An Act To Increase Access to Health Coverage and Qualify Maine for Federal Funding
Maine Legislature, Session 126, LD 1066
Committee Amendment CA_A_H286 (House)
Amends: 22 MRSA §3174-G

COMMITTEE AMENDMENT "A" to H.P. 759, L.D. 1066, Bill, "An Act To 
Increase Access to Health Coverage and Qualify Maine for Federal Funding" 
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,~, 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; aHd 
Sec. A-2. 22 MRSA §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 
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COMMITTEE AMENDMENT "A"to H.P. 759,L.D.I066 
(2) A child under 21 years of age~~ 
Sec. A-3. 22 MRSA §3174-G, sub-§l, ~~ and I are enacted to read: 
H. Beginning January 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 
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)(10)(A)(i)(VIID 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 
3l74-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 one of the following amounts in effect for the 
period specified: 
A. One hundred percent for calendar quarters in 2014,2015 and 2016; 
B. Ninety-five percent for calendar quarters in 2017; 
C. Ninety-four percent for calendar quarters in 2018; 
D. Ninety-three percent for calendar quarters in 2019; or 
E. Ninety percent for calendar quarters in 2020; 
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. 
PARTB 
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 for newly eligible Medicaid individuals. If 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "~,, to H.P. 759, L.D. 1066 
required, by October 1, 2013, the commissioner shall prepare and submit to the federal 
Department of Health and Human Services, Centers for Medicare and Medicaid Services 
an analysis of the benefits available under the MaineCare childless adult waiver 
population as of December 1, 2009. 
In preparing and submitting this analysis, the 
commissioner shall compare these services to those of the 3 benchmark plans specified 
by the federal Department of Health and Human Services, Centers for Medicare and 
Medicaid Services. 
Sec. B-2. Report. The Commissioner of Health and Human Services shall report 
no later than November 1,2013 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 federal Department of Health and Human Services 
regarding these efforts. 
PARTC 
Sec. C-l. Evaluation of programs. The Commissioner of Health and Human 
Services, the COlmnissioner of Corrections and the Executive Director of the State Board 
of Corrections shall 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, 
with the goal of identifying and maximizing General Fund savings. In evaluating the 
programs and services under this Part, the commissioners and the executive director 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; services provided for 
individuals between 21 and 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 
between 21 and 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; and medical services provided to persons in the 
care and custody of the Department of Corrections or a county correctional facility. 
Sec. C-2. 
Report. 
The Commissioner of Health and Human Services, the 
Commissioner of Corrections and the Executive Director of the State Board of 
Corrections shall report no later than March 1,2014 to the Joint Standing Committee on 
Appropriations and Financial Affairs, the Joint Standing Committee on Health and 
Human Services and the Joint Standing Committee on Criminal Justice and Public Safety 
on the amount of General Fund savings resulting from the MaineCare expansion 
authorized in Part A and identified in section 1. The report must include the amount of 
savings realized during fiscal year 2013-14 by service area or program and the amount of 
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COMMITTEE AMENDMENT "A" to H.P. 759, L.D. 1066 
savings projected to be achieved during the remainder of that fiscal year and during fiscal 
year 2014-15 by service area or program. 
Sec. C-3. Calculation and transfer. Notwithstanding any other provision oflaw, 
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 4 by financial order upon the approval of the Governor. 
These transfers are considered adjustments to appropriations in fiscal year 2013-14 and 
fiscal year 2014-15. The State Controller shall transfer any amounts identified under this 
Part greater than the amounts specified in section 4 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 on Appropriations and Financial Affairs no later than June 30, 2014 for fiscal 
year 2013-14 and 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. 
Sec~ C-4. 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. 
GENERAL FUND 
Unallocated 
GENERAL FUND TOTAL 
2013-14 
($2,700,000) 
($2,700,000) 
2014-15 
($5,900,000) 
($5,900,000) 
PARTD 
Sec. D-l. Appropriations and allocations. The following appropriations and 
allocations are made. 
HEALTH AND HUMAN SERVICES, DEPARTMENT OF (FORMERLY DHS) 
Bureau of Family Independence - Regional 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. 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT ,,~ .. to H.P. 759, L.D. 1066 
GENERAL FUND 
POSITIONS - LEGISLATIVE COUNT 
Personal Services 
All Other 
GENERAL FUND TOTAL 
OTHER SPECIAL REVENUE FUNDS 
Personal Services 
All Other 
OTHER SPECIAL REVENUE FUNDS TOTAL 
Medical Care - Payments to Providers 0147 
2013-14 
2014-15 
83.000 
83.000 
$1,842,615 
$1,896,901 
$167,534 
$167,534 
$2,010,149 
$2,064,435 
2013-14 
2014-15 
$4,185,245 
$4,308,290 
$322,362 
$326,739 
$4,507,607 
$4,635,029 
Initiative: Provides funds for the costs of MaineCare coverage for newly eligible adults 
under 139% of the federal poverty line. 
FEDERAL EXPENDITURES FUND 
All Other 
FEDERAL EXPENDITURES FUND TOTAL 
2013-14 
2014-15 
$62,851,289 
$263,724,061 
$62,851,289 
$263,724,061 
Medical Care - Payments to Providers 0147 
Initiative: Provides funds for the costs of MaineCare coverage for the childless adult 
waiver population. 
