An Act To Increase Health Security by Expanding Federally Funded Health Care for Maine People
Maine Legislature, Session 126, LD 1578
Committee: Health and Human Services
Sponsors: EVES, JACKSON, EVANGELOS, SANBORN, WILSON, WINCHENBACH, ALFOND, CAIN, SAVIELLO
Amends: 22 MRSA §3174-G, 22 MRSA §3173-C

Legislative Document 
No. 1578 
H.P. 1149 
House of Representatives, December 30, 2013 
An Act To Increase Health Security by Expanding Federally 
Funded Health Care for Maine People 
Approved for introduction by a majority of the Legislative Council pursuant to Joint Rule 
203. 
Received by the Clerk of the House on December 23, 2013.  Referred to the Committee on 
Health and Human Services pursuant to Joint Rule 308.2 and ordered printed pursuant to Joint 
Rule 401. 
MILLICENT M. MacFARLAND 
Clerk 
Presented by Speaker EVES of North Berwick. 
Cosponsored by Senator JACKSON of Aroostook and 
Representatives: EVANGELOS of Friendship, McELWEE of Caribou, SANBORN of 
Gorham, WILSON of Augusta, WINCHENBACH of Waldoboro, Senators: President 
ALFOND of Cumberland, CAIN of Penobscot, SAVIELLO of Franklin. 
Be it enacted by the People of the State of Maine as follows: 
PART A 
Sec. A-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. A-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. A-3.  22 MRSA §3174-G, sub-§1, ¶¶H and I are enacted to read: 
H.  Effective July 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 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 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)(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. 
Sec. A-4.  Contingent repeal.  The Maine Revised Statutes, Title 22, section 
3174-G, subsection 1, paragraphs H and I are repealed if: 
1.  Enhanced Federal Medical Assistance Percentage.  The enhanced Federal 
Medical Assistance Percentage with respect to amounts expended for medical assistance 
for newly eligible Medicaid individuals described in 42 United States Code, Section 
1396a(a)(10)(A)(i)(VIII) is reduced below 100% for calendar quarters in 2014, 2015 and 
2016; 
2.  Reduction in enhanced Federal Medical Assistance Percentage effective.  The 
reduction in the enhanced Federal Medical Assistance Percentage described in subsection 
has taken effect; and 
3.  Legislative session of at least 30 days.  After the reduction of the enhanced 
Federal Medical Assistance Percentage as described in subsections 1 and 2, the 
Legislature has convened and conducted a session of at least 30 calendar days. 
Sec. A-5.  Repeal.  The Maine Revised Statutes, Title 22, section 3174-G, 
subsection 1, paragraphs H and I are repealed December 31, 2016. 
PART B 
Sec. B-1.  Obtaining federal approval for enhanced federal match.  The 
Commissioner of Health and Human Services shall take all steps necessary to secure an 
enhanced Federal Medical Assistance Percentage for services provided to the MaineCare 
childless adult waiver population in the State equal to that available under the federal 
Patient Protection and Affordable Care Act, 42 United States Code, Section 18001, et 
seq. for newly eligible Medicaid individuals.  No later than September 1, 2014, the 
commissioner shall prepare and submit to the United States Department of Health and 
Human Services, Centers for Medicare and Medicaid Services in a format required by the 
Secretary of the United States Department of Health and Human Services an analysis of 
the benefits available under the MaineCare childless adult waiver population as of 
December 1, 2009 and all necessary information to certify that members of the childless 
adult population were not eligible on December 1, 2009 to receive full benefits, 
benchmark coverage as described in Section 1937(b)(1), subparagraph (A), (B) or (C) of 
the United States Social Security Act or benchmark equivalent coverage as described in 
United States Code, Section 1397(b)(2). In preparing and submitting this analysis, the 
commissioner shall compare the services available to the childless adult population, 
specifically hearing services, to those of the 3 benchmark plans specified by the United 
States Department of Health and Human Services, Centers for Medicare and Medicaid 
Services and shall indicate to the secretary whether hearing services were a covered 
service for the childless adult population as of December 1, 2009 and whether they are a 
covered service under the 3 benchmark plans.  The Commissioner of Health and Human 
Services shall submit information certified by an actuary for the purpose of certifying the 
benefits available to the childless adult population on December 1, 2009 if required to do 
so by the secretary.  If the secretary does not require information certified by an actuary 
for that purpose, the commissioner may not pursue the services of an actuary or submit 
information certified by an actuary for the purpose of certifying the benefits available to 
the childless adult population on December 1, 2009.  If the secretary requires the 
submission of additional information to demonstrate that members of the childless adult 
population otherwise qualify as "newly eligible" individuals as described in Section 
1905(y)(2) of the United States Social Security Act, in order for the State to secure an 
enhanced Federal Medical Assistance Percentage as set forth in Section 1905(y)(1) of the 
United States Social Security Act, the Department of Health and Human Services shall 
provide all required information to the secretary within 30 days of the secretary's sending 
notification that additional information is required. 
