An Act To Fully Implement Health Insurance Exchanges and To Make Maine Law Consistent with Federal Law
Maine Legislature, Session 126, LD 1094
Committee: Insurance and Financial Services
Sponsors: WOODBURY
Amends: 5 MRSA §12004-I, 24-A MRSA §4347, 24-A MRSA §3953, 22 MRSA §3174-G

Legislative Document 
No. 1094 
S.P. 376 
In Senate, March 19, 2013 
An Act To Fully Implement Health Insurance Exchanges and To 
Make Maine Law Consistent with Federal Law 
Reference to the Committee on Insurance and Financial Services suggested and ordered 
printed. 
DAREK M. GRANT 
Secretary of the Senate 
Presented by Senator WOODBURY of Cumberland. 
Be it enacted by the People of the State of Maine as follows: 
PART A 
Sec. A-1.  5 MRSA §12004-I, sub-§31-B is enacted to read: 
31-B.   
Sec. A-2.  24-A MRSA c. 56-C is enacted to read: 
CHAPTER 56-C 
HEALTH EXCHANGE UNDER FEDERAL AFFORDABLE CARE ACT 
§4347.  Maine Health Exchange Advisory Board 
The Maine Health Exchange Advisory Board, referred to in this section as "the 
advisory board," established under Title 5, section 12004-I, subsection 31-B, is 
established to advise the Federal Government, the Governor, the Legislature, the 
Department of Health and Human Services and the bureau regarding the interests of 
individuals and employers with respect to any federally facilitated exchange, partnership 
exchange or state-based exchange that may be created for this State pursuant to the 
federal Affordable Care Act. 
1.  Appointment; composition.  The advisory board consists of 17 members 
appointed pursuant to this subsection. 
A.  The Governor shall appoint 12 members of the advisory board with the approval 
of the joint standing committee of the Legislature having jurisdiction over insurance 
and financial services matters: 
(1)  Two persons representing health insurance carriers; 
(2)  One person representing dental insurance carriers; 
(3)  One person representing insurance producers; 
(4)  One person representing Medicaid recipients; 
(5)  One person representing health care providers and health care facilities; 
(6)  One person who is an advocate for enrolling hard-to-reach populations, 
including individuals with mental health or substance abuse disorders; 
(7)  One person who is a public health expert; and 
(8)  Four members representing individuals and small businesses, including: 
(a)  One person who can reasonably be expected to purchase individual 
coverage through an exchange with the assistance of a premium tax credit 
Health Care 
Maine Health 
Exchange Advisory 
Board 
Legislative per diem 
and travel expenses 
24-A MRSA §4347 
and who can reasonably be expected to represent the interests of consumers 
purchasing individual coverage through the exchange; 
(b)  One person representing an employer that can reasonably be expected to 
purchase group coverage through an exchange who can reasonably be 
expected to represent the interests of such employers; 
(c)  One person representing navigators or entities likely to be licensed as 
navigators; and 
(d)  One person employed by an employer that can reasonably be expected to 
purchase group coverage through an exchange who can reasonably be 
expected to represent the interests of such employees. 
Prior to making appointments to the advisory board, the Governor shall seek 
nominations from the public statewide associations representing the interests under 
this paragraph and other entities as appropriate. 
B.  Five members of the advisory board must be members of the Legislature, of 
whom at least 3 must serve on the joint standing committee of the Legislature having 
jurisdiction over insurance and financial services matters: 
(1)  Two members of the Senate, appointed by the President of the Senate, 
including one member recommended by the Senate Minority Leader; and 
(2)  Three members of the House of Representatives, appointed by the Speaker of 
the House, including one member recommended by the House Minority Leader. 
2.  Term.  Except for members who are Legislators, members of the advisory board 
serve 3-year terms.  A member may not serve more than 2 consecutive terms.  Members 
who are Legislators serve 2-year terms coterminous with their elected terms.  Except for a 
member who is a Legislator, a member may continue to serve after expiration of the 
member's term until a successor is appointed. 
