An Act To Improve MaineCare and Promote Employment
Maine Legislature, Session 123, LD 1746
Committee: Health and Human Services
Sponsors: BARTLETT, PERRY, MARRACHE, MITCHELL, GROSE, MILLER, WALCOTT
Amends: 19-A MRSA §2001, 19-A MRSA §2004, 19-A MRSA §2006, 22 MRSA §18, 22 MRSA §3174-G, 22 MRSA §3174-T, 22 MRSA §3174-L

Legislative Document 
No. 1746 
S.P.613 
March 27,2007 
An Act To Improve MaineCare and Promote Employment 
Reference to the Committee on Health and Human Services suggested and ordered printed. 
Presented by Senator BARTLETT of Cumberland. 
JOY J. O'BRIEN 
Secretary of the Senate 
Cosponsored by Representative PERRY of Calais and Senators: MARRACHE of Kennebec, 
MITCHELL of Kennebec, Representatives: GROSE of Woolwich, MILLER of Somerville, 
WALCOTT of Lewiston. 
Printed on recycled paper 
/ 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1. 19-A MRSA §2001, sub-§5-A is enacted to read: 
5-A. Medical child support. "Medical child support" means support for the child's 
health care expenses, including but not limited to enrollment in employer-sponsored 
group health plans, purchase of private health insurance plans, participation in public 
health insurance plans and cash payments of premiums, copayments, deductibles and 
routine and extraordinary medical expenses not otherwise covered by health insurance 
plans. 
Sec. 2. 19-A MRSA §2004, as enacted by PL 1995, c. 694, Pt. B, §2 and affected 
by Pt. E, §2, is amended to read: 
§2004. Income information, medical and child support worksheets 
1. 
Court actions. This subsection governs the exchange and filing of income 
affidavits, medical child support and child support worksheets and supporting 
documentation in court actions. 
A. 
In a court action to determine or modify support of a minor child, the plaintiff 
and defendant shall exchange, prior to mediation, affidavits regarding income aad~ 
assets and ability to provide medical child support. These affidavits must conform 
with the forms provided by the court and must be accompanied by supporting 
documentation of current income, such as pay stubs, tax returns, employer statements 
or, if the plaintiff or defendant is self-employed, receipts and expenses, and 
information on employer-sponsored group health insurance and private health 
insurance available to the plaintiff and defendant. 
B. 
The parties shall exchange prior to the commencement of mediation a completed 
medical child support and child support worksheet worksheets. The worksheet must 
be completed in accordance with the support guidelines. 
C. 
At least 3 days prior to a court hearing, whether contested or uncontested, the 
parties shall file with the court and exchange, if they have not already done so, the 
completed affidavits and medical child support and child support worksheets. The 
parties are not required to file with the court the supporting documentation, unless 
otherwise directed. 
D. 
If a party fails to comply with this subsection, the court may, in its discretion: 
(1) Impose economic sanctions; or 
(2) Presume for the purpose of determining a current medical child support and 
child support obligation that the party has an earning capacity equal to the 
average weekly wage of a worker in this State as determined by the most recent 
Department of Labor statistics. A different annual income may be used if there is 
sufficient reliable evidence to conclude reasonably that the noncomplying party 
earns a greater or lesser actual income. 
E. 
The court may admit Department of Labor statistics into evidence for purposes 
of computing a parental support obligation. 
2. Administrative proceedings. The department shall adopt rules regarding the 
provision of infonnation necessary to apply the medical child support and child support 
guidelines in administrative proceedings. 
Sec.3. 19-A MRSA §2006, sub-§l-A is enacted to read: 
I-A. Determination of medical child support. After the court or hearing officer 
reviews income infonnation and the medical child support and child support worksheets 
and other relevant infonnation, the court or hearing officer shall determine the amount of 
medical child support to be contributed by the custodial and noncustodial parent and how 
that medical support is to be payable. 
A. In determining any new or modified court or administrative order for medical 
child support, the court or hearing officer issuing the order must consider whether the 
coverage available to the child through a parent's employer-sponsored grOUP health 
insurance plan or private health insurance is affordable, accessible, stable and 
comprehensive. In determining whether coverage is comprehensive, the court or 
hearing officer must consider the unique medical, mental health and social service 
needs of the child and whether the coverage available includes basic dental coverage, 
orthodontics, eyeglasses and mental health and substance abuse services. When the 
child is eligible for medical assistance under the state plan under Title XIX of the 
federal Social Security Act or for child health assistance under the state plan under 
Title XXI of the federal Social Security Act, there is a presumption that this coverage 
is more comprehensive than private coverage unless that coverage is provided under 
Title 22, section 18. 
