterly fiscal reports. 
The bill requires the 
waiver application to be filed by January 1, 2004.