An Act To Improve the Health of Maine Citizens and the Economy of Maine by Providing Affordable Market-based Coverage Options to Low-income Uninsured Citizens
Maine Legislature, Session 127, LD 0633
Committee Amendment CA_A_S487 (Senate)
Amends: 22 MRSA §3174-G

COMMITTEE AMENDMENT " A" to S.P. 226, L.D. 633, Bill, "An Act To 
Improve the Health of Maine Citizens and the Economy of Maine by Providing 
Affordable Market-based Coverage Options to Low-income Uninsured Citizens" 
Amend the bill by striking out everything after the enacting clause and inserting the 
following: 
'PART A 
Sec. A-1. 22 MRSA §3174-G, sub-§1, ,rF, 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; aH4 
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 
COMMITTEE AMENDMENT 
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COMMITfEE AMENDMENT" A" to S.P. 226, L.D. 633 
(2) A child under 21 years ofage7; arni 
Sec. A-3. 22 MRSA §3174-G, sub-§1, ~ 
is enacted to read: 
H. Beginning January 1, 2017, a person under 65 years of age who is not otherwise 
eligible for assistance under this section and who qualifies for medical assistance 
pursuant to 42 United States Code, Section 1396a(a)(lO)(A)(i)(VIII) when the 
person's income is equal to or below 133% plus 5% of the nonfann income official 
poverty line for the applicable family size, subject to the requirements of this 
paragraph. 
(1) A person with income equal to or below 100% of the nonfarm income 
official poverty line for the applicable family size is eligible to receive coverage 
that is identical to the coverage provided to a person eligible under paragraph E. 
(2) A person with income above 100% and equal to or below 133% plus 5% of 
the nonfarm income official poverty line for the applicable family size is eligible 
to receive coverage through a private individual or group qualified health plan 
along with all other services as provided to a person eligible under paragraph E. 
The department shall enroll a person in a qualified health plan and provide 
premium assistance in accordance with this subparagraph, except that a person 
described in this subparagraph who is defined as "medically frail" in accordance 
with 42 Code of Federal Regulations, Section 440.315(£) is exempt from 
mandatory enrollment in a private individual or group qualified health plan and 
must receive MaineCare coverage. 
A person who has access to or who is 
enrolled in a private group health plan or who is enrolled in the Private Health 
Insurance Premium Program pursuant to section 18 may receive coverage under 
this subparagraph. 
(a) A person who participates in the Private Health Insurance Premium 
Program under section 18 and this subparagraph is responsible for premium 
payments up to 2% of annual income and copayments in accordance with 42 
United States Code, Section 13960. Premiums and allowable cost sharing 
incurred by all persons in the house:hold may not exceed an aggregate limit of 
5% of the household's income. 
(b) If a premium is not paid for any month for which it is due and remains 
unpaid, the department shall give notice of nonpayment upon the premium 
becoming overdue and again at the beginning of the 3rd month following 
nonpayment. If the overdue premium is not paid within 30 days of the end of 
the 3rd month, coverage must then be terminated unless the person qualifies 
for a waiver of the premium for good cause as determined in rules adopted by 
the department. 
{c) 
A person whose coverage has been terminated for nonpayment of 
premium and who has received coverage for a month or longer without 
premium payment may not receive premium assistance until either the person 
pays any unpaid premium or after a waiting period equal to the number of 
months for which payment was not made, up to a maximum waiting period 
of3 months. 
COMMITTEE AMENDMENT 
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COMMIITEE AMENDMENT "A" to S.P. 226, L.D. 633 
(3) The department may contract with health carriers authorized in this State 
under Title 24-A to provide coverage as authorized in this paragraph to maximize 
savings and to ensure access to and quality of services. 
(4) The department shall develop mechanisms to create a seamless system of 
eligibility for premium assistance for a person who, at the time of enrollment in a 
qualified health plan pursuant to this paragraph, is already enrolled in a group or 
individual qualified health plan. If having the federally facilitated marketplace 
under the United States Department of Health and Human Services determine 
eligibility for coverage under this paragraph is more efficient and seamless, the 
department shall initiate a procedure to enable the federally facilitated 
marketplace to make those determinations, in which case the department shall 
establish a prompt and accessible system to resolve disputes. 
