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_H704 (House)
Amends: 22 MRSA §3174-G

COMMITTEE AMENDMENT "/+" 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 bill by striking out everything after the enacting clause and before the 
summary and inserting the following: 
'PART A 
Sec. A-I. 22 MRSA §3174-G, sub-§l, ~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; aae 
Sec. A-2. 22 MRS A §3174-G, sub-§l, ~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 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT "4,, to H.P. 1149, L.D. 1578 
(2) A child under 21 years of age7~ 
Sec. A-3. 22 MRS A §3174-G, suh-§I, "H and I are enacted to read: 
H. Beginning 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)(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; and 
1. 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)(YIII) 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. 
Sec. A-4. Contingent repeal. The Maine Revised Statutes, Title 22, section 
3174-G, subsection 1, paragraphs H and I are repealed upon the earlier 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)(lO)(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; and 
2. December 31,2016. 
PARTB 
Sec. B-1. 
Research organization evaluation. 
The Office of Fiscal and 
Program Review shall contract with a nonpartisan research organization, referred to in 
this section as "the research organization," to study the impact of the MaineCare 
expansion authorized in the Maine Revised Statutes, Title 22, section 3174-G, subsection 
1, paragraphs H and I on programs and services under this Part 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 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT ,,4 "to H.P. 1149, L.D. 1578 
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 
Title 22, section 254-D; services provided for individuals 21 to 64 years of age who are 
currently eligible for MaineCare under the medically needy program; services provided 
under the State's demonstration project waiver under Section 1115 of the United States 
Social Security Act, 42 United States Code, Section 301, et seq., for individuals with 
HN / AIDS; 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 as defined by the federal Department of Health and 
Human Services and updated annually in the Federal Register under authority of 42 
United States Code, Section 9902(2); services provided to individuals awaiting a 
MaineCare disability determination who are subsequently determined disabled; 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; and medical 
services provided to persons in the care and custody of the Department of Corrections or 
a county correctional facility. The research organization also shall examine 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 Title 22, section 317 4-G, 
subsection 1, paragraphs H and I. 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. 
The research organization shall report twice, no later than February 15, 2015 and 
February 15, 2016, respectively, 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 Title 22, section 3174-G, subsection 1, paragraphs H and I and 
by the research organization pursuant to this section. 
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 of this Part and the amount of savings projected to be achieved 
through fiscal year 2020-21 by service area or program. 
Sec. B-2. Health insurance marketplace report. The Office of Fiscal and 
Program Review shall contract with a nonpartisan research organization to examine the 
financial feasibility of providing health care coverage to newly eligible MaineCare 
members through a health insurance marketplace in a manner similar to that of Medicaid 
expansion coverage in Arkansas or Iowa and the feasibility of establishing a state basic 
health program similar to Washington's basic health plan. The Office of Fiscal and 
Program Review shall report by February 15,2015 to the joint standing committee of the 
Legislature having jurisdiction over health and human services matters regarding the 
feasibility of providing health care coverage to newly eligible MaineCare members 
through a health insurance marketplace in a manner similar to that of Medicaid expansion 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT" A" to H.P. 1149, L.D. 1578 
coverage in Arkansas or Iowa and the feasibility of establishing a state basic health 
program similar to Washington's basic health plan. 
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, paragraphs H and I and shall transfer the amounts up to the amounts 
specified in section 5 of 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 section 5 of 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 of the 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 3174-G, subsection 1, 
paragraphs H and I exceeds the savings to the General Fund, including any amount 
deposited in the MaineCare Stabilization Fund pursuant to section 3 of this Part, due to 
the expansion of coverage for those individuals. Following its review of the report 
received on February 15, 2016 pursuant to section 2 of this Part the joint standing 
committee may report out a bill to the Second Regular Session of the 127th Legislature 
regarding determinations and conclusions of the report. 
Sec. B-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 initial savings to be identified 
under this Part in existing state programs that result from the expansion of MaineCare 
eligibility. 
GENERAL FUND 
Unallocated 
GENERAL FUND TOTAL 
2013-14 
$0 
$0 
COMMITTEE AMENDMENT 
2014-15 
($5,900,000) 
($5,900,000) 
~ .,. 
