An Act To Establish a Unified-payor, Universal Health Care System
Maine Legislature, Session 127, LD 0815
Committee Amendment CA_A_S69 (Senate)

LD 815 
LR 584(02) 
An Act To Establish a Unified-payor, Universal Health Care System 
Fiscal Note for Bill as Amended by Committee Amendment "A" t:::rl.i1 ') 
Committee: Insurance and Financial Services 
Fiscal Note Required: Yes 
Fiscal Note 
Legislative Cost/Study 
Current biennium cost increase - General Fund 
Potential current biennium revenue increase - General Fund 
The general operating expenses of participation in the Maine Health Care Advisory Council are projected to be $2,000 
in fiscal year 2015-16 and $2,000 in fiscal year 2016-17. If more than 4 meetings are held during the interim the 
estimated cost for legislators to attend each additional meeting is projected to be $500 per meeting for legislative per 
diem and expenses. The Legislature'S Other Special Revenue Funds account will be used to provide reimbursement to 
legislators for attending meetings of the advisory council. The Executive Director's office will seek reimbursement 
from the Maine Health Care Advisory Council for these costs. 
Fiscal Detail and Notes 
The bill would result in an increase in General Fund costs, the amount and timing of which cannot be determined at 
this time. 
The bill requires the Department of Professional and Financial Regulation (DPFR) to establish the "Maine Health 
Benefit Marketplace (Marketplace)" as a health benefit exchange to facilitate the purchases and sale of qualified 
health plans and qualified stand-alone dental benefit plans in the individual market and establish a "Small Business 
Health Options Program (SHOP) exchange" to assist qualified employers in facilitating the enrollment of their 
employees in qualified health plans and qualified stand-alone dental benefit plans offered in the small group market. 
This estimate assumes an implementation date of October 1, 2016, at which time staff and resources will be needed to 
establish the "Maine Health Benefit Marketplace" to begin enrollment on or after October 15,2016 but no later than 
January 1,2017. It also assumes a General Fund appropriation will be provided for any costs associated with 
establishing and managing the Marketplace in excess of grants received, and that no fees will be charged to 
individuals or employers for use of the exchanges until a funding mechanism has been submitted to and approved by 
the 128th Legislature. 
LR0584(02) - Fiscal Note - Page 1 of2 
DPFR does not have sufficient infornlation to detennine the level of staffing requHcd and whether this staff will be 
employed or procured through contracts. A General Fund appropriation will be required, at a minimum, for start-up 
and ongoing costs, including but not limited to funding for the Director of the Marketplace (Specification 2 Range 91 
which ranges from 72,030 - 100,713), additional staff, contracts, administration, general operations and legal support 
from the Office of the Maine Attorney General. 
The anticipated fiscal impact to the Department of Health and Human Services is unable to be detennined because the 
amount of involvement that will be required by DHHS and the affect this will have on MaineCare will only be 
detennined as part of the marketplace and the Maine Health Care Trust Fund setup and financing plan. Section 378 B-
states "The State Controller shall transfer a $600,000 working capital advance to the dedicated account of the Maine 
Health Care Trust Fund" and further notes that the Maine Health Care Agency "shall repay this working capital 
advance by June 30th, 2020." 
The creation of the Maine Health Care Plan is contingent upon the receipt of a waiver, from the United States 
Department of Health and Human Services, under Section 1332 of the federal Affordable Care Act pursuant to 
subsection 2. 
Future appropriations to fully fund implementation of the program will be required. These appropriations will be 
included in future legislation, based on the reports, required in this bill, to the legislature. 
LR0584(02) - Fiscal Note - Page 2 of2