(5) The department shall ensure premium and cost-sharing assistance is available 
to eligible persons with incomes above 100% and equal to or below 133% plus 
5% of the nonfarm income official poverty line for the applicable family size 
who apply through the federally facilitated marketplace under the United States 
Department of Health and Human Services or through an application made to the 
department. Premium and cost-sharing assistance may not amount to less than 
that the individual would have received in advanced premium tax credits from 
purchasing a health plan on the federally facilitated marketplace or cost-sharing 
reductions had the individual not enrolled in a private individual or group 
qualified health plan pursuant to subparagraph (2). 
( 6) The department shall adopt rules necessary to implement this paragraph in a 
timely manner, including adopting emergency rules pursuant to Title 5, section 
8054. 
These emergency rules must be adopted by January 1, 2017. 
Rules 
adopted pursuant to this subparagraph are routine technical rules as defined by 
Title 5, chapter 375, subchapter 2-A. 
(7) This paragraph is repealed as of the earlier of the following: 
(a) Upon notification to the department or other public declaration by the 
United States Department of Health and Human Services, Centers for 
Medicare and Medicaid Services that the enhanced federal medical assistance 
percentage that applies with respect to amounts expended for medical 
assistance for individuals newly eligible for Medicaid described in 42 United 
States Code, Section 1396a(a)(l O)(A)(i)(VIII) is reduced below the amounts 
specified in 42 United States Code, Section 1396d(y)(l) and that reduction 
has taken effect. The commissioner shall notify the Secretary of State, the 
Secretary of the Senate, the Clerk of the House of Representatives and the 
Revisor of Statutes when, pursuant to this division, notification is received or 
public declaration is made; and 
(b) June 30, 2019. 
Sec. A-4. 
Substance use disorder treatments. 
By June 30, 2017, the 
Department of Health and Human Services, after consultation with a stakeholder group 
that includes representatives of health insurance carriers, substance use disorder and other 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT" A" to S.P. 226, L.D. 633 
health care providers and representatives of MaineCare members, shall seek approval 
from the United States Department of Health and Human Services, Centers for Medicare 
and Medicaid Services to provide coverage for a full continuum of substance use disorder 
treatment services, including inpatient and short-term residential facilities. 
Sec. A-5. Waivers and state plan amendment requests; accepting grant 
funding to assist with waiver submission. The Department of Health and Human 
Services may apply for and accept private foundation grants to be used to cover the 
department's costs of preparing and submitting any waivers and state plan amendments to 
the Federal Government and for administering, negotiating and implementing the 
provisions of the Maine Revised Statutes, Title 22, section 3174-G, subsection 1, 
paragraph H, including writing the state implementation plan, if required as a result of the 
provisions of this Part. 
On or before January I, 2017, the commissioner shall submit to the United States 
Department of Health and Human Services, Centers for Medicare and Medicaid Services 
any waivers and state plan amendments necessary to implement Title 22, section 3174-G, 
subsection I, paragraph H. The commissioner shall act expeditiously to achieve 
implementation of Title 22, section 317 4-G, subsection 1, paragraph H. Any waiver or 
state plan amendment submitted pursuant to this section must include provisions to 
provide the following: 
1. Coverage for services for adults described in Title 22, section 3174-G, subsection 
I, paragraph H, subparagraph (2) through insurance premium assistance; 
2. Positive incentives for persons who participate in wellness initiatives, health home 
initiatives and other initiatives aimed at reducing and managing substance use disorders, 
mental health disorders or chronic diseases, including, but not limited to, diabetes and 
heart disease, as well as programs aimed at reducing risk factors for cancer or chronic 
diseases, including, but not limited to, obesity and smoking; 
3. Prevention initiatives to address chronic health conditions, including adequately 
informing newly eligible persons under Title 22, section 3174-G, subsection I, paragraph 
H of primary care providers participating in the MaineCare program and accepting 
patients under the MaineCare program and providing incentives for adopting healthy 
behaviors through reduced cost sharing for accessing appropriate, clinically 
recommended services, including preventive visits, annual wellness exams and 
preventive health care services. The incentives must use relevant, evidence-based 