COMMITTEE AMENDMENT"~" to H.P. 1149, L.D. 1578 
ADMINISTRATIVE AND FINANCIAL 
SERVICES, DEPARTMENT OF 
DEPARTMENT TOTALS 
GENERAL FUND 
DEPARTMENT TOTAL-ALL FUNDS 
LEGISLATURE 
Legislature 0081 
2013-14 
2014-15 
$0 
($5,900,000) 
$0 
($5,900,000) 
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 the expansion 
of MaineCare eligibility. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
LEGISLATURE 
DEPARTMENT TOTALS 
GENERAL FUND 
DEPARTMENT TOTAL-ALL FUNDS 
SECTION TOTALS 
GENERAL FUND 
SECTION TOTAL - ALL FUNDS 
2013-14 
$0 
$0 
2013-14 
$0 
$0 
2014-15 
$100,000 
$100,000 
2014-15 
$100,000 
$100,000 
2013-14 
2014-15 
$0 
($5,800,000) 
$0 
($5,800,000) 
PART C 
Sec. C-l. Appropriations and allocations. The following appropriations and 
allocations are made. 
HEALTH AND HUMAN SERVICES, DEPARTMENT OF (FORMERLY DHS) 
Medical Care - Payments to Providers 0147 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT ,,1/ "to H.P. 1149, L.D. 1578 
Initiative: Provides funds for the costs of MaineCare coverage through December 31, 
2016, for childless adults at or below 133% of the nonfarm income official poverty line 
plus 5% for the applicable family size as required by federal law. 
FEDERAL EXPENDITURES FUND 
All Other 
FEDERAL EXPENDITURES FUND TOTAL 
Office of Family Independence - District 0453 
2013-14 
2014-15 
$0 
$327,657,166 
$0 $327,657,166 
Initiative: Provides funding for 6 Family Independence Unit Supervisor positions, 13 
Office Assistant II positions and 64 Eligibility Specialist positions in the Office of Family 
Independence - District 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. 
GENERAL FUND 
POSITIONS - LEGISLATNE COUNT 
Personal Services 
All Other 
GENERAL FUND TOTAL 
OTHER SPECIAL REVENUE FUNDS 
Personal Services 
All Other 
OTHER SPECIAL REVENUE FUNDS TOTAL 
2013-14 
0.000 
$0 
$0 
$0 
2013-14 
$0 
$0 
$0 
2014-15 
83.000 
$1,909,557 
$95,105 
$2,004,662 
2014-15 
$4,325,301 
$381,651 
$4,706,952 
Office of MaineCare Services 0129 
Initiative: Provides funding for the one-time costs of changes to the Maine Integrated 
Health Management Solution and the Automated Client Eligibility System as a result of 
expanding MaineCare eligibility. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
2013-14 
$0 
$0 
COMMITTEE AMENDMENT 
2014-15 
$110,539 
$110,539 
COMMITTEE AMENDMENT "A" to H.P. 1149, L.D. 1578 
FEDERAL EXPENDITURES FUND 
All Other 
FEDERAL EXPENDITURES FUND TOTAL 
HEALTH AND HUMAN SERVICES, 
DEPARTMENT OF (FORMERLY DHS) 
DEPARTMENT TOTALS 
GENERAL FUND 
FEDERAL EXPENDITURES FUND 
OTHER SPECIAL REVENUE FUNDS 
DEPARTMENT TOTAL-ALL FUNDS 
PARTD 
2013-14 
$0 
$0 
2013-14 
2014-15 
$994,852 
$994,852 
2014-15 
$0 
$2,115,201 
$0 $328,652,018 
$0 
$4,706,952 
$0 $335,474,172 
Sec. D-l. Written notices required regarding MaineCare coverage. At the 
time of enrolling in the MaineCare program a member who is eligible under the Maine 
Revised Statutes, Title 22, section 3174-G, subsection 1, paragraph H or I, the 
Department of Health and Human Services shall provide written notice that is readable at 
the 6th-grade reading level to the member that the member's MaineCare coverage will 
end no later than December 31, 2016 unless a law is passed to extend coverage past that 
date. 
