An Act To Increase Health Security by Expanding Federally Funded Health Care for Maine People
Maine Legislature, Session 126, LD 1578
Committee Amendment CA_A-HA_A_H849 (House)
Amends: 22 MRSA §3174-X, 22 MRSA §3195

HOUSE AMENDMENT ,,/I "to COMMITTEE AMENDMENT "A" to H.P. 1149, 
L.D. 1578, Bill, "An Act To Increase Health Security by Expanding Federally Funded 
Health Care for Maine People" 
Amend the amendment in Part A by striking out all of sections 3 and 4 and inserting 
the following: 
'Sec. A-3. 22 MRS A §3174-G, sub-§l, ~~H and I are enacted to read: 
H. Beginning August 1. 2014, a person 21 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 whose 
income is equal to or below 133% of the nonfarm income official poverty line plus 
5% for the applicable family size as required by federal law. 
(1) Before July 1, 2015, the coverage for a person eligible for medical assistance 
under this paragraph is the same coverage that is provided to a person eligible 
under paragraph E. 
(2) Beginning July 1. 2015, or at whatever later date is provided under law, the 
coverage for a person eligible for medical assistance under this paragraph who is 
subject to section 3195 is limited to insurance premium assistance under that 
section and any additional services approved pursuant to a federally approved 
waiver. 
Notwithstanding Title 5, section 8054, if it is necessary to meet the requirements set 
forth in this paragraph, the department shall adopt emergency rules under Title 5, 
chapter 375, without the necessity of demonstrating that immediate adoption is 
necessary to avoid a threat to public health or safety or the general welfare; and 
I. Beginning October 1. 2019, a person 19 or 20 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)(lO)(A)(i)(VIII) and whose 
income is equal to 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. 
HOUSE AMENDMENT 
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HOUSE AMENDMENT iF" to COMMITTEE AMENDMENT "An to H.P. 1149, L.D. 1578 
Sec. A-4. 22 MRSA §3174-XX is enacted to read: 
§3174-XX. Participation in Private Health Insurance Premium Program 
A member eligible for coverage pursuant to section 3174-G, subsection 1, paragraph 
H who is not medically frail is required to participate in the Private Health Insurance 
Premium Program in order to receive medical assistance in accordance with section 18, 
The department shall identify all members who have access to group health plan coverage 
and shall inform each member that participation is mandatory for that member. 
Sec. A-5. 22 MRSA §3195 is enacted to read: 
§3195. Maine Marketplace Premium Assistance 
Beginning July 1, 2015, the department shall administer the Maine Marketplace 
Premium Assistance program to provide insurance premium assistance, if cost-effective, 
for adults who are not disabled, not pregnant, not medically frail and do not have children 
under 19 years of age and are eligible under section 3174-G, subsection 1, paragraph H to 
purchase insurance coverage from qualified health plans on the federally facilitated 
exchange. 
A person eligible under section 3174-G, subsection 1, paragraph H who 
purchases insurance coverage from a qualified health plan on the federally facilitated 
exchange is responsible for any cost sharing imposed by the plan that is in accordance 
with 42 United States Code, Section 13960. 
As a condition of participation in the Maine Marketplace Premium Assistance 
program, a qualified health plan must offer to each federally qualified health center, as 
defined in Section 1905(1 )(2)(B) of the Social Security Act, 42 United States Code, 
Section 1396dO)(2)(B), that is providing services in geographic areas served by the plan, 
the opportunity to contract with that plan to provide to the plan's enrollees all ambulatory 
services that are covered by the plan that the center offers and must reimburse each such 
center for services as provided in Section 1302(g) of the federal Patient Protection and 
Affordable Care Act. Public Law 111-148, as amended by the federal Health Care and 
Education Reconciliation Act of 2010, Public Law 111-152, as added by Section 
10104(b)(2) of that Act. 
Sec. A-6. Preparation and submission of necessary federal waivers. On or 
before December 1,2014, the Commissioner of Health and Human Services shall prepare 
and submit to the federal Centers for Medicare and Medicaid Services any necessary 
waivers to implement the Maine Marketplace Premium Assistance program established in 
the Maine Revised Statutes, Title 22, section 3195. A waiver submitted pursuant to this 
section must include: 
1. A plan for limiting coverage for MaineCare services for adults described in Title 
22, section 3195 to insurance premium assistance provided under the Maine Marketplace 
Premium Assistance program and any additional benefits that are provided pursuant to 
subsection 2; 
2. A plan for providing access to services that are currently provided under the 
State's Medicaid state plan benefit package but are not provided by qualified health plans 
offered in the State on the federally facilitated exchange; 
HOUSE AMENDMENT 
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HOUSE AMENDMENT "~,, to COMMITTEE AMENDMENT "A" to H.P. 1149, L.D. 1578 
3. A process to exempt adults specified under Title 22, section 3195 who for medical 
or other reasons are determined exempt by the Commissioner of Health and Human 
Services from participation in the Maine Marketplace Premium Assistance program; and 
4. 