research and resources and waive or reduce premiums or copayments for participation in 
health improvement programs or activities; 
4. A plan for providing access to services for adults described in Title 22, section 
4-G, subsection I, paragraph H, subparagraph (2) that are provided to those eligible 
under Title 22, section 3174-G, subsection l, paragraph E but are not provided by 
individual or group qualified health plans provided by a carrier; 
5. Limitation of premium payments to up to 2% of household income and limitation 
of copayments as allowed under 42 United States Code, Section 13960 up to a maximum 
aggregate limit of 5% of household income for individuals covered under Title 22, 
section 3174-G, subsection 1, paragraph H, subparagraph (2); 
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COMMITTEE AMENDMENT" A" to S.P. 226, L.D. 633 
6. A mechanism by which the department will pay directly to health care providers 
and private health insurance carriers any direct payment of premium assistance and cost 
sharing that is due to the health care providers or health insurance carriers that is beyond 
the maximum amount allowed by federal law and regulation; 
7. A request for federal approval for brokers and agents or other qualified persons 
who are assisting people with applications for advanced premium tax credits, including 
certified application counselors based in federally qualified health centers, to also assist 
with applications for the MaineCare program or premium assistance through a private 
individual or group qualified health plan pursuant to Title 22, section 3174-G, subsection 
1, paragraph H, subparagraph (2); 
8. A plan for creating a seamless system of eligibility for premium assistance for 
those who are already enrolled in a group or individual qualified health plan, including 
having the federally facilitated marketplace under the United States Department of Health 
and Human Services determine eligibility for coverage under Title 22, section 3174-G, 
subsection 1, paragraph H if making the determination through the federally facilitated 
marketplace would be more efficient and seamless; 
9. A plan for achieving savings by: 
A. Ensuring that coverage provided under Title 22, section 3174-G, subsection 1, 
paragraph H reduces costs for health care that would otherwise be incurred by the 
Department of Corrections; and 
B. Ensuring that coverage provided under Title 22, section 3174-G, subsection 1, 
paragraph H reduces costs for health care that would otherwise be incurred after the 
release of a prisoner from a state correctional facility or county or regional jail as a 
result of untreated mental health and substance use disorders, including assisting 
prisoners prior to release with applying for coverage under Title 22, section 3174-G, 
subsection 1, paragraph H and ensuring that applications are made for coverage under 
Title 22, section 3174-G, subsection 1, paragraph H for inpatient hospital services 
prior to release; and 
10. Provisions for referring unemployed individuals who qualify for the coverage 
under Title 22, section 3174-G, subsection 1, paragraph H to the Department of Labor for 
information on job search and training opportunities. 
Sec. A-6. Interim reporting. Between the effective date of the Maine Revised 
Statutes, Title 22, section 3174-G, subsection 1, paragraph Hand the dates of approval of 
the waiver and state plan amendment by the United States Department of Health and 
Human Services, Centers for Medicare and Medicaid Services necessary for 
implementation of Title 22, section 3174-G, subsection 1, paragraph H, the Department 
of Health and Human Services shall provide monthly reports to the joint standing 
committee of the Legislature having jurisdiction over health and human services matters 
and to the joint standing committee of the Legislature having jurisdiction over 
appropriations and financial affairs on the progress of implementation of that paragraph, 
any issues that might delay implementation or act as barriers to implementation and any 
possible solutions to those issues and barriers. 
Sec. A-7. 
Reporting on implementation status. 
By June 1, 2017, the 
Commissioner of Health and Human Services shall report to the joint standing committee 
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COMMITTEE AMENDMENT" A" to S.P. 226, L.D. 633 
of the Legislature having jurisdiction over health and human services matters and to the 
joint standing committee of the Legislature having jurisdiction over appropriations and 
financial affairs on the status of implementation of the Maine Revised Statutes, Title 22, 
section 317 4-G, subsection 1, paragraph H, including information on enrollment, costs, 
revenues generated from the Federal Government and other revenues, anticipated state 
savings and other issues pertinent to implementation. 
Sec. A-8. Appropriations and allocations. The following appropriations and 
allocations are made. 
