An Act To Increase Access to Health Security by Expanding Federally Funded Health Care for Maine People
Maine Legislature, Session 127, LD 0854
Committee Amendment CA_A_H470 (House)
Amends: 22 MRSA §3174-G

COMMITTEE AMENDMENT ,f+" to H.P. 588, L.D. 854, Bill, "An Act To 
Increase Access to Health Security by Expanding Federally Funded Health Care for 
Maine People" 
Amend the bill by inserting after the enacting clause and before section 1 the 
following: 
'PART A' 
Amend the bill by striking out all of section 3 and inserting the following: 
'Sec. 3. 22 MRSA §3174-G, sub-§l, ~ 
is enacted to read: 
H. Beginning January 1, 2016. a person under 65 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. 
The following program requirements and 
contingencies apply. 
(1) Medicaid services provided under this paragraph must be provided within the 
limits of the state and federal funds provided and allocated for the program 
budget. Funds budgeted for services under this paragraph must include an annual 
inflationary adiustment equivalent to the rate of inflation in the Medicaid 
program. 
(2) On a quarterly basis, the commissioner shall determine the fiscal status of 
program expenditures as a result of expansion under this paragraph and report the 
fiscal status of the program to the joint standing committees having jurisdiction 
over health and human services matters and appropriations and financial affairs. 
A committee reported to may request and receive information necessary to 
determine the fiscal status of the program 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT" A" to H.P. 588, L.D. 854 
(3) After the fIrst quarter of fIscal year 2016-17, if the commissioner reasonably 
anticipates that the cost of the program will exceed the budgeted amount for the 
population described in this paragraph after considering any administrative 
changes available that may reduce program cost and all savings achieved and 
anticipated to be achieved in the MaineCare or state funded-programs as a result 
of this coverage, the commissioner may terminate the program 90 days after 
reporting to the joint standing committees having jurisdiction over health and 
human services matters and appropriations and fInancial affairs that expenses for 
services provided under this subsection are anticipated to exceed the appropriated 
funds. 
(4) If the federal medical assistance percentage for individuals eligible under this 
paragraph is, by federal law, reduced below the amounts specifIed in 42 United 
States Code, Section 1396d(y)(1), the commissioner has the authority to 
terminate the program 90 days after the change is made to the federal law. 
The commissioner shall adopt rules pursuant to this paragraph, as necessary, to 
establish program requirements and to ensure that program expenditures are within 
the budgeted amounts. Rules adopted pursuant to this paragraph are routine technical 
rules as defIned in Title 5, chapter 375, subchapter 2-A. Notwithstanding Title 5, 
section 8054, if it is necessary to meet the requirements set forth in this paragraph, 
the department shall adopt emergency rules under Title 5, chapter 375 without the 
necessity of demonstrating that immediate adoption is necessary to avoid a threat to 
public health or safety or the general welfare. 
PARTB 
Sec. B-1. Evaluation report. The Office of Fiscal and Program Review, referred 
to in this section as "the fIscal offIce," shall study the impact of the MaineCare expansion 
authorized in the Maine Revised Statutes, Title 22, section 317 4-G, subsection 1, 
paragraph H 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 fIscal office information and assistance 
requested for preparation of the evaluation. In evaluating the programs and services 
under this Part, the fIscal offIce 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 HIV/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 
COMMITTEE AMENDMENT 
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(,0 .• 
COMMITTEE AMENDMENT "A" to H.P. 588, L.D. 854 
as defmed 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 
fiscal office also shall examine the amount of payment for services that hospitals received 
during fiscal years 2015-16 and 2016-17 as a result of the expansion of MaineCare 
eligibility pursuant to Title 22, section 3174-G, subsection 1, paragraph H. 
The fiscal office shall report, no later than February 15,2016 and February 15,2017, 
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, paragraph H and by the fiscal office pursuant to 
this section. The reports must include the amount of savings expected and realized 
during fiscal years 2015-16 and 2016-17 by service area or program, the amount 
deposited in the MaineCare Stabilization Fund pursuant to section 2 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. 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, paragraph H and shall transfer the amounts up to the amounts 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 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 4 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, 2016 for fiscal year 2015-16 and no later than April 30, 2017 for fiscal year 
2016-17 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 2017-2018 
biennium. 
Sec. B-3. Review and responsibility. Following receipt of the reports from the 
fiscal office 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, paragraph H exceeds the savings 
to the General Fund, including any amount deposited in the MaineCare Stabilization 
COMMITTEE AMENDMENT 
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COMMITTEE AMENDMENT "A" to RP. 588, L.D. 854 
Fund pursuant to section 2 of this Part, due to the expansion of coverage for those 
individuals. 
