An Act To Strengthen Maine's Hospitals and Increase Access to Health Care
Maine Legislature, Session 127, LD 0798
Committee: Health and Human Services
Sponsors: DEVIN
Amends: 22 MRSA §3174-G, 22 MRSA §3173-C

Legislative Document 
No. 798 
H.P. 547 
House of Representatives, March 10, 2015 
An Act To Strengthen Maine's Hospitals and Increase Access to 
Health Care 
Reference to the Committee on Health and Human Services suggested and ordered printed. 
ROBERT B. HUNT 
Clerk 
Presented by Representative DEVIN of Newcastle. 
Be it enacted by the People of the State of Maine as follows: 
PART A 
Sec. A-1.  22 MRSA §3174-G, sub-§1, ¶F, as amended by PL 2011, c. 380, Pt. 
KK, §2, is further amended to read: 
F.  A person 20 to 64 years of age who is not otherwise covered under paragraphs A 
to E when the person's family income is below or equal to 125% of the nonfarm 
income official poverty line, provided except that the commissioner shall adjust the 
maximum eligibility level in accordance with the requirements of the paragraph. 
(2)  If the commissioner reasonably anticipates the cost of the program to exceed 
the budget of the population described in this paragraph, the commissioner shall 
lower the maximum eligibility level to the extent necessary to provide coverage 
to as many persons as possible within the program budget. 
(3)  The commissioner shall give at least 30 days' notice of the proposed change 
in maximum eligibility level to the joint standing committee of the Legislature 
having jurisdiction over appropriations and financial affairs and the joint standing 
committee of the Legislature having jurisdiction over health and human services 
matters; and 
Sec. A-2.  22 MRSA §3174-G, sub-§1, ¶G, as enacted by PL 2011, c. 380, Pt. 
KK, §3, is amended to read: 
G.  A person who is a noncitizen legally admitted to the United States to the extent 
that coverage is allowable by federal law if the person is: 
(1)  A woman during her pregnancy and up to 60 days following delivery; or 
(2)  A child under 21 years of age.; 
Sec. A-3.  22 MRSA §3174-G, sub-§1, ¶¶H and I are enacted to read: 
H.  Beginning January 1, 2016, a person 21 to 64 years of age who is not otherwise 
eligible for medical assistance under this section, who qualifies for medical assistance 
pursuant to 42 United States Code, Section 1396a(a)(10)(A)(i)(VIII) and whose 
income is equal to or below 133% of the nonfarm income official poverty line plus 
5% for the applicable family size as required by federal law.  A person eligible for 
medical assistance under this paragraph must receive the same coverage as is 
provided to a person eligible under paragraph E; and 
I.  Beginning October 1, 2019, a person 19 or 20 years of age who is not otherwise 
eligible for medical assistance under this section, who qualifies for medical assistance 
pursuant to 42 United States Code, Section 1396a(a)(10)(A)(i)(VIII) and 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 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 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. 
Sec. A-5.  Repeal.  The Maine Revised Statutes, Title 22, section 3174-G, 
subsection 1, paragraphs H and I are repealed December 31, 2020. 