HEALTH AND HUMAN SERVICES, DEPARTMENT OF (FORMERLY OHS) 
Medical Care - Payments to Providers 0147 
Initiative: Deappropriates funds for an adjustment in the MaineCare baseline. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
Medical Care - Payments to Providers 0147 
2015-16 
$0 
$0 
2016-17 
($6,936,665) 
($6,936,665) 
Initiative: Provides funding for additional medical claims due to expanding 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. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
FEDERAL EXPENDITURES FUND 
All Other 
FEDERAL EXPENDITURES FUND TOT AL 
2015-16 
$0 
$0 
2016-17 
$30,551,956 
$30,551,956 
2015-16 
2016-17 
$0 $222,859, 155 
$0 $222,859, 155 
Office of Family Independence - District 0453 
Initiative: Provides funding for 79 Eligibility Specialist positions, 8 Family Independence 
Unit Supervisor positions and 16 Office Assistant II positions. 
COMMITTEE AMENDMENT 
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COMMITIEE AMENDMENT" A" to S.P. 226, L.D. 633 
GENERAL FUND 
POSITIONS - LEGISLATIVE COUNT 
Personal Services 
All Other 
GENERAL FUND TOTAL 
OTHER SPECIAL REVENUE FUNDS 
POSITIONS - LEGISLATIVE COUNT 
Personal Services 
All Other 
OTHER SPECIAL REVENUE FUNDS TOT AL 
HEAL TH AND HUMAN SERVICES, 
DEPARTMENT OF (FORMERLY OHS) 
DEPARTMENT TOTALS 
GENERAL FUND 
FEDERAL EXPENDITURES FUND 
OTHER SPECIAL REVENUE FUNDS 
DEPARTMENT TOTAL-ALL FUNDS 
PARTB 
2015-16 
0.000 
$0 
$0 
$0 
2015-16 
0.000 
$0 
$0 
$0 
2015-16 
2016-17 
79.000 
$1,786,743 
$147,214 
$1,933,957 
2016-17 
24.000 
$4,023,188 
$540,422 
$4,563,610 
2016-17 
$0 
$25,549,248 
$0 $222,859,155 
$0 
$4,563,610 
$0 $252,972,013 
Sec. B-1. Calculation and transfer of savings. 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 as specified in section 4 of this Part by financial order upon the approval of the 
Governor. These transfers are considered adjustments to appropriations in fiscal year 
2016-17 and fiscal year 2017-18. 
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 t9 the joint standing committee 
of the Legislature having jurisdiction over appropriations and financial affairs no later 
than May 31, 2017 for fiscal year 2016-17 and no later than May 31, 2018 for fiscal year 
2017-18 and shall submit adjustments to baseline budget requests totaling no less than 
$27,000,000 per year to reflect the continuation of the identified savings in the 2018-2019 
biennium. 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A" to S.P. 226, L.D. 633 
The Commissioner of Health and Human Services, the Commissioner of Corrections 
and the commissioner of any other department that recognizes savings as a result of 
implementation of the Maine Revised Statutes, Title 22, section 3174-G, subsection 1, 
paragraph H shall report no later than April 30, 2017, April 30, 2018 and April 30, 2019 
to the joint standing committee of the Legislature having jurisdiction over health and 
human services matters, 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 criminal justice and public safety matters on the 
amount of General Fund savings and other fund savings resulting from coverage provided 
under that paragraph, including, but not limited to, savings to substance abuse and mental 
health programs; medical services provided to persons in the care and custody of or upon 
release by the Department of Corrections or a county jail or regional jail; reimbursement 
to cities and towns for general assistance provided under Title 22, chapter 1161; services 
provided for individuals between 21 and 64 years of age who are currently eligible for the 
MaineCare program under medically needy, spend-down criteria; services provided under 
the Maine Medicaid Section 1115 Health Care Reform Demonstration for Individuals 
with HIV/AIDS; services provided for parents participating in family reunification 
activities under Title 22, chapter 1071; services provided for disabled individuals between 
and 64 years of age with incomes below 139% of the federal poverty level; services 
provided to individuals awaiting a MaineCare program 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; services provided under the State's breast and 
cervical cancer treatment program; and other programs in which savings are achieved. 
The report must include the amount of savings realized during fiscal year 2017-18 by 
service area or program and the amount of savings projected to be achieved during the 
remainder of that fiscal year and during the next fiscal year by service area or program. 
Sec. B-2. 
Reporting of revenue. 