PARTE 
Sec. E-l. Implement reforms in programs for adults with intellectual 
disabilities. The Department of Health and Human Services, referred to in this Part as 
"the department," shall implement the reforms identified in this section and shall transfer 
all savings resulting from those reforms and adjust reimbursement rates for providers of 
services as necessary to develop the funds that will reduce waiting lists for services under 
the MaineCare Benefits Manual, Chapter 101, Chapter II, Section 21, Home and 
Community Benefits for Members with Intellectual Disabilities or Autistic Disorder and 
Section 29, Support Services for Adults with Intellectual Disabilities or Autistic Disorder 
to less than 6 months by January 15, 2015. 
1. The department shall implement the following reforms specified in Public Law 
2013, chapter 368, Part SS, section 4, including implementing the plan for services called 
for by that law: 
A. Each individual will receive a strength-based standardized assessment of that 
individual's strengths or needs to inform a person-centered plan; 
B. Each individual will be assessed for the natural family and community support 
networks potentially available to that individual; 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT" (1" to H.P. 1149, L.D. 1578 
C. The State will establish a broad menu option model designed to match the amount 
and kind of paid support servicell needed by each individual; 
D. Each individual will have a designated community resource assistant whose job it 
is to help individuals at any age navigate the local array of services; 
E. The State will develop a thorough and accessible information repository; 
F. The State will establish early support and planning for steps to transition 
individuals from childhood services to adult services; 
G. The State will undertake educational efforts in each neighborhood to educate and 
foster inclusiveness and awareness of the community; 
H. The State's developmental services will deliver only the paid services needed; and 
I. Formal services will be based on individual and realistic needs. 
2. 
The department shall carry out the directives and proceed to implement the 
directives contained in the following laws: 
A. In Resolve 2013, chapter 24, the directive to the department to add home support 
as a covered service permitting a member to live as independently as possible in the 
member's own home; 
B. In Public Law 2013, chapter 368, Part NN, the directive to the department to 
review rate methodology to reduce costs for those with extraordinarily high medical 
needs; and 
C. 
In Public Law 2013, chapter 368, Part SS, section 1, the directive to the 
department to pursue waivers to use electronic technology to lessen dependence, 
reduce the need for overnight support and eliminate unnecessary staffing costs. 
3. The department shall consider the following reforms: 
A. Decreasing the cost of health care to persons with intellectual disabilities by 
implementing care management for long-term support service providers; 
B. Increasing the number of occupants from one or 2 to 3 or 4 in small home support 
residential programs in all cases where it can be done without encountering 
behavioral impediments; 
C. Expediting the filling of residential beds by ensuring that vacancies are prioritized 
for individuals needing residential services; 
D. 
Substituting foster homes for hourly staff care in those situations where 
individuals require long-term or permanent living arrangements for daily support; and 
E. Accelerating the teaching of independent living skills with a focus on populations 
transitioning from school to adult living. 
Sec. E-2. Savings from reforms. 
The savings generated by reforming the 
MaineCare services for adults with intellectual disabilities and autism pursuant to section 
I of this Part must be used to serve those on the waiting list for services under the 
MaineCare Benefits Manual, Chapter 101, Chapter II, Section 21, Home and Community 
Benefits for Members with Intellectual Disabilities or Autistic Disorder and Section 29, 
Support Services for Adults with Intellectual Disabilities or Autistic Disorder. 
The 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT"~" to H.P, 1149, LD. 1578 
department shall develop a plan with clear steps and a timeline to ensure that waiting lists 
for services under Sections 21 and 29 do not exceed 6 months by January 15,2015, and 
shall present its plan to the Legislature by October 1,2014. 
Sec. E-3. Emergency rule-making authority. The department is authorized to 
adopt emergency rules under the Maine Revised Statutes, Title 5, sections 8054 and 8073 
to implement the provisions of this Part over which the department has subject matter 
jurisdiction without having to show that immediate adoption is necessary to avoid a threat 
to public health, safety or general welfare. 
PARTF 
Sec. F-l. Fraud investigation. The Department of the Attorney General shall 
undertake an initiative to strengthen fraud investigation in the MaineCare program. The 
Department of the Attorney General shall establish 2 new positions within the Health 
Care Crimes Unit to investigate allegations of misuse of public funds in the MaineCare 
program and to aid the Attorney General in the prosecution of crimes and other legal 
actions related to misuse of public funds. 