B. In determining any new or modified court or administrative order for medical 
child support the court or hearing officer issuing the order must consider whether 
public health insurance pursuant to Title 22, section 18 and Title 22, chapter 855 is 
more reasonable in cost, accessible, stable and comprehensive than coverage under 
paragraph A. 
C. If a child is incurring extraordinary medical expenses that cannot be covered 
under paragraphs A and B and the future expenses are determinable because of the 
permanent, chronic or recurring nature of the illness or disorder, the sums actually 
being expended for the medical expenses must be added to the medical child support 
entitlement. 
D. If a party is paying health insurance premiums that the court or hearing officer or 
applicable administrative agency determines is appropriate to the needs of the child, 
then the sums actually being expended for health insurance premiums for the child or 
children for whom support is being ordered must be subtracted from the medical 
child support entitlement. The court shall determine the pro rata share of the health 
insurance premium actually expended that is attributable to each child. 
E. To determine to what extent medical child support should be payable for public 
health insurance or participation in the Private Health Insurance Premium Program, 
Title 22, section 18, an order establishing medical child support shall require that 
each party cooperates with the department if a child is or becomes eligible for and is 
enrolled in a medical assistance plan under Title XIX and Title XXI of the federal 
Social Security Act. 
Sec. 4. 19-A MRSA §2006, sub-§3, as amended by PL 2003, c. 415, §7, is 
further amended to read: 
3. Total basic support obligation. The total basic support obligation is determined 
by adding the child care costs, health insurance pretlliums and eJ(traordinary medical 
expenses and medical child support to the basic support entitlement as follows. 
A. 
When each child is under the age of 12 years, the sums actually being expended 
for child care costs must be added to the basic support entitlement to determine the 
total basic support obligation. 
B. If a child is incurring extraordinary medical expenses, the future incidence of 
which is determinable because of the permanent, chronic or recurring nature of the 
illness or disorder, the sums actually being expended for the medical expenses must 
be added to the basic support entitlement to determine the total basic support 
obligation. 
C. If a party is paying health insurance pretlliums, the sums actually being expended 
for health insurance pretlliums for the child or children for whom support is being 
ordered must be added to the basic support entitlement to determine the total basic 
support obligation. 
The court shall determine the pro rata share of the health 
insurance pretllium actually eJ(pended that is attributable to each child. 
Sec. 5. 19-A MRSA §2006, sub-§5, as amended by PL 2003, c. 415, §§9 and 10, 
is further amended to read: 
5. Special circumstances. The court or hearing officer shall consider the following 
special circumstances in determining child support and medical child support in new and 
modified orders. 
A. When the parent who is not the primary care provider is legally obligated to 
support a child in that party's household other than the child for whom a support order 
is being sought, an adjustment must be made to that party's parental support 
obligation. 
The adjustment is made by using the nonprimary residential care 
provider's annual gross income to compute a theoretical support obligation under the 
support guidelines for each child in that household. 
Neither the child support 
received by nor the financial contributions of the other parent of each child in the 
household are considered in the theoretical support calculation. The obligation is 
then subtracted from the annual gross income, and the adjusted income is the amount 
used to calculate support. The adjustment is used in all appropriate cases, except 
when the result would be a reduction in an award previously established. 
B. When the parties' combined annual gross income exceeds $240,000, the child 
support table is not applicable, except that the basic weekly child support entitlement 
of a child is presumed to be not less than that set forth in the table for a combined 
annual gross income of $240,000. 
C. The subsistence needs of the nonprimary care provider must be taken into account 
when establishing the parental support obligation. If the annual gross income of the 
nonprimary care provider is less than the federal poverty guideline, the nonprimary 
care provider's weekly parental support obligation for each child for whom a support 
award is being established or modified may not exceed 10% of the nonprimary care 
provider's weekly gross income, regardless of the amount of the parties' combined 
annual gross income. The child support table includes a self-support reserve for 
obligors earning less than $12,600 per year. If the nonprimary care provider's annual 
gross income, without adjustments, is in the self-support reserve, the amount listed in 
the table for the number of children is the nonprimary care provider'S basic support 
obligation, regardless of the parties' combined annual gross income. The nonprimary 
care provider's proportional share of childcare, health insurance premiums and 
extraordinary medical expenses are added to this basic support obligation. 
D. Whea Except as provided in paragraphs F and G, when the parties have equal 
annual gross incomes and provide substantially equal care for each child for whom 
support is being determined, neither party is required to pay the other a parental 
support obligation. 
The parties shall share equally the child care costs, health 
insm=ance premiHms and Hninsm=ed and medical expenses child support. 