Sec. B-2.  Report.  The Commissioner of Health and Human Services shall report 
no later than November 1, 2014 to the Joint Standing Committee on Appropriations and 
Financial Affairs and the Joint Standing Committee on Health and Human Services on 
efforts to secure the maximum Federal Medical Assistance Percentage under section 1, 
including any correspondence with the United States Department of Health and Human 
Services regarding these efforts. 
PART C 
Sec. C-1.  Research organization evaluation.  The Office of Fiscal and 
Program Review shall contract with a nonpartisan research organization to evaluate the 
impact of the MaineCare expansion authorized in Part A on programs and services that do 
not currently receive Federal Medical Assistance Percentage matching funds or do not 
qualify for enhanced Federal Medical Assistance Percentage matching funds under the 
federal Patient Protection and Affordable Care Act, 42 United States Code, Section 
18001, et seq., with the goal of identifying and maximizing General Fund savings.  The 
Commissioner of Health and Human Services, the Commissioner of Corrections and the 
Executive Director of the State Board of Corrections shall provide to the research 
organization information and assistance requested for preparation of the evaluation.  In 
evaluating the programs and services under this Part, the research organization shall at a 
minimum evaluate the impact on the following programs and services: the state-funded 
Mental Health Services - Community, Office of Substance Abuse and General Assistance 
- Reimbursement to Cities and Towns programs; the elderly low-cost drug program under 
the Maine Revised Statutes, Title 22, section 254-D; services provided for individuals 21 
to 64 years of age who are currently eligible for MaineCare under medically needy, 
spend-down criteria; services provided under the Maine HIV/AIDS Section 1115 
Demonstration Waiver; services provided for parents participating in family reunification 
activities; services provided for disabled individuals 21 to 64 years of age with incomes 
below 139% of the federal poverty level; services provided to individuals awaiting a 
MaineCare disability determination for whom the applications are subsequently granted; 
services provided to individuals who would have been considered eligible on the basis of 
a disability but for whom the full determination process was not completed; medical 
services provided to persons in the care and custody of the Department of Corrections or 
a county correctional facility; and the amount of payment for services that hospitals 
received during fiscal years 2014-15 and 2015-16 as a result of the expansion of 
MaineCare eligibility pursuant to Part A.  In addition, the research organization shall 
evaluate any savings and the impact on health outcomes achieved through initiatives 
implemented pursuant to the State Innovation Models Initiative grant. 
Sec. C-2.  Report.  The research organization that conducts the evaluation under 
section 1 shall report no later than October 1st in 2014 and 2015 and February 15, 2016 to 
the joint standing committee of the Legislature having jurisdiction over appropriations 
and financial affairs, the joint standing committee of the Legislature having jurisdiction 
over health and human services matters and the joint standing committee of the 
Legislature having jurisdiction over criminal justice and public safety matters on the 
amount of General Fund savings resulting from the MaineCare expansion authorized in 
Part A and identified in section 1.  The reports must include the amount of savings 
expected and realized during fiscal years 2014-15 and 2015-16 by service area or 
program, the amount deposited in the MaineCare Stabilization Fund pursuant to section 3 
and the amount of savings projected to be achieved through state fiscal year 2020-21 by 
service area or program. 