A plan that limits MaineCare spending for services under a waiver on a per 
member, per month basis to the average per member, per month cost for MaineCare 
services for individuals included in the waiver during the 12-month period immediately 
prior to the effective date of the waiver. 
Sec. A-7. 
Repeal. 
The Maine Revised Statutes, Title 22, section 3174-G, 
subsection 1, paragraph H is repealed upon the earliest of the following: 
1. The meeting of all of the following conditions: 
A. The enhanced Federal Medical Assistance Percentage with respect to amounts 
expended for medical assistance for newly eligible Medicaid individuals described in 
United States Code, Section 1396a(a)(10)(A)(i)(VIII) is reduced below 100% for 
any calendar quarter in 2014, 2015 or 2016; 
B. The reduction in the enhanced Federal Medical Assistance Percentage described in 
paragraph A has taken effect; and 
C. After the reduction of the enhanced Federal Medical Assistance Percentage as 
described in paragraphs A and B, the Legislature has convened and conducted a 
session of at least 30 calendar days; 
2. September 29,2015, ifby July 1,2015 a waiver submitted to the federal Centers 
for Medicare and Medicaid Services in accordance with section 6 has not been approved, 
in order to provide for notice to recipients and compliance with federal law; and 
3. December 31,2016. 
Sec. A-S. Appropriations and allocations. The following appropriations and 
allocations are made. 
HEALTH AND HUMAN SERVICES, DEPARTMENT OF 
Office of MaineCare Services 0129 
Initiative: Provides funding for the one-time costs of preparing and submitting the Maine 
Marketplace Premium Assistance program waiver. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
FEDERAL EXPENDITURES FUND 
All Other 
FEDERAL EXPENDITURES FUND TOTAL 
2013-14 
$0 
$0 
2013-14 
$0 
$0 
HOUSE AMENDMENT 
2014-15 
$500,000 
$500,000 
2014-15 
$500,000 
$500,000 
, . • 
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HOUSE AMENDMENT 'If" to COMMITTEE AMENDMENT "A" to H.P. 1149, L.D. 1578 
Amend the amendment in Part B in section 1 in the first paragraph in the 5th line 
(page 2, line 35 in amendment) by striking out the following: "paragraphs H and I" and 
inserting the following: 'paragraph H' 
Amend the amendment in Part B in section 1 in the first paragraph in the 3rd line 
from the end (page 3, line 22 in amendment) by striking out the following: "paragraphs 
H and I" and inserting the following: 'paragraph H' 
Amend the amendment in Part B in section 1 in the 2nd paragraph in the 7th line 
(page 3, line 31 in amendment) by striking out the following: "paragraphs H and I" and 
inserting the following: 'paragraph H' 
Amend the amendment in Part B by striking out all of sections 3 and 4 (page 4, lines 
to 29 in amendment) and inserting the following: 
'Sec. B-3. Calculation and transfer. Notwithstanding any other provision of 
law, the State Budget Officer shall calculate the amount of savings identified in this Part 
that applies against each General Fund account statewide as a result of the expansion of 
MaineCare eligibility authorized in the Maine Revised Statutes, Title 22, section 3174-G, 
subsection 1, paragraph H and shall transfer the amounts up to the amounts specified in 
this Part by financial order upon the approval of the Governor. These transfers are 
considered adjustments to appropriations in fiscal year 2014-15. The State Controller 
shall transfer any amounts identified. under this Part greater than the amounts specified in 
this Part to the MaineCare Stabilization Fund established under Title 22, section 3174-
KK. The State Budget Officer shall provide a report of the transferred amounts to the 
joint standing committee of the Legislature having_jurisdiction over appropriations and 
financial affairs no later than April 30, 2015 for fiscal year 2014-15 and shall submit 
adjustments to baseline budget requests totaling no less than $11,800,000 per year to 
reflect the continuation ofthe identified savings in the 2016-2017 biennium. 