The Department of Administrative and 
Financial Services, Maine Revenue Services shall report to the joint standing committee 
of the Legislature having jurisdiction over appropriations and financial affairs no later 
than April 30, 2017 and April 30, 2018 regarding any new revenues resulting from 
coverage provided under the Maine Revised Statutes, Title 22, section 3174-G, 
subsection 1, paragraph H. 
Sec. B-3. Evaluation by legislative offices. By May 15, 2017 and May 15, 
2018, the Office of Fiscal and Program Review, referred to in this section as "the fiscal 
office," shall independently review reports required pursuant to sections 1 and 2 of this 
Part and report 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 government oversight matters on its determination of the savings 
and new revenue, if any, that have been achieved as a result of implementation of the 
Maine Revised Statutes, Title 22, section 3174--G, subsection 1, paragraph H. This report 
must also include information about the amount of federal funds received by the State as 
a result of coverage authorized under that paragraph. 
After reviewing the information provided by the fiscal office, the joint standing 
committee of the Legislature having jurisdiction over government oversight matters shall 
determine if additional information is needed to determine the effectiveness of providing 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A" to S.P. 226, L.D. 633 
health coverage under Title 22, section 3174-G, subsection 1, paragraph H and may 
request further review by the Office of Program Evaluation and Government 
Accountability. If the joint standing committee of the Legislature having jurisdiction 
over government oversight matters makes a request to the Office of Program Evaluation 
and Government Accountability, the Office of Program Evaluation and Government 
Accountability shall conduct an independent, objective review of the report provided by 
the fiscal office and of the information provided to the fiscal office by state agencies. 
The Office of Program Evaluation and Government Accountability may request 
additional information from any state agencies as appropriate to evaluate the 
effectiveness of providing health coverage under Title 22, section 3174-G, subsection 1, 
paragraph H. 
In its review, the Office of Program Evaluation and Government 
Accountability shall take into consideration revenues generated as a result of providing 
health coverage under Title 22, section 3174-G, subsection 1, paragraph H, savings to 
state-funded programs including Maine's criminal justice programs, savings to the 
counties from health care costs associated with the operation of the county jails and 
regional jails, savings in reimbursement to cities and towns for general assistance 
provided under Title 22, chapter 1161 and other factors including: the effectiveness of 
coverage in reducing uncompensated care provided by hospitals and federally qualified 
health centers; the reduction in the State's rate of uninsured persons; and increased access 
to preventive care and treatment services that help to reduce cancer risks and chronic 
disease, substance use disorder and mental health disorders, obesity and heart disease. If 
the Office of Program Evaluation and Government Accountability conducts a review 
pursuant to this section, the report must be completed by June 30, 2018. 
Sec. B-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 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 
SUMMARY 
2015-16 
2016-17 
$0 ($13,000,000) 
$0 ($13,000,000) 
This amendment is the majority report of the committee and replaces the bill, which 
is a concept draft. 
It authorizes the State to accept federal funds to provide health 
insurance coverage to adults with incomes equal to or below 133% plus 5% of the 
nonfarm income official federal poverty line. Individuals with incomes equal to or below 
100% of the nonfarm income official poverty line receive coverage through the 
MaineCare program. Individuals with income levels over 100% of the federal poverty 
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COMMITTEE AMENDMENT" A" to S.P. 226, L.D. 633 
line and up to 138% of the federal poverty line would receive coverage through private 
health insurance plans, through premium assistance at the same level that would be 
provided through advanced premium tax credits. Individuals within this group defined as 
"medically frail" in accordance with 42 Code of Federal Regulations, Section 440.315(f) 
are exempt from mandatory enrollment in a private individual or group qualified health 
plan. 
The amendment requires MaineCare members with incomes over 100% and equal to 
or below 138% of the federal poverty line who are receiving private health coverage 
through a private individual or group qualified health plan to pay premiums and cost 
sharing up to a maximum of 5% of the household's income. The amendment provides for 
termination of coverage for nonpayment of premium without good cause. Good cause 
must be defined by rules adopted by the Department of Health and Human Services. 
The amendment authorizes the Department of Health and Human Services to contract 
with health insurance plans to provide coverage in order to maximize savings and to 
ensure access to and quality of services. 
The amendment repeals the expanded coverage if the enhanced federal medical 
assistance percentage is reduced below that specified in the federal law or if expanded 
coverage is not reauthorized by the Legislature by June 30, 2019. 