Sec. C-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 Part A and shall transfer the amounts up to the 
amounts specified in section 6 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 section 6 to the MaineCare Stabilization Fund established under the 
Maine Revised Statutes, 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 June 
30, 2015 for fiscal year 2014-15 and no later than June 30, 2016 for fiscal year 2015-16. 
Sec. C-4.  Review and responsibility.  Following receipt of the reports from the 
research organization as required under section 2, 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 Part A, 
section 3 exceeds the savings to the General Fund, including any amount deposited in the 
MaineCare Stabilization Fund pursuant to section 3, due to the expansion of coverage for 
those individuals.  Following its review of the report received on February 15, 2016, the 
joint standing committee may report out a bill to the 127th Legislature regarding its 
determinations and conclusions. 
Sec. C-5.  Appropriations and allocations.  The following appropriations and 
allocations are made. 
ADMINISTRATIVE AND FINANCIAL SERVICES, DEPARTMENT OF 
Executive Branch Departments and Independent Agencies - Statewide 0017 
Initiative: Deappropriates funds on a statewide basis for savings to be identified under 
this Part in existing state programs that result from the expansion of MaineCare 
eligibility. 
LEGISLATURE 
Legislature 0081 
Initiative: Provides one-time funding for the Office of Fiscal and Program Review to 
contract with a nonpartisan research organization to evaluate the impact of Medicaid 
expansion. 
PART D 
Sec. D-1.  Appropriations and allocations.  The following appropriations and 
allocations are made. 
GENERAL FUND 
2013-14
2014-15
Unallocated 
$0
($5,900,000)
GENERAL FUND TOTAL 
$0
($5,900,000)
ADMINISTRATIVE AND FINANCIAL 
SERVICES, DEPARTMENT OF 
DEPARTMENT TOTALS 
2013-14
2014-15
GENERAL FUND 
$0
($5,900,000)
DEPARTMENT TOTAL - ALL FUNDS 
$0
($5,900,000)
GENERAL FUND 
2013-14
2014-15
All Other 
$0
$100,000
GENERAL FUND TOTAL 
$0
$100,000
LEGISLATURE 
DEPARTMENT TOTALS 
2013-14
2014-15
GENERAL FUND 
$0
$100,000
DEPARTMENT TOTAL - ALL FUNDS 
$0
$100,000
SECTION TOTALS 
2013-14
2014-15
GENERAL FUND 
$0
($5,800,000)
SECTION TOTAL - ALL FUNDS 
$0
($5,800,000)
HEALTH AND HUMAN SERVICES, DEPARTMENT OF (FORMERLY DHS) 
Medical Care - Payments to Providers 0147 
Initiative: Provides funds for the costs of MaineCare coverage for newly eligible adults 
under 139% of the federal poverty line. 
Medical Care - Payments to Providers 0147 
Initiative: Provides funds for the costs of MaineCare coverage for the childless adult 
waiver population. 
Office of Family Independence - District 0453 
Initiative: Provides funding for 6 Family Independence Unit Supervisor positions, 13 
Office Assistant II positions and 64 Eligibility Specialist positions in the Office for 
Family Independence program and for related All Other costs necessary to implement and 
administer the MaineCare eligibility changes. This assumes the Eligibility Specialist 
positions are funded 25% General Fund and 75% Other Special Revenue Funds and the 
other positions are funded 50% General Fund and 50% Other Special Revenue Funds. 