Sec. B-4. Review and responsibility. Following receipt of the reports from the 
research organization as required under section 1 of this Part, the joint standing 
committee of the Legislature having jurisdiction over health and human services matters 
shall review the information provided in the reports and shall determine if the net cost to 
the General Fund of providing coverage under the MaineCare program to individuals 
pursuant to the Maine Revised Statutes, Title 22, section 3 1 74-G, subsection 1, paragraph 
H exceeds the savings to the General Fund, including any amount deposited in the 
MaineCare Stabilization Fund pursuant to section 2 of this Part, due to the expansion of 
coverage for those individuals. The joint standing committee may report out a bill to the 
conclusions of the reports.' 
Amend the amendment in Part D in section 1 in the first paragraph in the 3rd line 
(page 7, line 17 in amendment) by striking out the following: "paragraphs H or I" and 
inserting the following: 'paragraph H' 
Amend the amendment by relettering or renumbering any nonconsecutive Part letter 
or section number to read consecutively. 
HOUSE AMENDMENT 
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HOUSE AMENDMENT "ff:to COMMITTEE AMENDMENT "A" to H.P. 1149, L.D. 1578 
SUMMARY 
This amendment is modeled on the marketplace premium assistance program enacted 
into law in New Hampshire. 
Beginning August 1, 2014, this amendment provides 
medical assistance under the MaineCare program as a bridge to purchasing insurance 
coverage from qualified health plans on the federally facilitated exchange for newly 
eligible adult populations. Beginning July 1, 2015, medical assistance for childless adults 
is limited to assistance in purchasing insurance coverage from qualified health plans on 
the federally facilitated exchange under a new program, the Maine Marketplace Premium 
Assistance program, administered by the Department of Health and Human Services and 
any additional services approved by the federal Centers for Medicare and Medicaid 
Services pursuant to a waiver submitted by the department. Under the amendment, the 
person purchasing such insurance coverage is responsible for assuming cost sharing 
authorized under federal law, and employees who have access to employer health plans 
are required to participate in those plans. In order for qualified health plans to participate 
in the Maine Marketplace Premium Assistance program, plans must offer to each 
federally qualified health center an opportunity to contract with the plans and ensure that 
reimbursement for each center is according to the federal Patient Protection and 
Affordable Care Act. 
This amendment directs the Commissioner of Health and Human Services to prepare 
and submit to the federal Centers for Medicare and Medicaid Services any necessary 
waivers to implement the Maine Marketplace Premium Assistance program and provides 
funding for the one-time costs of preparing and submitting any Maine Marketplace 
Premium Assistance program waivers. 
This amendment retains the provisions in Committee Amendment "A" providing for 
the repeal of the expansion of MaineCare if the enhanced Federal Medical Assistance 
Percentage for calendar years 2014 to 2016 is reduced below certain stated levels or 
December 31, 2016, whichever is earlier. In addition, this amendment provides that if a 
waiver to implement the Maine Marketplace Premium Assistance program has not been 
approved by July 1, 2015, the expansion of MaineCare eligibility provided under this 
legislation is repealed 90 days thereafter. 
FISCAL NOTE REQUIRED 
SPONSORED BY: ~ 
(Speaker EVES) 
TOWN: North Berwick 
HOUSE AMENDMENT 
Revised: 04115114 
~ac.. 
LD 1578 
LR 2357(05) 
An Act To Increase Health Security by Expanding Federally Funded Health Care for Maine People 
Fiscal Note for House Amendment If to Committee Amendment" A" 
Net Cost (Savings) 
General Fund 
Appropriations/Allocations 
General Fund 
Federal Expenditures Fund 
Fiscal Detail and Notes 
Sponsor: Spkr. Eves of North Berwick 
Fiscal Note Required: Yes 
Fiscal Note 
FY 2013-14 
$0 
$0 
$0 
FY 2014-15 
$500,000 
$500,000 
$500,000 
Projections 
FY 2015-16 
$0 
$0 
$0 
Projections 
FY 2016-17 
$0 
$0 
$0 
The amendment adds a fiscal year 2014-15 appropriation of $500,000 for the Office of MaineCare Services in the 
Department of Health and Human Services for the State's share of the costs of preparing and SUbmitting the Maine 
Marketplace Premium Assistance program waiver. The fiscal note assumes the costs of expanding MaineCare 
eligibility through the Maine Marketplace Premium Assistance program waiver will be done within the appropriations 
and allocations included in the bill. 
LR2357(05) - Fiscal Note - Page 1 of 1