The amendment requires the Department of Health and Human Services to prepare 
and submit to the Federal Government any state plan amendments and federal waivers by 
January 1, 2017 necessary to implement the program. 
The amendment authorizes the Department of Health and Human Services to apply 
for and accept private foundation grants to b1~ used to cover the cost of preparing and 
submitting any waivers and state plan amendments to the Federal Government required as 
a result of expanding coverage. It requires the department to develop mechanisms to 
create a seamless system for determining eligibility for the MaineCare program and for 
premium assistance for those who are already enrolled in a group or individual qualified 
health plan, using the federally facilitated marketplace to determine eligibility for the 
MaineCare program and for individuals in a private individual or group qualified health 
plan if it is determined to be more efficient. 
The amendment also requires the 
department, after consultation with a stakeholder group, to file a waiver to test a full 
continuum of substance use disorder treatment that will, among other things, authorize 
Medicaid coverage for services provided in inpatient and short-term residential facilities. 
The amendment requires monthly reporting to the committees of jurisdiction on the 
status of waiver submission until the disposition of such a waiver is determined, and on 
the status of implementation of the Maine Revised Statutes, Title 22, section 3174-G, 
subsection 1, paragraph H no later than June 1, 2017 and by April 30, 2017, April 30, 
2018 and April 30, 2019 on savings generated for state-funded programs as a result of 
implementation. It requires the Department of Administrative and Financial Services, 
Maine Revenue Services to report by April 30, 2017 and April 30, 2018 on revenues 
generated as a result of expanded coverage. It requires that savings and revenues be 
verified by the Office of Fiscal and Program Review by May 15, 2017 and May 15, 2018. 
It transfers any savings to the MaineCare Stabilization Fund prior to the next fiscal year. 
It requires the Office of Fiscal and Program Review to report its findings to the joint 
standing committee of the Legislature having jurisdiction over appropriations and 
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COMMITTEE AMENDMENT "A "to S.P. 226, L.D. 633 
financial affairs and to the joint standing committee of the Legislature having jurisdiction 
over government oversight matters and authorizes the latter committee to request further 
review and reporting by the Office of Program Evaluation and Government 
Accountability on the effectiveness of providing coverage through expanded MaineCare 
coverage. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
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Revised: 04/05/16 
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LD633 
LR 1188(02) 
An Act To Improve the Health of Maine Citizens and the Economy of Maine by Providing Affordable 
Market-based Coverage Options to Low-income Uninsured Citizens 
Fiscal Note for Bill as Amended by Committee Amendment ''A" 
Committee: Health and Human Services 
Net Cost (Savings) 
General Fund 
Appropriations/ Allocations 
General Fund 
Federal Expenditures Fund 
Other Special Revenue Funds 
Revenue 
Federal Expenditures Fund 
Other Special Revenue Funds 
Fiscal Detail and Notes 
Fiscal Note Required: Yes 
Fiscal Note 
FY 2015-16 
FY 2016-17 
$0 
$12,549,248 
$0 
$12,549,248 
$0 
$222,859,155 
$0 
$4,563,610 
$0 
$222,859,155 
$0 
$4,563,610 
(s-4i7} 
Projections 
FY 2017-18 
$36,010,365 
$36,010,365 
$469,552,481 
$6,084,810 
$469 ,552,481 
$6,084,810 
Projections 
FY 2018-19 
$44,569,453 
$44,569,453 
$469,882,4' 
$6,084,81,, 
$492,882,438 
$6,084,810 
Part A of this bill 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 (FPL), with the 5% federal income adjustment 
for family size. Individuals with income equal to or below 100% FPL would receive coverage through MaineCare. 
Individuals with income over 100% FPL through 138% FPL would receive coverage through private health insurance 
plans, through premium assistance at the same level that would be provided through advanced premium tax credits. 
Part A also requires those with income over 100% and equal to or below 138% FPL who are receiving private health 
coverage through the Maine Private Health Insurance Protection Program to pay premiums and cost sharing up to a 
maximum of 5% of household income. Part A also allows for the tennination of the program under two scenarios: 1) If 
the federal share for individuals eligible under this paragraph is reduced below the amounts specified in 42 United 
States Code, Section 1396d(y)(l) or 2) if expanded coverage is not reauthorized by the legislature by June 30, 2019. 