3.  Duties.  The advisory board shall: 
A.  Advise the Federal Government, the Governor, the Legislature, the Department of 
Health and Human Services and the bureau regarding the interests of individuals and 
employers with respect to any federally facilitated exchange, partnership exchange or 
state-based exchange that may be created for this State; 
B.  Serve as a liaison between any exchange and individuals and small businesses 
enrolled in the exchange; 
C.  Evaluate the implementation and operation of any federally facilitated exchange, 
partnership exchange or state-based exchange with respect to the following: 
(1)  The essential health benefits benchmark plan designated in this State under 
the federal Affordable Care Act, including whether the State should change its 
designation; 
(2)  Whether state laws governing health insurance coverage for wellness 
programs and smoking cessation programs are in compliance with federal 
regulations; 
(3)  The consumer outreach and enrollment conducted by the exchange and 
whether the navigator program is effective; 
(4)  The coordination between the state Medicaid program and the exchange; 
(5)  Whether individual subsidies are adequate; 
(6)  Whether the exchange is effective in providing access to health insurance 
coverage for small businesses; and 
(7)  The implementation of rebates under the federal Affordable Care Act and 
section 4319. 
D.  Following the release of guidance or regulations from the federal Centers for 
Medicare and Medicaid Services addressing the basic health program option, as set 
forth in the federal Affordable Care Act, conduct a study, and make 
recommendations as appropriate, that examines the following: 
(1)  The affordability of health insurance coverage for low-income populations 
earning between 133% and 200% of the federal poverty level, including the 
impact of premium levels and cost sharing on access to health care by these 
populations; 
(2)  The health needs and limited income of these populations; 
(3)  The potential cost savings to the state Medicaid program as a result of the 
adoption of a basic health program due to the decrease in the administrative 
burden associated with individuals churning off and on Medicaid as their 
incomes fluctuate; 
(4)  Systems to create automatic and seamless coverage for individuals who 
transfer between a basic health program and Medicaid coverage; 
(5)  The impact of a basic health program on the State's ability to negotiate rates 
or receive rebates under any health insurance coverage offered by or through the 
State; and 
(6)  The most cost-effective and affordable method of delivering basic health 
program health insurance coverage by comparing and contrasting coverage and 
applicable out-of-pocket costs provided through a Medicaid look-alike program, 
a standard health plan offered through the Consumer Operated and Oriented Plan 
program under the federal Affordable Care Act or any other insurance product 
offered through a state-based exchange or federally facilitated exchange. 
E.  Based on the evaluation conducted by the advisory board pursuant to paragraphs 
C and D, recommend whether the State should transition to a partnership model or 
state-based exchange or implement any other changes in policy or law that would 
improve the operation of a federally facilitated exchange for consumers and small 
businesses in the State. If the advisory board recommends that the State transition to 
an alternative model from a federally facilitated exchange, the advisory board shall 
recommend a work plan and timeline for the transition, including estimated costs. 
4.  Compensation.  Except for members of the advisory board who are Legislators, 
members serve as volunteers and without compensation or reimbursement for expenses. 
Members who are Legislators are entitled to receive the legislative per diem as defined in 
Title 3, section 2 and reimbursement for travel for attendance at meetings of the board. 
5.  Quorum.  A quorum is a majority of the members of the advisory board. 
6.  Chair.  The advisory board shall annually choose one of its members to serve as 
chair for a one-year term. 
7.  Meetings.  The advisory board shall meet at least 4 times a year at regular 
intervals and may meet at other times at the call of the chair. Meetings of the board are 
public proceedings as provided by Title 1, chapter 13, subchapter 1. 
8.  Records.  Except for information designated as confidential under federal or state 
law, information obtained by the advisory board is a public record as provided by Title 1, 
chapter 13, subchapter 1. 
Sec. A-3.  Maine Health Exchange Advisory Board initial member terms.  
Notwithstanding the Maine Revised Statutes, Title 24-A, section 4347, subsection 2, 
except for members who are Legislators, initial appointees to the Maine Health Exchange 
Advisory Board must include 3 members appointed to one-year terms, 4 members 
appointed to 2-year terms and 5 members appointed to 3-year terms. 
PART B 
Sec. B-1.  24-A MRSA §3953, sub-§1, as enacted by PL 2011, c. 90, Pt. B, §8, is 
amended to read: 
1.  Guaranteed access reinsurance mechanism established.  The Maine 
Guaranteed Access Reinsurance Association is established as a nonprofit legal entity.  As 
a condition of doing business in the State, an insurer that has issued or administered 
medical insurance within the previous 12 months or is actively marketing a medical 
insurance policy or medical insurance administrative services in this State must 
participate in the association.  The Dirigo Health Program established in chapter 87 and 
any other state-sponsored health benefit program shall also participate in the association.  