PART B 
Sec. B-1.  Obtaining federal approval for enhanced federal match.  The 
Commissioner of Health and Human Services shall take all steps necessary to secure an 
enhanced Federal Medical Assistance Percentage for services provided to the MaineCare 
childless adult waiver population in the State equal to that available under the federal 
Patient Protection and Affordable Care Act, Public Law 111-148, as amended by Public 
Law 111-152, for individuals newly eligible for Medicaid.  The commissioner shall 
prepare and submit to the federal Department of Health and Human Services, Centers for 
Medicare and Medicaid Services in a format required by the Secretary of the federal 
Department of Health and Human Services an analysis of the benefits available under the 
MaineCare childless adult waiver as of December 1, 2009 and all necessary information 
to certify that members of the childless adult population were not eligible on December 1, 
2009 to receive full benefits, benchmark coverage as described in Section 1937(b)(1), 
subparagraph (A), (B) or (C) of the United States Social Security Act or benchmark 
equivalent coverage as described in 42 United States Code, Section 1396u-7(b)(2). In 
preparing and submitting this analysis, the commissioner shall compare the services 
available to the childless adult population, specifically hearing services, to those of the 3 
benchmark plans specified by the federal Department of Health and Human Services, 
Centers for Medicare and Medicaid Services and shall indicate to the secretary whether 
hearing services were a covered service for the childless adult population as of December 
1, 2009 and whether they are a covered service under the 3 benchmark plans.  The 
Commissioner of Health and Human Services shall submit information certified by an 
actuary for the purpose of certifying the benefits available to the childless adult 
population on December 1, 2009 if required to do so by the secretary.  If the secretary 
does not require information certified by an actuary for that purpose, the commissioner 
may not pursue the services of an actuary or submit information certified by an actuary 
for the purpose of certifying the benefits available to the childless adult population on 
December 1, 2009.  If the secretary requires the submission of additional information to 
demonstrate that members of the childless adult population otherwise qualify as "newly 
eligible" individuals as described in Section 1905(y)(2) of the United States Social 
Security Act, in order for the State to secure an enhanced Federal Medical Assistance 
Percentage as set forth in Section 1905(y)(1) of the United States Social Security Act, the 
Department of Health and Human Services shall provide all required information to the 
secretary within 30 days of the secretary's sending notification that additional information 
is required. 
Sec. B-2.  Report.  The Commissioner of Health and Human Services shall report 
no later than February 1, 2016 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. 
PART C 
Sec. C-1.  Research organization evaluation.  The Office of Fiscal and 
Program Review shall contract with a private, nonpartisan research organization to 
evaluate the impact of the MaineCare expansion authorized in Part A on programs and 
services that do not currently receive Federal Medical Assistance Percentage matching 
funds or do not qualify for enhanced Federal Medical Assistance Percentage matching 
funds under the federal Patient Protection and Affordable Care Act, Public Law 111-148, 
as amended by Public Law 111-152, with the goal of identifying and maximizing General 
Fund savings.  The Commissioner of Health and Human Services, the Commissioner of 
Corrections and the Executive Director of the State Board of Corrections shall provide to 
the research organization information and assistance requested for preparation of the 
evaluation.  In evaluating the programs and services under this Part, the research 
organization shall at a minimum evaluate the impact on the following programs and 
services: the state-funded Mental Health Services - Community, Office of Substance 
Abuse and General Assistance - Reimbursement to Cities and Towns programs; the 
elderly low-cost drug program under the Maine Revised Statutes, Title 22, section 254-D; 
services provided for individuals between 21 and 64 years of age who are currently 
eligible for MaineCare 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, section 4041; 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.  The research organization shall also examine the amount of 
payment for services that hospitals received during calendar years 2016 and 2017 as a 
result of the expansion of MaineCare eligibility pursuant to Part A.  In addition, the 
research organization shall evaluate any savings and the impact on health outcomes 
achieved through initiatives implemented pursuant to the state innovation models 
initiative grant. 
Sec. C-2.  Report.  The research organization that conducts the evaluation under 
section 1 shall report no later than March 1 in 2016 and 2017 and February 15 in 2018 to 
the joint standing committee of the Legislature having jurisdiction over appropriations 
and financial affairs, the joint standing committee of the Legislature having jurisdiction 
over health and human services matters and the joint standing committee of the 
Legislature having jurisdiction over criminal justice and public safety matters on the 
amount of General Fund savings resulting from the MaineCare expansion authorized in 
Part A and identified in section 1.  The reports must include the amount of savings 
realized during calendar years 2016 and 2017 by service area or program, the amount 
deposited in the MaineCare Stabilization Fund pursuant to section 3 and the amount of 
savings projected to be achieved through state fiscal year 2020-21 by service area or 
program. 