FEDERAL EXPENDITURES FUND 
2013-14
2014-15
All Other 
$0
$263,724,061
FEDERAL EXPENDITURES FUND TOTAL 
$0
$263,724,061
FEDERAL EXPENDITURES FUND 
2013-14
2014-15
All Other 
$0
$61,474,140
FEDERAL EXPENDITURES FUND TOTAL 
$0
$61,474,140
GENERAL FUND 
2013-14
2014-15
POSITIONS - LEGISLATIVE COUNT 
0.000
83.000
Personal Services 
$0
$1,896,901
All Other 
$0
$167,534
GENERAL FUND TOTAL 
$0
$2,064,435
OTHER SPECIAL REVENUE FUNDS 
2013-14
2014-15
Personal Services 
$0
$4,308,290
All Other 
$0
$326,739
OTHER SPECIAL REVENUE FUNDS TOTAL 
$0
$4,635,029
PART E 
Sec. E-1.  22 MRSA §3173-C, sub-§7, as amended by PL 2009, c. 415, Pt. A, 
§12, is further amended to read: 
7.  Copayments.  Notwithstanding any other provision of law, the following 
copayments per service per day are imposed and reimbursements are reduced, or both, to 
the following levels: 
A.  Outpatient hospital services, $3; 
B.  Home health services, $3; 
C.  Durable medical equipment services, $3; 
D.   Private duty nursing and personal care services, $5 per month; 
E.  Ambulance services, $3; 
F.  Physical therapy services, $2; 
G.  Occupational therapy services, $2; 
H.  Speech therapy services, $2; 
I.  Podiatry services, $2; 
J.  Psychologist services, $2; 
K.  Chiropractic services, $2; 
L.  Laboratory and x-ray services, $1; 
M.  Optical services, $2; 
N.  Optometric services, $3; 
O.  Mental health clinic services, $2; 
P.  Substance abuse services, $2; 
Q.  Hospital inpatient services, $3 per patient day; 
R.  Federally qualified health center services, $3 per patient day, effective July 1, 
2004; and 
S.  Rural health center services, $3 per patient day. 
HEALTH AND HUMAN SERVICES, 
DEPARTMENT OF (FORMERLY DHS) 
DEPARTMENT TOTALS 
2013-14
2014-15
GENERAL FUND 
$0
$2,064,435
FEDERAL EXPENDITURES FUND 
$0
$325,198,201
OTHER SPECIAL REVENUE FUNDS 
$0
$4,635,029
DEPARTMENT TOTAL - ALL FUNDS 
$0
$331,897,665
The department may adopt rules to adjust the copayments set forth in this subsection.  
The rules may adjust amounts to ensure that copayments are deemed nominal in amount 
and may include monthly limits or exclusions per service category.  The need to maintain 
provider participation in the Medicaid program to the extent required by 42 United States 
Code, Section 1396a(a)(30)(A) or any successor provision of law must be considered in 
any reduction in reimbursement to providers or imposition of copayments. 
For an adult when the adult’s family income is above 100% of the nonfarm income 
official poverty line, the department shall adopt rules to adjust the copayments 
established under this subsection to reflect the maximum allowable amounts authorized 
under 42 United States Code, Section 1396o; to increase copayments as authorized by 42 
United States Code, Section 1396o(h); and in compliance with 42 United States Code, 
Section 1396o(b)(3) to impose a copayment for services received at a hospital emergency 
room of up to twice the amount established as the copayment for outpatient services if the 
services are not emergency services.  The department shall track aggregate copayments in 
compliance with 42 Code of Federal Regulations, Section 447.68 and, by rule, make 
adjustments to copayments to ensure compliance with federal law. 
Sec. E-2.  Contingent effective date.  Those sections of this Act that enact the 
Maine Revised Statutes, Title 22, section 3174-G, subsection 1, paragraphs H and I take 
effect 30 days after the United States Department of Health and Human Services, Centers 
for Medicare and Medicaid Services confirms in writing to the Commissioner of Health 
and Human Services that the enhanced Federal Medical Assistance Percentage set forth in 
Section 1905(y)(1) of the United States Social Security Act is applicable to the 
individuals who received coverage as of December 1, 2009, who are described in Title 
22, section 3174-G, subsection 1, paragraph F and who are defined in Section 1905(y)(2) 
of the United States Social Security Act.  Upon receipt of confirmation from the federal 
Centers for Medicare and Medicaid Services, the Commissioner of Health and Human 
Services shall notify in writing the President of the Senate, the Speaker of the House of 
Representatives and the Revisor of Statutes and shall provide them with a copy of the 
written confirmation. 