Sec. F-2. Appropriations and allocations. The following appropriations and 
allocations are made. 
ATTORNEY GENERAL, DEPARTMENT OF THE 
Administration - Attorney General 0310 
Initiative: Provides funds for 2 Attorney General Detective positions in the Health Care 
Crimes Unit. 
FEDERAL EXPENDITURES FUND 
POSITIONS - LEGISLATIVE COUNT 
Personal Services 
All Other 
FEDERAL EXPENDITURES FUND TOTAL 
SUMMARY 
2013-14 
2014-15 
0.000 
2.000 
$0 
$176,638 
$0 
$30,380 
$0 
$207,018 
This amendment, which is the majority report of the committee, replaces the bill. 
The amendment contains the following provisions. 
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 eligible are those 21 to 64 years of age, effective July 1, 
2014, and, if the expansion of MaineCare coverage is not repealed, adults 19 and 20 years 
of age, beginning October 1, 2019. The expansion of Medicaid eligibility contained in 
this Part is repealed the earlier of either December 31, 2016 or 3 circumstances occuring: 
COMMITTEE AMENDMENT 
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'i.,. 
COMMITTEE AMENDMENT" An to H.P. 1149, L.D. 1578 
the enhanced Federal Medical Assistance Percentage for calendar years 2014 to 2016 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. 
Part B requires the Office of Fiscal and Program Review to contract with a 
nonpartisan research organization to evaluate the financial feasibility of providing health 
care coverage to newly eligible MaineCare members through the health insurance 
marketplace, modeled after Medicaid expansion coverage in Arkansas or Iowa, and the 
feasibility of establishing a state basic health program similar to Washington's basic 
health plan and to report the findings of the evaluation to the joint standing committee of 
the Legislature having jurisdiction over health and human services matters by February 
15, 2015. It directs the Office of Fiscal and Program Review to contract for an 
examination of 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, 42 United States Code, Section 18001 
et seq., with the goal of identifying and maximizing General Fund savings. It requires that 
the research organization report by February 15,2015 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 reports must include 
the amount of savings expected and realized during fiscal years 2014-15 and 2015-16 by 
service area or program. It 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. It 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 April 30, 2015 for fiscal year 2014-15 and to submit adjustments to baseline 
budget requests totaling no less than $11,800,000 per year to reflect the continuation of 
the identified savings in the 2016-2017 biennium. 
Part C provides funding for positions in the Department of Health and Human 
Services, Office of Family Independence - District program. 
Part D requires the department, when enrolling a MaineCare member who is eligible 
under the Maine Revised Statutes, Title 22, section 3174-G, subsection 1, paragraph H or 
I, to provide written notice that is readable at the 6th-grade reading level to the member 
that the member's MaineCare coverage will end no later than December 31, 2016 unless a 
law is passed to extend coverage past that date. 
Part E directs the department to implement reforms specified in Public Law 2013, 
chapter 368, Part SS, section 4, to carry out the directives and implement the initiatives 
contained in Resolve 2013, chapter 24 and Public Law 2013, chapter 368, Part NN and 
Part SS, section 1 and to consider 5 reforms. This Part requires that savings resulting 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "~,, to H.P. 1149, L.D. 1578 
from accomplishing the required reforms in programs for adults with intellectual 
disabilities and autism be used to serve persons on the waiting lists for benefits under the 
MaineCare Benefits Manual, Chapter 101, Chapter II, Section 21, Home and Community 
Benefits for Members with Intellectual Disabilities or Autistic Disorder and Section 29, 
Support Services for Adults with Intellectual Disabilities or Autistic Disorder. This Part 
directs the department to develop a plan with clear steps and a timeline to ensure that 
waiting lists for services under Sections 21 and 29 do not exceed 6 months by January 15, 
2015, and to present the plan to the Legislature by October 1,2014. This Part authorizes 
the department to adopt emergency rules to accomplish the duties contained in law. 
Part F directs the Department of the Attorney General to undertake an initiative to 
strengthen fraud investigation in the MaineCare program. 