D-l. 
When the parties do not have equal annual gross incomes but provide 
substantially equal care for each child for whom support is being determined, the 
presumptive parental support obligation must be determined as follows. 
(1) The enhanced support entitlement for each child must be determined. 
(2) Using the enhanced support entitlement, a parental support obligation for 
each child must be determined by dividing the total enhanced support obligation 
between the parties in proportion to their respective gross incomes. 
(3) The party with the higher annual gross income has a presumptive obligation 
to pay the other party the lower of: 
(a) 
The difference between their parental support obligations as 
calculated in subparagraph (2); and 
(b) The presumptive parental support obligation determined for the 
payor party using the basic support entitlement under the support 
guidelines as though the other party provided primary residential care 
of the child. 
(4) The parties shall share the child care costs, health insm=ance premil::Hfis and 
HninsHred except as provided in paragraphs F and G, and medical expenses child 
support in proportion to their incomes. 
E. When each party is the primary residential care provider for at least one of the 
children involved, a child support obligation must first be computed separately for 
each party for each child residing primarily with the other party, based on a 
calculation pursuant to the support guidelines, and using as input in each calculation 
the number of children in each household, rather than the total number of children. 
The amounts determined in this manner represent the theoretical support obligation 
due each party for support of each child for whom the party has primary residential 
responsibility. 
Each party's proportionate share of child care costs and healtll 
insuranee premiums medical child support is added to the amounts calculated, and the 
party owing the greater amount of child support shall pay the difference between the 
amounts as a parental support obligation. 
F. Parties with incomes below 200% of the federal poverty guidelines are exempt 
from purchasing groups or private health insurance as part of their medical child 
support obligation unless such coverage is available at no cost. 
G. Parties with incomes between 150% and 200% of the federal poverty guidelines 
may be ordered to make payments toward the cost of medical child support, 
including, but not limited to, public insurance based on a sliding scale pursuant to 
Title 22, section 18 and Title 22, chapter 855. 
H. 
Any amount of medical support payment that a noncustodial parent whose 
income is above 200% of the federal poverty guidelines is ordered by a court or 
administrative agency to pay to a custodial parent whose income is below 200% of 
federal poverty guidelines must first be used by the custodial parent to offset the 
premium for public health insurance coverage for the child, in accordance with rules 
adopted by the Department of Health and Human Services. 
Sec. 6. 22 MRS A §18, sub-§l, as enacted by PL 1997, c. 795, §5, is amended to 
read: 
1. Program. The Private Health Insurance Premium Program is operated by the 
Bureau of Medical Services within the department and implements the provisions of 42 
United States Code, Section 1396a(a)(25)(G) and 1396e. 
The bureau shall seek to 
maximize emollment in the program pursuant to section 3174-LL. 
Sec. 7. 22 MRSA §18, sub-§l-A is enacted to read: 
I-A. Comparable coverage. A person emolled in the Private Health Insurance 
Premium Program with children eligible for Medicaid under section 3174-G is eligible 
for MaineCare benefits not otherwise provided by a private or employer-sponsored group 
health plan. 
Sec. 8. 22 MRSA §18, sub-§l-B is enacted to read: 
I-B. Sliding scale. To the extent that participation in the Private Health Insurance 
Premium Program is the result of a medical child support order under Title 19-A, section 
2004, the department shall establish a sliding scale for applicable premiums and cost-
sharing amounts that do not exceed the amounts established under section 3174-T. 
Sec. 9. 22 MRSA §3174-G, sub-§l, ~E, as amended by PL 2003, c. 469, Pt. A, 
§5 and as affected by c. 673, Pt. Y, §3, is further amended to read: 
E. The parent or caretaker relative of a child described in paragraph B or D when the 
child's family income is equal to or below 200% of the nonfarm income official 
poverty line, subject to adjustment by the commissioner under this paragraph. 