Sec. C-3.  Calculation and transfer. Notwithstanding any other provision of law, 
the State Budget Officer shall calculate the amount of savings identified in this Part that 
applies against each General Fund account statewide as a result of the expansion of 
MaineCare eligibility authorized in Part A and shall transfer the amounts by financial 
order upon the approval of the Governor.  These transfers are considered adjustments to 
appropriations in fiscal year 2015-16 and fiscal year 2016-17. The State Controller shall 
transfer any amounts identified under this Part greater than the amounts specified in 
section 6 to the MaineCare Stabilization Fund established under the Maine Revised 
Statutes, Title 22, section 3174-KK.  The State Budget Officer shall provide a report of 
the transferred amounts to the joint standing committee of the Legislature having 
jurisdiction over appropriations and financial affairs no later than June 30, 2016 for fiscal 
year 2015-16 and no later than June 30, 2017 for fiscal year 2016-17. 
Sec. C-4.  Review and responsibility.  Following receipt of the reports from the 
research organization as required under section 2, the joint standing committee of the 
Legislature having jurisdiction over health and human services matters shall review the 
information provided in the reports and shall determine if the net cost to the General Fund 
of providing coverage under the MaineCare program to individuals pursuant to Part A, 
section 3 exceeds the savings to the General Fund, including any amount deposited in the 
MaineCare Stabilization Fund pursuant to section 3, due to the expansion of coverage for 
those individuals.  Following its review of the report received on February 15, 2018, the 
joint standing committee may report out a bill to the 128th Legislature regarding its 
determinations and conclusions. 
PART D 
Sec. D-1.  22 MRSA §3173-C, sub-§7, as amended by PL 2009, c. 415, Pt. A, 
§12, is further amended to read: 
7.  Copayments.  Notwithstanding any other provision of law, the following 
copayments per service per day are imposed and reimbursements are reduced, or both, to 
the following levels: 
A.  Outpatient hospital services, $3; 
B.  Home health services, $3; 
C.  Durable medical equipment services, $3; 
D.  Private duty nursing and personal care services, $5 per month; 
E.  Ambulance services, $3; 
F.  Physical therapy services, $2; 
G.  Occupational therapy services, $2; 
H.  Speech therapy services, $2; 
I.  Podiatry services, $2; 
J.  Psychologist services, $2; 
K.  Chiropractic services, $2; 
L.  Laboratory and x-ray services, $1; 
M.  Optical services, $2; 
N.  Optometric services, $3; 
O.  Mental health clinic services, $2; 
P.  Substance abuse services, $2; 
Q.  Hospital inpatient services, $3 per patient day; 
R.  Federally qualified health center services, $3 per patient day, effective July 1, 
2004; and 
S.  Rural health center services, $3 per patient day. 
The department may adopt rules to adjust the copayments set forth in this subsection.  
The rules may adjust amounts to ensure that copayments are deemed nominal in amount 
and may include monthly limits or exclusions per service category.  The need to maintain 
provider participation in the Medicaid program to the extent required by 42 United States 
Code, Section 1396a(a)(30)(A) or any successor provision of law must be considered in 
any reduction in reimbursement to providers or imposition of copayments. 
For an adult when the adult’s family income is above 100% of the nonfarm income 
official poverty line, the department shall adopt rules to adjust the copayments 
established under this subsection to reflect the maximum allowable amounts authorized 
under 42 United States Code, Section 1396o; to increase copayments as authorized by 42 
United States Code, Section 1396o(h); and in compliance with Section 1396o(b)(3) to 
impose a copayment for services received at a hospital emergency room of up to twice 
the amount established as the copayment for outpatient services if the services are not 
emergency services.  The department shall track aggregate copayments in compliance 
with 42 Code of Federal Regulations, Section 447.68 and, by rule, make adjustments to 
copayments to ensure compliance with federal law. 