The Department of the 
Attorney General is directed to establish 2 new positions within the Health Care Crimes 
Unit to investigate allegations of misuse of public funds in the MaineCare program and to 
aid the Attorney General in the prosecution of crimes and other legal actions related to 
misuse of public funds. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 03/11114 ;tva-c:. 
LD 1578 
LR2357(02) 
An Act To Increase Health Security by Expanding Federally Funded Health Care for Maine People 
Fiscal Note for Bill as Amended by Committee Amendment '~' 
Committee: Health and Human Services 
[H~1{)Lf) 
Net Cost (Savings) 
General Fund 
Appropriations/Allocations 
General Fund 
Federal Expenditures Fund 
Other Special Revenue Funds 
Revenue 
Other Special Revenue Funds 
Fiscal Detail and Notes 
Fiscal Note Required: Yes 
Fiscal Note 
FY 2013-14 
$0 
$0 
$0 
$0 
$0 
FY 2014-15 
Projections 
FY 2015-16 
($3,684,799) 
($1,668,768) 
($3,684,799) 
$328,859,036 
$4,706,952 
$4,706,952 
($1,668,768) 
$356,841,833 
$4,836,712 
$4,836,712 
Projections 
FY 2016-17 
$3,292,400 
$3,292,400 
$279,676,385 
$4,970,364 
$4,970,364 
This bill implements and adjusts funding related to the expansion of MaineCare under the federal Affordable Care 
Act. 
Part B requires an evaluation of current state programs to identify savings that would result from the MaineCare 
expansion, identifies programs and popUlations that may realize savings and deappropriates funds statewide. The 
specific programs and amount of savings that will be realized and distributed to each program cannot by determined at 
this time. As a benchmark, the implementation of the MaineCare childless adults waiver effective October 2002 
enrolled approximately 15,000 persons by the end of the first year and resulted in savings of $1,800,000 that was 
subsequently deappropriated from the Mental Health Services - Community program in fiscal year 2002-03 (PL 2001 
c.714). Part B includes a deappropriation of $5,900,000 in 2014-15 in the Executive Branch Departments and 
Independent Agencies -Statewide program in the Department of Administrative and Financial Services for the initial 
savings to be identified in existing programs as a result of the expansion of MaineCare eligibility. 
LR2357(02) - Fiscal Note - Page 1 of 3 
CACH''lOLf) 
Part B includes an appropriation of $100,000 in fiscal year 2014-15 for the Office of Fiscal and Program Review to 
contract with a nonpartisan research organization to evaluate the impact of the MaineCare expansion on State 
programs and to examine the financial feasibility of providing coverage through a Health Insurance Marketplace 
model. This level of contract funding will likely be insufficient to fund any detailed analysis of both the impact of 
MaineCare expansion and the financial feasibility of a Health Insurance Marketplace model. This level would not be 
sufficient to fund any actuarial analysis. 
Part C of the bill includes General Fund appropriations of $2,004,662 in 2014-15 for the Office of Family 
Independence - District program in the Department of Health and Human Services for the State share of the costs of 
new positions to administer the MaineCare eligibility expansion. Funding for the new positions included in Part C 
reflect a 75% federal match for the 64 Eligibility Specialist positions and a 50% federal match for the other new 
positions. The funding for the Eligibility Specialist positions assumes a 700 person caseload for each new position. 
This is the target caseload the Department of Health and Human Services has identified for the Eligibility Specialist 
positions. 
Part C also includes Federal Expenditures Fund allocations totaling $327,657,166 in 2014-15 as shown below. The 
estimated federal allocations assume 100 percent federal matching funds through December 31, 2016 for the childless 
adult waiver popUlation with incomes less than 134% of the federal poverty line. The fiscal note also assumes funding 
for the payment of three months of claims for this population after December 31, 2016 at the 95% enhanced federal 
match rate. 
