An Act To Provide Health Care Savings Accounts and Health Care Management in MaineCare
Maine Legislature, Session 122, LD 0442
Committee: Health and Human Services
Sponsors: CAMPBELL, CURLEY, GLYNN, LEWIN, LINDELL, SHIELDS
Amends: 22 MRSA §3

Legislative Document 
No. 442 
H.P.327 
House of Representatives, January 27, 2005 
An Act To Provide Health Care Savings Accounts and Health Care 
Management in MaineCare 
Reference to the Committee on Health and Human Services suggested and ordered printed. 
Presented by Representati ve BOWEN of Rockport. 
17/~/J7·711~ 
MILLICENT M. MacFARLAND 
Clerk 
Cosponsored by Representatives: CAMPBELL of Newfield, CURLEY of Scarborough, 
GLYNN of South Portland, LEWIN of Eliot, LINDELL of Frankfort, SHIELDS of Auburn. 
Printed on recycled paper 
Be it enacted by the People of the State of Maine as follows: 
Sec. I. 22 MRSA §3I74-GG is enacted to read: 
§3l74-GG. 
MaineCare health care savings accounts and health 
care management 
The department shall establish health care savings accounts 
and 
a 
health 
care 
management 
program 
within 
the 
MaineCare 
program. 
The 
terms 
of 
the 
health care 
management 
program, 
referred to in this section as "the program," and of the health 
care 
savings 
accounts 
are 
subject 
to 
approval 
of 
a 
waiver 
application by the federal Centers for Medicare and Medicaid 
Services and rules adopted by the department to implement the 
program. 
The requirements for health care savings accounts and 
the program are as follows. 
1. 
Member election. 
Upon initial MaineCare enrollment or 
continuing eligibility review, 
a member must discuss enrollment 
options with an enrollment counselor to be assigned to a health 
care manager to administer the member's benefits. 
2. 
Program operation. 
A member receives health coverage 
that includes benefits for preventive, routine and catastrophic 
illness or injury 
care, using networks and payment structures 
negotiated by the health care manager. 
Routine care program 
benefits are determined by the member, with participation by the 
health care manager for accounting assistance only, up to the 
amount contained in the member's health care savings account. 
Preventive and catastrophic program benefits are determined by 
the member, paid for under contract by the health care manager, 
with administrative services provided by the health care manager. 
3. 
Member account. 
Each member, with the participation of 
the health care manager for accounting assistance only, shall 
establish an individual or family health care savings account to 
which contributions must be paid by the department based on 
average MaineCare costs in the prior year, 
adjusted by age, 
gender 
and other factors determined by the department to be 
actuar ially applicable. 
Account balances unpaid at the end of 
each calendar year carry forward to the next year for use during 
that year or may be transferred as provided in subsection 6. 
4. 
Capitation. 
Health care managers 
contract with the 
department to provide coverage and benefits under the program and 
are 
paid 
a 
capitated rate per enrolled 
member 
for 
routine 
preventi ve and catastrophic care. 
Rates must be set based on 
average 
MaineCare costs in the prior year, 
adjusted by age, 
gender and other factors determined by the department to be 
actuarially applicable. 
Page l-LRllOO (l) 
5. 
Purchase of coverage. 
A member 
may purchase health 
coverage individually or as a member of a group from a carrier 
authorized to transact business in this State pursuant to Title 
or Title 24-A. 
The member may fund the purchase of health 
coverage through transfers of the balance in the member's health 
care savings account and of the funds that the department would 
otherwise pay to the health care manager. 
6. 
Transfer. 
At the end of the year, a member may elect to 
transfer all or a portion of the balance remaining in a member 
account 
under 
subsection 
to 
a 
family 
development 
account 
established under Title 10, 
chapter 110, 
subchapter 4-A. 
An 
amount transferred from a member account to a family development 
account is subject to the provisions of this subsection. 
A. 
The amount transferred pursuant to this subsection is 
eligible to be matched as permitted under Title 10, section 
1076, subsection 4, paragraph B. 
B. 
The amount transferred pursuant to this subsection may 
be 
withdrawn 
for 
health care 
purposes 
under Title 
10, 
section 1077, subsection 1, paragraph F. 
C. 
Any amount deposited into the family development account 
pursuant to this subsection as a matching contribution to 
the 
amount 
transferred 
from 
a 
member 
account 
may 
be 
wi thdrawn for any of the purposes under Title 10, section 
1077, subsection 1. 
7. 
Reporting. 
The department shall report by February 15th 
of each year to the joint standing committees of the Legislature 
having jurisdiction over appropriations and financial affairs and 
health and human services matters regarding operation of the 
health care savings accounts and the program within the MaineCare 
program. 
8. 
Rulemaking. 
Rules adopted pursuant to this section are 
routine technical rules as defined in Title 5, 
chapter 
375, 
subchapter 2-A. 
SUMMARY 
This 
bill 
directs 
the 
Department 
of 
Health 
and 
Human 
Services to establish health savings accounts and a health care 
management program wi thin the MaineCare program, 
subject to a 
waiver 
from 
the 
federal 
Centers 
for 
Medicare 
and 
Medicaid 
Services. 
The bill requires the department to report by February 
15th of 
each year 
to 
the 
joint standing committees 
of the 
Legislature having jurisdiction over appropriations and financial 
affairs and health and human services matters regarding operation 
of the health care savings accounts and health care management 
program within the MaineCare program.