Medicaid services provided under this paragraph must be provided within the limits 
of the program budget. Funds appropriated for services under this paragraph must 
include an annual inflationary adjustment equivalent to the rate of inflation in the 
Medicaid program. On a quarterly basis, the commissioner shall determine the fiscal 
status of program expenditures under this paragraph. If the commissioner determines 
that expenditures will exceed the funds available to provide Medicaid coverage 
pursuant to this paragraph, the commissioner must adjust the income eligibility limit 
for new applicants to the extent necessary to operate the program within the program 
budget. If, after an adjustment has occurred pursuant to this paragraph, expenditures 
fall below the program budget, the commissioner must raise the income eligibility 
limit to the extent necessary to provide services to as many eligible persons as 
possible within the fiscal constraints of the program budget, as long as the income 
limit does not exceed 200% of the nonfarm income official poverty line; aHd 
Sec. 10. 22 MRS A §3174-G, sub-§I, ~-1 is enacted to read: 
E-l. The parent or caretaker relative described in paragraph E, who has received 
benefits under this chapter in the past 3 months and whose income now exceeds the 
I evel in paragraph E, may purchase coverage under this chapter for a period of up to 
months at a premium level that does not exceed the premiums established for 
MaineCare under the Katie Beckett option authorized by the federal Tax Equity and 
Fiscal Responsibility Act of 1982 and a contribution toward administrative costs no 
greater than the maximum level allowed under COBRA; 
Sec. 11. 22 MRS A §3174-G, sub-§I, ~F, as amended by PL 2003, c. 469, Pt. A, 
§5 and affected by c. 673, Pt. Y, §3, is further amended to read: 
F. 
A person 20 to 64 years of age who is not otherwise covered under paragraphs A 
to E when the person's family income is below or equal to 125% of the nonfarm 
income official poverty line, provided that the commissioner shall adjust the 
maximum eligibility level in accordance with the requirements of the paragraph. 
(2) If the commissioner reasonably anticipates the cost of the program to exceed 
the budget of the population described in this paragraph, the commissioner shall 
lower the maximum eligibility level to the extent necessary to provide coverage 
to as many persons as possible within the program budget. 
(3) The commissioner shall give at least 30 days' notice of the proposed change 
in maximum eligibility level to the joint standing committee of the Legislature 
having jurisdiction over appropriations and fmancial affairs and the joint standing 
committee of the Legislature having jurisdiction over health and human services 
matters~~ 
Sec. 12. 22 MRSA §3174-G, sub-§l, -,rG is enacted to read: 
G. A young adult 19 years of age or 20 years of age when the household income is 
equal to or below 200% of the nonfarm income official poverty line; and 
Sec. 13. 22 MRS A §3174-G, sub-§I, ~H is enacted to read: 
H. A qualified working disabled person when the person's family unearned income is 
equal to or below 150% of the nonfarm income official poverty line and when the 
Pag'! 6 - 123LR0370(OlH 
total unearned and earned income does not exceed 250% of the nonfann income 
official poverty line. 
Sec. 14. 22 MRSA §3174-T, sub-§2, ~E, as amended by PL 2001, c. 450, Pt. A, 
§3, is further amended to read: 
E. 
Coverage under the Cub Care program may be purchased for children described 
in subparagraphs (1) and (2) for a period of up to 18 months as provided in this 
paragraph at a premium level that is revenue neutral and that covers the cost of the 
benefit does not exceed premiums established for MaineCare under the Katie Beckett 
option authorized by the federal Tax Equity and Fiscal Responsibility Act of 1982 
and a contribution toward administrative costs no greater than the maximum level 
allowable under COBRA. 
The department shall adopt rules to implement this 
paragraph. The following children are eligible to enroll under this paragraph: 
(1) A child who is enrolled under paragraph A or B and whose family income at 
the end of the child's 12-month enrollment tenn exceeds the maximum allowable 
income set in that paragraph; and 
(2) A child who is enrolled in the Medicaid program and whose family income 
exceeds the limits of that program. The department shall terminate Medicaid 
coverage for a child who enrolls in the Cub Care program under this 
subparagraph. 
Sec. 15. 22 MRSA §3174-LL is enacted to read: 
§3174-LL. Medical support for children 
The department shall ensure that the parents of children eligible for and enrolled in 
Medicaid under section 3174-G provide medical child support to the extent authorized 
under Title 19-A, section 2006 and the Private Health Insurance Premium Program and in 
accordance with the guidelines in this section. 
1. Exceptions to enrollment in health insurance plans. The department may not 
petition the court in any proceeding regarding a new or modified medical child support 
order to require a parent with an income below 200% of the nonfann income official 
poverty line to purchase private health insurance or enroll in a group health plan unless 
such enrollment is available at no cost or the parent is eligible for assistance under section 
~ 
2. Exception to payment of cash medical support. Except as provided in Title 19-
A, section 2006, subsection 5, paragraphs F and G the department may not petition the 
court in any proceeding regarding new or modified medical child support order to require 
a parent with an income between 150% and 200% of the nonfann income official poverty 
line to pay cash medical support or for any extraordinary medical expenses as defined at 
Title 19-A, section 2001, subsection 4. 
Sec. 16. Third-party liability unit established. The Department of Health and 
Human Services shall establish a centralized 3rd-party liability unit that will work to 
maximize the use of private health insurance coverage pursuant to the Maine Revised 
Statutes, Title 22, section 18. 