FY 2013-14 
FY 2014-15 
FY 2015-16 
FY 2016-17 
Childless Adults @ or below 133% ofFPL 
Estimated Population 
55,965 
Est. Annual Cost Per Person 
$5,855 
$0 
$327,657,166 
$343,712,367 
$180,277,137 
Assumed Federal Match 
100.0% 
100.0% 
. 100.0% 
100.0% 
State Share of Costs 
$0 
$0 
$0 
$0 
Childless Adults - CY 2017 Costs 
Estimated Cost 
$0 
$0 
$0 
$90,138,568 
Assumed Federal Match 
100.0% 
100.0% 
100.0% 
95.0% 
State Share of Costs 
$0 
$0 
$0 
$4,506,928 
The bill does not include appropriations for the MaineCare costs of coverage for the parents population from 101 % to 
133% of the federal poverty line. Funding for coverage for this population through December 31, 2013 and for 
continued transitional MaineCare coverage was included in PL 2013, c. 368, the 2014-2015 Biennial Budget bill (LD 
1509) at a General Fund funding level estimated at the time to be $8,825,036 for fiscal year 2013-14 and $9,319,223 
for fiscal year 2014-15. PL 2011 c. 657 had originally eliminated coverage for this population effective September 
30, 2012 contingent on federal approval of a waiver of federal Patient Protection and Affordable Care Act 
maintenance of effort requirements. Because the federal waiver was not granted, restoring the PL 2011, c. 657 
deappropriation of $5,866,833 ($7,822,444 annualized) for this initiative was included in the adjustments to the 
MaineCare baseline in the 2014-2015 Biennial Budget. 
The Department of Health and Human Services now estimates this population has a General Fund cost of 
approximately $17 million per year, even though there have been no substantive program changes that would 
definitively explain a change in estimate of this magnitude. This fiscal note reflects the difference between the 
baseline adjustment used to prepare the 2014-2015 Biennial Budget and the department's latest estimate - see table 
below. If there are no subsequent MaineCare appropriations or de appropriations affecting this population during the 
126th Legislature, continued funding for this population will be included in the 2016-2017 MaineCare biennial budget 
baseline. Any biennial 2016-2017 MaineCare budget savings to that baseline will be based on enacted adjustments 
made by the 127th Legislature. 
LR2357(02) - Fiscal Note - Page 2 of 3 
CACf1~100 
FY2013-14 
FY 2014-15 
FY 2015-16 
FY 2016-17 
Parents (Between 101 and 133% of the Federal Poverty Line) 
Estimated Population 
15,000 
2014-2015 Budget Baseline Adjustment 
$0 
$0 
$25,424,935 
$26,670,757 
Assumed Federal Match 
61.8% 
61.6% 
61.6% 
61.6% 
State Share of Costs 
$0 
$0 
$9,775,888 
$10,254,906 
Updated DHHS Estimates 
$0 
$0 
$46,411,365 
$48,685,105 
Assumed Federal Match 
61.8% 
61.6% 
61.6% 
61.6% 
State Share of Costs 
$0 
$0 
$17,845,170 
$18,719,423 
2016-2017 GF Baseline Adjustment 
·$0 
$0 
$8,069,282 
$8,464,517 
The fiscal note assumes any secondary impact on the numbers of persons participating in MaineCare as a result of this 
bill's expansion of MaineCare eligibility would be minimal based on the fact that most of the populations affected by 
the bill have been covered by MaineCare or on a MaineCare waitlist within the last year. The secondary impact on 
MaineCare participation as a result of implementation of the federal Patient Protection and Affordable Care Act 
(ACA) on MaineCare eligibility groups not addressed by the bill is not a result of this bill and therefore not included 
in this fiscal note. Any secondary ACA impact on the childless adult expansion population is assumed to have a 
minimal impact on General Fund costs given the 100% federal match. The secondary ACA impact on the parents 
expansion population could be significant and if it exceeds the growth assumptions for this population may result in 
additional General Fund costs beginning in fiscal year 2014-15. While the bill in aggregate assumes savings that could 
offset these General Fund costs, it does not include a mechanism to return savings to the MaineCare program until 
savings exceed the assumed statewide deappropriation included in this bill. 
Additional costs and/or savings resulting from Part E requirements related to programs for adults with intellectual 
disabilities and autism are assumed to be absorbed within existing resources for existing programs. 
Part F provides a Federal Expenditures Fund allocation of$207,018 in fiscal year 2014-15 for the Department of the 
Attorney General for 2 Attorney General Detective positions in the Healthcare Crimes Unit. 
LR2357(02) - Fiscal Note - Page 3 of 3