Sec. D-2.  Contingent effective date.  If a majority of the legal votes cast 
pursuant to Part E of this Act are cast in favor of this Act, that section of this Act that 
enacts the Maine Revised Statutes, Title 22, section 3174-G, subsection 1, paragraphs H 
and I takes effect 30 days after the United States Department of Health and Human 
Services, Centers for Medicare and Medicaid Services confirms in writing to the 
Commissioner of Health and Human Services that the enhanced Federal Medical 
Assistance Percentage set forth in Section 1905(y)(1) of the United States Social Security 
Act is applicable to the individuals who received coverage as of December 1, 2009, who 
are described in Title 22, section 3174-G, subsection 1, paragraph F and who are defined 
in Section 1905(y)(2) of the United States Social Security Act.  Upon receipt of 
confirmation from the federal Centers for Medicare and Medicaid Services, the 
Commissioner of Health and Human Services shall notify in writing the President of the 
Senate, the Speaker of the House of Representatives and the Revisor of Statutes and shall 
provide them with a copy of the written confirmation. 
PART E 
Sec. E-1.  Statutory referendum procedure; submission at election; form 
of question; effective date. This Act must be submitted to the legal voters of the State 
at a statewide election held in the month of November following passage of this Act. The 
municipal officers of this State shall notify the inhabitants of their respective cities, towns 
and plantations to meet, in the manner prescribed by law for holding a statewide election, 
to vote on the acceptance or rejection of this Act by voting on the following question: 
"Do you favor expanding medical coverage under the MaineCare 
program, which would qualify Maine to receive federal funding for the 
cost of coverage for members who enroll under the expansion?" 
The legal voters of each city, town and plantation shall vote by ballot on this question 
and designate their choice by a cross or check mark placed within a corresponding square 
below the word "Yes" or "No."  The ballots must be received, sorted, counted and 
declared in open ward, town and plantation meetings and returns made to the Secretary of 
State in the same manner as votes for members of the Legislature.  The Governor shall 
review the returns.  If a majority of the legal votes are cast in favor of this Act, the 
Governor shall proclaim the result without delay and this Act becomes effective 30 days 
after the date of the proclamation except that that section of this Act that enacts the Maine 
Revised Statutes, Title 22, section 3174-G, subsection 1, paragraphs H and I takes effect 
as provided in Part D of this Act. 
The Secretary of State shall prepare and furnish to each city, town and plantation all 
ballots, returns and copies of this Act necessary to carry out the purposes of this 
referendum. 
SUMMARY 
This bill, which is contingent on approval by the voters of the State at referendum, 
does the following. 
1. It 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.  It repeals the expansion of 
medical coverage under the MaineCare program December 31, 2020, and it provides for 
repeal of the expansion prior to 2020 under certain circumstances. 
2. It requires the Commissioner of Health and Human Services to provide certain 
information to the Secretary of the United States Department of Health and Human 
Services to enable the secretary to make the determination as to the eligibility of the State 
to obtain an enhanced Federal Medical Assistance Percentage for services for MaineCare 
members eligible as childless adults. It provides that until the secretary confirms that the 
State will get the enhanced reimbursement rate as set forth in the federal Patient 
Protection and Affordable Care Act, for the childless adult population in MaineCare, 
including persons who were members under that eligibility grouping on December 1, 
2009, the expansion of medical coverage under the MaineCare program will not take 
effect.  It requires the commissioner, upon receiving confirmation from the United States 
Department of Health and Human Services, Centers for Medicare and Medicaid Services, 
to notify the President of the Senate, the Speaker of the House of Representatives and the 
Revisor of Statutes and to provide them with a copy of the written confirmation. 
3. It requires the Office of Fiscal and Program Review to contract with a private, 
nonpartisan research organization to evaluate the impact of the MaineCare expansion. It 
requires a report to the Legislature on the amount of General Fund savings resulting from 
the MaineCare expansion. 
4. It amends current law on copayments in the MaineCare program. It directs the 
Department of Health and Human Services to increase copayments for adults with 
income above 100% of the nonfarm income official poverty line to the maximum 
allowable under federal law and to increase nominal copayments by the annual 
percentage increase in the medical care component of the Consumer Price Index for All 
Urban Consumers.  It directs the department to increase MaineCare copayments for 
services provided in a hospital emergency room when the services are not emergency 
services.  It requires the department to track aggregate copayments in compliance with 
federal law.