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 
PARTe 
2015-16 
2016-17 
($13,000,000) ($27,000,000) 
($13,000,000) ($27,000,000) 
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 
Initiative: Deappropriates and deallocates funds for an adjustment in the MaineCare 
baseline. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
Medical Care - Payments to Providers 0147 
2015-16 
($6,936,665) 
($6,936,665) 
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 nonfann income official poverty line, with the 5% federal 
income adjustment for family size. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
2015-16 
$12,001,246 
$12,001,246 
COMMITTEE AMENDMENT 
2016-17 
$34,478,786 
$34,478,786 
COMMITTEE AMENDMENT "rt' to H.P. 588, L.D. 854 
FEDERAL EXPENDITURES FUND 
All Other 
FEDERAL EXPENDITURES FUND TOTAL 
Office of Family Independence - District 0453 
2015-16 
2016-17 
$205,254,579 $420,496,553 
$205,254,579 $420,496,553 
Initiative: Provides Personal Services and All Other funding for 79 Eligibility Specialist 
positions, 8 Family Independence Unit Supervisor positions and 16 Office Assistant II 
positions. 
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 TOTAL 
HEALTH AND HUMAN SERVICES, 
DEPARTMENT OF (FORMERLY DHS) 
DEPARTMENT TOTALS 
GENERAL FUND 
FEDERAL EXPENDITURES FUND 
OTHER SPECIAL REVENUE FUNDS 
DEPARTMENT TOTAL-ALL FUNDS 
2015-16 
79.000 
$1,786,743 
$147,214 
$1,933,957 
2015-16 
24.000 
$4,023,188 
$540,422 
$4,563,610 
2015-16 
2016-17 
79.000 
$2,382,324 
$196,285 
$2,578,609 
2016-17 
24.000 
$5,364,250 
$720,560 
$6,084,810 
2016-17 
$6,998,538 
$30,120,730 
$205,254,579 $420,496,553 
$4,563,610 
$6,084,810 
$216,816,727 $456,702,093 
Amend the bill by relettering or renumbering any nonconsecutive Part letter or 
section number to read consecutively. 
SUMMARY 
This amendment replaces the substantive provisions of the bill, designating as Part A 
the provision of the bill that expands medical coverage under the Medicaid program to 
adults under 65 years of age who qualify under federal law with incomes up to 133% of 
COMMITTEE AMENDMENT 
COMMITIEE AMENDMENT '!Jr' to H.P. 588, L.D. 854 
the nonfarm income official poverty line, with the 5% federal income adjustment for 
family size, and qualifies the State to receive enhanced federal funding for the cost of 
coverage of newly eligible members. It further provides for an annual expenditure cap 
for services, requiring quarterly expenditure reporting and a mechanism for terminating 
coverage if it is determined that expenditures will not remain within the cap. It also 
terminates coverage if the enhanced federal share drops below the amount specified in the 
federal Patient Protection and Affordable Care Act, 42 United States Code, Section 
18001, et seq., as enacted in 2010. 
Part B requires the Office of Fiscal and Program Review to study 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. 
The fiscal office shall report twice, no later than February 15, 2016 and February 15, 
2017, 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. 
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 fmancial order upon the 
approval of the Governor. Any remaining savings must be transferred to the MaineCare 
Stabilization Fund. It adds an appropriations and allocations section. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 06/17/15 
.::wac. 
.LD 854 
LR44(02) 
An Act To Increase Access to Health Security by Expanding Federally Funded Health Care for Maine 
People 
Fiscal Note for Bill as Amended by Committee Amendment 'Ff' CH ----Lf10 \ 
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 
Committee: Health and Human Services 
') 
Fiscal Note Required: Yes 
Fiscal Note 
FY 2015-16 
($6,001,462) 
($6,001,462) 
$205,254,579 
$4,563,610 
$205,254,579 
$4,563,608 
FY 2016-17 
$3,120,730 
$3,120,730 
$420,496,553 
$6,084,810 
$420,496,553 
$6,084,810 
Projections 
FY 2017-18 
$16,538,046 
$16,538,046 
$428,546,225 
$6,084,810 
$428,546,225 
$6,084,810 
Projections 
FY 2018-19 
$22,933,736 
$22,933,736 
$444,669,939 
$6,084,810 
$444,669,939 
$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, with the 5% federal income adjustment for 
family size, and the Medicaid services provided under this paragraph must be provided within the limits of the state 
and federal funds appropriated and allocated for the program budget. Part A also requires that, on a quarterly basis, the 
commissioner shall determine the fiscal status of program expenditures as a result of expansion under this paragraph 
and report the fiscal status of the program. Finally, Part A allows for the termination of the program under two 
scenarios: 1) after reporting that expenses for services provided under this subsection are anticipated to exceed the 
appropriated funds or 2) If the federal share for individuals eligible under this paragraph is reduced below the amounts 
specified in 42 United States Code, Section 1396d(y)(1). 
LR0044(02) - Fiscal Note - Page 1 of 3 
Part B of the bill as amended, includes a General Fund deappropriation of $13,000,000 in fiscal year 2015-16 and 
$27,000,000 in fiscal year 2016-17 in the Executive Branch Departments and Independent Agencies -Statewide 
program in the Department of Administrative aI].d Financial Services for savings to be identified in existing programs 
as a result of the' expansion of MaineCare eligibility. Part B of the amended bill also requires the Office of Fiscal and 
Program to do 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 de appropriates 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, a review was done of a report on potential savings created by an outside consulting group, 
familiar with Medicaid expansions. The review noted that, though the overall saving expected were high, it lead to a 
reasonable expectation of greater than $20,000,000 million in savings annually, with the full implementation of the 
expansion, as identified in this bill. 