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 
2013-14 
$29,301,300 
$29,301,300 
2013-14 
$2,010,149 
$92,152,589 
$4,507,607 
$98,670,345 
2014-15 
$61,474,140 
$61,474,140 
2014-15 
$2,064,435 
$325,198,201 
$4,635,029 
$331,897,665 
COMMITTEE AMENDMENT 
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COMMITTEEAMENDMENT"~"tOH.P. 759, L.D. 1066 
SUMMARY 
This amendment replaces the bill. 
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 
beginning January 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. 
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 1,2013 on these efforts. 
Part C requires the Commissioner of Health and Human Services, the Commissioner 
of Corrections and the Executive Director of the State Board of Corrections 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, with the goal of identifying and maximizing 
General Fund savings. Part C requires a report by March 1, 2014 to the Joint Standing 
Committee on Appropriations and Financial Affairs, the Joint Standing Committee on 
Health and Human Services and the Joint Standing Committee on Criminal Justice and 
Public Safety on the amount of General Fund savings resulting from the MaineCare 
expansion. The report must include the amount of savings realized during fiscal year 
2013-14 by service area or program and the amount of savings projected to be achieved 
during the remainder of that fiscal year and during fiscal year 2014-15. 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 on Appropriations and 
Financial Affairs no later than June 30, 2014 and a 2nd report by June 30, 2015. 
Part D provides funding for positions in the Department of Health and Human 
Services, Bureau of Family Independence. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 05/30/13 ;tvczc. 
LD 1066 
LR 1098(02) 
An Act To Increase Access to Health Coverage and Qualify Maine for Federal Funding 
Fiscal Note for Bill as Amended by Committee Amendment ,~, L H 
~ 8flc> 
Committee: Health and Human Services 
~ 
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 
FY2013-14 
($689,851) 
($689,851) 
$92,152,589 
$4,507,607 
$4,507,607 
FY 2014-15 
($3,835,565) 
($3,835,565) 
$325,198,201 
$4,635,029 
$4,635,029 
Projections 
FY2015-16 
($3,778,658) 
($3,778,658) 
$341,132,913 
$4,764,278 
$4,764,278 
Projections 
FY 2016-17 
$5,226,166 
$5,226,166 
$348,902,215 
$4,897,404 
$4,897,404 
This bill implements and adjusts funding related to the expansion of MaineCare under the federal Affordable Care 
Act. 
Part C 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 assuming 
these savings are then identified and distributed. The specific programs and amount of savings that will be realized 
and distributed to each cannot by determined at this time. As a benchmark, the implementation of the MaineCare 
childless adults waiver effective October 2002 resulted in subsequent savings of $1 ,800,000 deappropriated in the 
Mental Health Services - Community program in fiscal year 2002-03 (PL 2001 c.714). Part C includes 
deappropriations of $2,700,000 in 2013-14 and $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 savings to 
be identified in existing programs as a result of the expansion of Maine Care eligibility. 
LR1098(02) - Fiscal Note - Page 10f2 
CI'I CH-;)6'(P) 
Part 0 of the bill includes General Fund appropriations of $2,010, 149 in 2013-14 and $2,064,435 in 2014-15 for the 
Bureau of Family Independence - Regional program in the Department of Health and Human Services for the state 
share of the costs of83 new positions to administer the MaineCare eligibility expansion. Part 0 also includes Federal 
Expenditures Fund allocations totaling $92,152,589 in 2013-14 and $325,198,201 in 2014-15 as detailed below. The 
estimated federal allocations assume 100 percent federal matching funds for the first three years of the expansion for 
both the current childless adult waiver popUlation and the newly eligible adult popUlation below 139% of the federal 
poverty line and a 97.5 % federal match in 2016-17. Obtaining a 100% federal match for the current childless adult 
waiver population and not the "expansion states" federal match (estimated to be 80.78 % in 2013-14 and 82.70% in 
2014-15) assumes that under Part B, the Department of Health and Human Services will successfully take the steps 
indicated by the federal Department of Health and Human Services to secure the "newly eligible" 100% federal match. 
FY 2013-14 
FY 2014-15 
FY 2015-16 
FY 2016-17 
Childless Adults Waiver (below 100% of the Federal Poverty Line) 
Estimated Population 
10,500 
Estimated Cost per Year 
$5,581 
$29,301,300 
Assumed Federal Match 
State Share of Costs 
100.0% 
$0 
Childless Adults (Below 139% of the Federal Poverty Line) 
Estimated PopUlation 
45,045 
Estimated Cost per Year 
$5,581 
$62,851,289 
Assumed Federal Match 
State Share of Costs 
Total Federal Allocation 
Total State share 
100.0% 
$0 
$92,152,589 
$0 
$61,474,140 
100.0% 
$0 
$263,724,061 
100.0% 
$0 
$325,198,201 
$0 
$64,486,373 
100.0% 
$0 
$276,646,540 
100.0% 
$0 
$341,132,913 
$0 
$67,646,205 
97.5% 
$1,691,155 
$290,202,220 
97.5% 
$7,255,056 
$348,902,214 
$8,946,211 
Funding for the new positions included in Part D 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 
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. 
This bill does not include appropriations for the MaineCare costs of coverage for the current 19-20 year old 
population and for the current parents population under 139% of the federal poverty line. The Department of Health 
and Human Services has indicated funding for the continued MaineCare coverage for these populations has been 
included in the MaineCare baseline adjustments reflected in the proposed Governor's 2014-2015 Biennial Budget Bill, 
LD 1509. 
LR1098(02) - Fiscal Note - Page 2 of 2