Sec. 17. Rules. The Department of Health and Human Services shall adopt routine 
technical rules pursuant to the Maine Revised Statutes, Title 5, chapter 375, subchapter 2-
A to implement this Act. 
Sec. 18. Contingent effective Date. The provisions of this Act will be effective 
upon adoption of the final federal rules for 45 Code of Federal Regulations, Parts 302 to 
and 308. 
SUMMARY 
This bill requires the court, hearing officers or applicable administrative agency to 
consider, when determining new or modified orders for child support, a means to provide 
support for a child's health care expenses, including but not limited to enrollment in 
employer-sponsored group health insurance plans, purchase of private health insurance 
plans, participation in public health insurance plans and cash payments of premiums, 
copayments, deductibles and routine and extraordinary medical expenses not otherwise 
covered by health insurance plans. 
It requires plaintiffs and defendants to provide 
information related to their ability to provide medical child support including information 
on employer-sponsored group health insurance and private health insurance available to 
the plaintiff and defendant as part of the affidavits, medical child support and child 
support worksheets and other relevant information that the parties are required to file with 
the court. It requires the court or hearing officer to review the information submitted by 
the plaintiff and defendant and to determine the amount of medical child support to be 
contributed by each and how that support is to be payable. The bill exempts parties with 
incomes below 200% of the federal poverty guidelines from purchasing employer-
sponsored group or private health insurance as part of their medical child support 
obligation unless such coverage is available at no cost. It allows the court or hearing 
officers to order parties with incomes between 150% and 200% of the federal poverty 
guidelines to make payments toward the cost of public insurance based on a sliding scale 
pursuant to the Maine Revised Statutes, Title 22, section 18 and chapter 855. It requires 
any amount of medical support payment that a noncustodial parent whose income is 
above 200% of the federal poverty guidelines is ordered by a court or administrative 
agency to pay to a custodial parent whose income is below 200% of federal poverty 
guidelines to first be used by the custodial parent to offset the premium for public health 
insurance coverage for the child. It requires the Department of Health and Human 
Services to maximize enrollment in the Private Health Insurance Premium Program 
pursuant to Title 22, section 18 and allows persons enrolled in the Private Health 
Insurance Premium Program with children eligible for Medicaid under Title 22, section 
3174-G to be eligible for MaineCare benefits not otherwise provided by the private or 
employer-sponsored group health plan. It requires the Department of Health and Human 
Services to establish a sliding scale for applicable premiums and cost-sharing amounts 
that do not exceed the amounts established under Title 22, section 3174-T to the extent 
that participation in Title 22, section 18 is the result of a medical child support order 
under Title 19-A, section 2004. It allows people who have received Medicaid for their 
children for the past 3 months whose income exceeds limits pursuant to Title 22, section 
4-G, subsection 1, paragraph E-l to purchase coverage for up to 18 months at 
premiums not to exceed those under the Katie Beckett program and limits contributions 
toward administrative costs to the maximum amount allowed under COBRA. It makes 
working disabled persons with unearned income that is equal to or below 150% of the 
nonfarm income official poverty line and with a combined total earned and unearned 
income that does not exceed 250% of the nonfarm income official poverty line eligible 
for Medicaid. It makes young adults who are 19 years of age or 20 years of age when the 
household income is equal to or below 200% of the nonfarm income official poverty line 
eligible for Medicaid. It requires the Department of Health and Human Services to ensure 
that the parents of children eligible for Medicaid under Title 22, section 3174-G provide 
medical child support as defined in Title 19-A, section 2001, subsection 11 to the extent 
authorized under Title 19-A, section 2006, to the extent possible through the Private 
Health Insurance Premium Program pursuant to Title 22, section 18 and in accordance 
with the guidelines in this section. It prohibits the department from petitioning the court 
in any new or modified medical child support order to require a parent with an income 
below 200% of the nonfarm income official poverty line to purchase private health 
insurance or enroll in an employer-sponsored group health plan unless such enrollment is 
available at no cost or the parent is eligible for assistance under Title 22, section 18 or 
from making an administrative determination with the same effect. 
It prohibits the 
department from petitioning the court in any new or modified medical child support order 
to require a parent with an income between 150% and 200% of the nonfarm income 
official poverty line to include cash medical support or any extraordinary medical 
expenses as defined at Title 19-A, section 2001 or from making an administrative 
determination with the same effect. It requires the Department of Health and Human 
Services to establish a centralized 3rd-party liability unit that will work to maximize the 
use of private health insurance coverage pursuant to Title 22, section 18 and to adopt 
routine technical rules.