The bill as amended includes General Fund appropriations of $1,933,957 in fiscal year 2015-16 and $2,578,609 in 
fiscal year 2016-2017 for the Office of Family Independence - District program in the Department of Health and 
Human Services for the State share of the costs of 103 new positions to administer the MaineCare eligibility 
expansion. Funding for the new positions reflects a 75% federal match for the 79 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. 
The bill as amended includes a General Fund appropriation of $9,380,367 in fiscal year 2016-17 to the Department of 
Health and Human Services for medical costs for newly eligible childless adult population, as shown below. Federal 
Expenditures Fund allocations totaling $178,843,392 in fiscal year 2015-16 and $365,834,327 in fiscal year 2016-17 as 
shown below. The estimated appropriations and allocations assume 100 percent enhanced federal matching funds 
through December 31, 2016, 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 childless adult population with incomes less than 13 8% of the federal poverty line. 
FY 2015-16 
FY 2016-17 
FY 2017-18 
FY 2018-19 
Childless Adults @ or below 138% ofFPL 
Estimated Population 
58,240 
Est. Annual Cost Per Person 
Assumed Federal Match 
Federal Share of Costs 
State Share of Costs 
$6,142 
$178,843,392 
$375,214,694 
$393,602,227 
$412,891,315 
100.0% 
97.5% 
94.5% 
93.5% 
. $ 178,843,392 $ 365,834,327 
$ 371,954,105 
$ 386,053,380 
$0 
$9,380,367 
$21,648,122 
$26,837,935 
The bill as amended also includes General Fund appropriations of$11,184,976 in fiscal year 2015-16 and $23,465,879 
in fiscal year 2016-17 to the Department of Health and Human Services for medical costs for the parent's population 
from 101 % to 138% ofthe federal poverty level, as shown below. The below assumes 15,455 parents who lost 
coverage and an additional 4,500 parents who have not had MaineCare in the past, but will opt for MaineCare 
coverage after expansion. Since this group was eligible under previous rules, they will not be considered newly eligible 
and the state will receive the Regular FMAP. The bill as amended also includes Federal Expenditures Fund allocations 
for the parents identified below totaling $18,777,456 in fiscal year 2015-16 and $39,394,766 in fiscal year 2016-17, as 
shown below, for the regular FMAP matching funds. 
FY 2015-16 
FY 2016-17 
Parents (Between 101 and 133% of the Federal Poverty Line) 
Estimated Population 
Est. Annual Cost Per Person 
Assumed Federal Match 
Federal Share of Costs 
State Share of Costs 
19,955 
$3,003 
$29,962,433 
$62,860,645 
62.67% 
62.67% 
$18,777,456 
$39,394,766 
$11,184,976 
$23,465,879 
LR0044(02) - Fiscal Note - Page 2 of 3 
J 
... ~. ... 
• "'I)Ii 
" 
FY2017~18 
FY2018-19 
$65,940,100 
$69,170,416 
62.67% 
62.67% 
$41,324,661 
$43,349,100 
$24,615,439 
$25,821,316 
C J4-C HJ-+ 7 g 
The bill as amended also includes General Fund appropriations of $816,270 in fiscal year 2015-16 and $1,632,540 in 
fiscal year 2016-17 to the Department of Health and Human Services for medical costs 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 
CHIP FMAP. The bill as amended also includes Federal Expenditures Fund allocations for the children identified 
below totaling $7,633,730 in fiscal year 2015-16 and $15,267,460 in fiscal year 2016-17, as shown below, for the 
enhanced CHIP FMAP matching funds. 
FY 2015-16 
FY 2016-17 
FY 2017-18 
FY 2018-19 
Crowd-out Children (Between 101 and 133% of the Federal Poverty Line) 
Estimated Population 
4,800 
Est. Annual Cost Per Person 
$3,521 
$8,450,000 
$16,900,000 
$16,900,000 
$16,900,000 
Assumed Federal Match 
90.34% 
90.34% 
90.34% 
90.34% 
Federal Share of Costs 
$7,633,730 
$15,267,460 
$15,267,460 
$15,267,460 
State Share of Costs 
$816,270 
$1,632,540 
$1,632,540 
$1,632,540 
The bill as amended also includes deappropriations for the remaining funding in the baseline for the MaineCare costs 
of coverage for the parents population from 101 % to 138% ofthe federal poverty line. This group was covered through 
December 31,2013, with the possibility of transitional coverage extending through December 31,2014. The 
department identified a General Fund total in the baseline for spending on this population, as of May 2014, of 
$16,936,665. Of this baseline, $10,000,000 was de appropriated in PL 2013, c. 595 to fund Section 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, continued funding for this 
population was included in the 2016-2017 MaineCare biennial budget baseline. This bill deappropriates the remaining 
$6,936,665 that still remains in the baseline. 
Additional costs for the Legislature's Office of Fiscal and Program Review will be absorbed within existing budgeted 
resources. 
LR0044(02) - Fiscal Note - Page 3 on