The Department of Health and Human services (DHHS), after consultation with a stakeholder group, is required to file 
a waiver to test a full continuum of substance use disorder treatment. This part also authorizes the DHHS to apply for 
and accept private foundation grants to be used to cover the cost of preparing and submitting any waivers and state 
plan amendments to the federal government required as a result of expanding coverage. The DHHS will report monthly 
on the status of the waiver and will report no later than June 1, 2017 on the status of implementation of the program. 
LRl 188(02) - Fiscal Note: - Page 1 of 3 
The bill includes a General Fund appropriation of $1,933,957 in fiscal year 2016-2017 to the Office ofFamily 
Independence - District program in the DHHS for the State share of the costs of 103 new positions to administer the 
eligibility expansion. Funding for the new positions reflects a 75% federal match for the 79 Eligibility Specialist 
positions and a 50% federal match for 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 DHHS has identified for the Eligibility 
Specialist positions. Although this bill allows for the DHHS to utilize the federally facilitated marketplace for 
eligibility determinations, this estimate assumes that will not occur in the current or next biennium. 
The bill includes a General Fund appropriation of $4,422,964 in fiscal year 2016-17 to the DHHS for medical costs for 
the newly eligible childless adult population at or below 100% of the federal poverty level and a Federal Expenditures 
Fund allocation of $84,036,307 in fiscal year 2016-17, as shown below. The estimated costs assume 95% enhanced 
federal matching funds through December 31, 2017, 94% enhanced federal matching funds through December 31, 
2018 and 93% enhanced federal matching funds through December 31, 2019 for the childless adult population with 
incomes less than 100% of the federal poverty level. 
Childless Adults @ or below l 00% of FPL 
Estimated Population 
Est. Annual Cost Per Person 
Assumed Federal Match 
Federal Share of Costs 
State Share of Costs 
27,937 
$6,333 
FY 2015-16 
$ 
FY 2016-17 
FY2017-18 
FY 2018-19 
$ 88,459,270 
$ 183,995,281 
$ 191,355,092 
95.0% 
94.5% 
93.5% 
$ 84,036,307 
$ 173,875,541 
$ 178,917,011 
$ 
4,422,964 $ 10,119,740 $ 12,438,081 
The bill includes a General Fund appropriation of $4,525,464 in fiscal year 2016-17 to the DHHS for premium and 
coinsurance costs for the newly eligible childless adult population from 101 % to 13 8% of FPL on the Private Health 
Insurance market and a Federal Expenditures Fund allocation of $85,983,818 in fiscal year 2016-17, as shown below. 
The estimated costs assume 95% enhanced federal matching funds through December 31, 2017, 94% enhanced federal 
matching funds through December 31, 2018 and 93% enhanced federal matching funds through December 31, 2019 
for the childless adult population with incomes from 101 % to 138% of the federal poverty level. 
Childless Adults from 101 % to 13 8% of FPL 
Estimated Population 
Est. Annual Cost Per Person 
Assumed Federal Match 
Federal Share of Costs 
State Share of Costs 
31,557 
$5,736 
FY 2015-16 
$ 
FY 2016-17 
FY 2017-18 
FY 2018-19 
$ 90,509,282 
$ 194,490,377 
$ 208,853,584 
95.0% 
94.5% 
93.5% 
$ 85,983,818 
$ 183,793,406 
$ 195,278,101 
$ 
4,525,464 $ 10,696,971 $ 13,575,483 
The bill also includes a General Fund appropriation of $20,475,789 in fiscal year 2016-17 for the DHHS for premium 
and coinsurance costs for the parent population from 101 % to 138% of the federal poverty level on the Private Health 
Insurance market, as shown below. The below table assumes 15,455 parents who lost coverage and an additional 4,565 
parents who have not had MaineCare in the past, but will opt for this expansion coverage. Since this group was eligible 
under previous rules, they will not be considered newly eligible and the State will receive the regular Federal Medical 
Assistance Percentage (FMAP). The bill also includes a Federal Expenditures Fund allocation for the parents totaling 
$36,943,699 in fiscal year 2016-17, as shown below, for the regular FMAP matching funds. 