SUMMARY 
This bill accomplishes the following. 
Part A expands medical coverage under the MaineCare program to adults who 
qualify under federal law with incomes up to 133% of the nonfarm income official 
poverty line, with the 5% federal income adjustment for family size, and qualifies Maine 
to receive federal funding for 100% of the cost of coverage for members who enroll 
under the expansion. Adults who will be eligible are those 21 to 64 years of age effective 
July 1, 2014 and adults 19 and 20 years of age beginning October 1, 2019.  The 
expansion of Medicaid eligibility contained in this Part is repealed if 3 circumstances 
occur: the enhanced Federal Medical Assistance Percentage for calendar years 2014 
through 2020 is reduced below certain stated levels; the reduced enhanced Federal 
Medical Assistance Percentage has taken effect; and after the occurrence of the reduction 
of the enhanced Federal Medical Assistance Percentage the Legislature has convened and 
conducted a session of at least 30 calendar days.  This bill repeals the expansion of 
medical coverage under the MaineCare program on December 31, 2016. 
Part B requires the Commissioner of Health and Human Services to take all steps 
necessary to secure an enhanced federal match rate for services provided to the 
MaineCare childless adult waiver population and to report to the Joint Standing 
Committee on Appropriations and Financial Affairs and the Joint Standing Committee on 
Health and Human Services by November 1, 2014 on these efforts. 
Part C requires the Office of Fiscal and Program Review to contract with a 
nonpartisan research organization to evaluate the impact of the MaineCare expansion on 
programs and services that do not currently receive Federal Medical Assistance 
Percentage matching funds or do not qualify for enhanced Federal Medical Assistance 
Percentage matching funds under the federal Patient Protection and Affordable Care Act, 
United States Code, Section 18001, et seq., with the goal of identifying and 
maximizing General Fund savings. Part C requires a report by October 1st in 2014 and 
2015 and February 15, 2016 to the joint standing committee of the Legislature having 
jurisdiction over appropriations and financial affairs, the joint standing committee of the 
Legislature having jurisdiction over health and human services matters and the joint 
standing committee of the Legislature having jurisdiction over criminal justice and public 
safety matters on the amount of General Fund savings resulting from the MaineCare 
expansion.  The report must include the amount of savings expected and realized during 
fiscal years 2014-15 and 2015-2016 by service area or program.  Part C requires the State 
Budget Officer to calculate the amount of savings that applies against each General Fund 
account for all departments and agencies from savings associated with the MaineCare 
expansion and to transfer the amounts by financial order upon the approval of the 
Governor. It requires the State Controller to transfer any remaining savings to the 
MaineCare Stabilization Fund.  Part C requires the State Budget Officer to 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 June 30, 2015 
for fiscal year 2014-15 and no later than June 30, 2016 for fiscal year 2015-16. 
Part D provides funding for positions in the Department of Health and Human 
Services, Office of Family Independence. 
Part E amends current law on copayments in the MaineCare program.  This bill 
directs the Department of Health and Human Services to increase copayments for adults 
with income above 100% of the nonfarm income official poverty line to the maximum 
allowable under federal law and to increase nominal copayments by the annual 
percentage increase in the medical care component of the Consumer Price Index for All 
Urban Consumers.  It directs the department to increase MaineCare copayments for 
services provided in a hospital emergency room when the services are not emergency 
services and requires the department to track aggregate copayments in compliance with 
federal law.  Part E provides that until the United States Department of Health and 
Human Services, Centers for Medicare and Medicaid Services confirms that the State will 
get the enhanced reimbursement rate, the expansion of medical coverage under the 
MaineCare program will not take effect.