Beginning January 1, 2014 and until December 31, 2016 or until such time as the 
transitional reinsurance program administered pursuant to the federal Affordable Care 
Act is terminated, the authority of the association granted by this chapter is suspended. 
Sec. B-2.  Maine Guaranteed Access Reinsurance Association; 
amendment to plan of operation.  On or before October 1, 2013, the Board of 
Directors of the Maine Guaranteed Access Reinsurance Association shall submit an 
amendment to the association's plan of operation to the Superintendent of Insurance for 
approval as provided in the Maine Revised Statutes, Title 24-A, section 3953, subsection 
to implement the suspension of the operations of the association pursuant to this Act.  
In amending the plan of operation, the board of directors shall, at a minimum, explain 
how operations will be suspended, describe the actions necessary to pay reinsurance on 
qualified claims attributable to the time period prior to January 1, 2014 and describe the 
actions necessary to suspend assessments. 
PART C 
Sec. C-1.  22 MRSA §3174-G, sub-§1, ¶F, as amended by PL 2011, c. 380, Pt. 
KK, §2, 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 financial affairs and the joint standing 
committee of the Legislature having jurisdiction over health and human services 
matters; and 
Sec. C-2.  22 MRSA §3174-G, sub-§1, ¶G, as enacted by PL 2011, c. 380, Pt. 
KK, §3, is amended to read: 
G.  A person who is a noncitizen legally admitted to the United States to the extent 
that coverage is allowable by federal law if the person is: 
(1)  A woman during her pregnancy and up to 60 days following delivery; or 
(2)  A child under 21 years of age.; 
Sec. C-3.  22 MRSA §3174-G, sub-§1, ¶¶H and I are enacted to read: 
H.  Beginning January 1, 2014, a person 21 years of age to 64 years of age who is not 
otherwise eligible for medical assistance under this section, who qualifies for medical 
assistance pursuant to 42 United States Code, Section 1396a(a)(10)(A)(i)(VIII) and 
who has income at or below 133% of the nonfarm income official poverty line plus 
5% for the applicable family size as required by federal law.  A person eligible for 
medical assistance under this paragraph must receive the same coverage as is 
provided to a person eligible under paragraph E; and 
I.  Beginning October 1, 2019, a person 19 years of age and 20 years of age who is 
not otherwise eligible for medical assistance under this section, who qualifies for 
medical 
assistance 
pursuant 
to 
United 
States 
Code, 
Section 
1396a(a)(10)(A)(i)(VIII) and who has income at or below 133% of the nonfarm 
income official poverty line plus 5% for the applicable family size as required by 
federal law.  A person eligible for medical assistance under this paragraph must 
receive the same coverage as is provided to a person eligible under paragraph E. 
SUMMARY 
Part A of the bill establishes the Maine Health Exchange Advisory Board to advise 
the Federal Government, Governor and Legislature on the implementation and operation 
of a health exchange in this State pursuant to the federal Patient Protection and 
Affordable Care Act. The advisory board is composed of 17 members, including 5 
members who are Legislators. 
Part B of the bill suspends the authority of the Maine Guaranteed Access Reinsurance 
Association from January 1, 2014 until December 31, 2016 or until such time as the 
transitional reinsurance program administered by the federal Department of Health and 
Human Services pursuant to the federal Patient Protection and Affordable Care Act is no 
longer operational. This Part also directs the Board of Directors of the Maine Guaranteed 
Access Reinsurance Association to amend the association's plan of operation and submit 
an amendment to the plan of operation on or before October 1, 2013 to the 
Superintendent of Insurance for approval. The amended plan of operation must include, 
but is not limited to, an explanation of how operations will be suspended, the actions 
necessary to pay reinsurance on qualified claims attributable to the time period prior to 
January 1, 2014 and the actions necessary to suspend assessments. 
Part C of the bill expands medical coverage under the MaineCare program to adults 
with family incomes up to 133% of the nonfarm income official poverty line and qualifies 
Maine to receive federal funding for 100% of the cost of coverage for members who 
enroll under the expansion.  Adults eligible are those 21 years of age to 64 years of age 
beginning January 1, 2014 and those 19 years of age and 20 years of age beginning 
October 1, 2019.