Parents (Between 101 and 133% of the FPL) 
Estimated Population 
Est. Annual Cost Per Person 
Assumed Federal Match 
Federal Share of Costs 
20,020 
$5,736 
FY 2015-16 
FY 2016-17 
FY 2017-18 
FY 2018-19 
$ 57,419,488 
$ 123,385,553 
$ 132,497,635 
64.34% 
64.34% 
64.34% 
$ 36,943,699 
$ 79,386,265 
$ 85,248,978 
LRl 188(02) - Fiscal Note - Page 2 of3 
State Share of Costs 
$ 20,475,789 
$ 43,999,288 
$ 47,248,657 , 
The bill also includes a General Fund appropriation of$193,711 in fiscal year 2016-17 for the DHHS for medical c, 
for the children who have not had MaineCare in the past, but whose family will opt for MaineCare coverage after 
expansion. Since these children were eligible under previous rules, they will not be considered newly eligible and the 
State will receive the enhanced Children's Health Insurance Program (CHIP) FMAP. The bill also includes Federal 
Expenditures Fund allocations for children totaling $9,843,135 in fiscal year 2016-17, as shown below, for the 
enhanced CHIP FMAP matching funds. 
FY 2015-16 
Crowd-out Children (Between 101 and 133% of the FPL) 
Estimated Population 
4,565 
Est. Annual Cost Per Person 
$4,397 
Assumed Federal Match 
Federal Share of Costs 
State Share of Costs 
FY 2016-17 
FY 2017-18 
$ 10,036,846 
$ 21,077,239 
98.07% 
$ 20,670,448 
$ 
$ 
98.07% 
9,843,135 
193,711 
$ 
406,791 
FY 2018-19 
$ 22,131,183 
98.07% 
$ 21,704,051 
$ 
427,132 
The bill also includes deappropriations for the remaining funding in the MaineCare baseline for the costs of coverage 
for the parents population from 101 % to 138% of the FPL. This group was covered through December 31, 2013, with 
the possibility of transitional coverage extending through December 31, 2014. The DHHS identified, as of May 2014, 
an annual General Fund total in the baseline for spending on this population of$16,936,665. Of this amount, 
$10,000,000 was deappropriated in PL 2013, c. 595 to fund Sections 21 and 29 waitlist members and to increase 
nursing facility reimbursement rates. Since there were no subsequent MaineCare appropriations or deappropriations 
affecting this population during the 126th Legislature or the 1st Regular Session of the 127th Legislature, continued 
funding for this population is included in the 2016-2017 MaineCare biennial budget baseline. This bill deappropriatr 
the remaining $6,936,665 that is in the baseline. 
Part B of the bill includes a General Fund deappropriation of $13,000,000 in fiscal year 2016-17 in the Executive 
Branch Departments and Independent Agencies -Statewide program in the Department of Administrative and Financial 
Services for savings to be identified by the State Budget Officer in existing programs as a result of the expansion of 
eligibility. Part B also requires Maine Revenue Services to report by April 30, 2017 and April 30, 2018 regarding 
revenues generated as a result of expanded coverage. It requires that savings and revenues be verified by the Office of 
Fiscal and Program Review by March 15, 2017 and May 15, 2018. It also requires the Office of Fiscal and Program 
Review to report its findings to the joint standing c01mnittee having jurisdiction over appropriations and financial 
affairs and to the joint standing committee having jurisdiction over government oversight and authorizes the latter 
committee to request further review and reporting by the Office of Program Evaluation and Government 
Accountability on the effectiveness of providing coverage through expanded MaineCare coverage. The specific 
programs and amount of savings that will be realized and distributed to each program cannot by detennined at this 
time. As a benchmark, a review was done of a report on potential savings created by an outside consulting group 
familiar with Medicaid expansions. While that group's overall savings identified appear to be on the high side, the 
review does support a reasonable expectation of greater than $20,000,000 million in savings annually with the full 
implementation of the expansion. 
Additional costs for the Legislature's Office of Fiscal and Program Review can be absorbed within existing budgeted 
resources. Additional costs for the Legislature's Office of Program Evaluation and Government Accountability to 
conduct a review can be absorbed within existing budgeted resources but may affect the resources available to perfonn 
other assigned reviews. 
LRl 188(02) - Fiscal Note - Page 3 of3