An Act To Protect and Improve the Health of Maine Citizens and the Economy of Maine
Maine Legislature, Session 128, LD 0226
Committee: Health and Human Services
Sponsors: SAVIELLO
Amends: 22 MRSA §3174-G

Legislative Document
No. 226
S.P. 72
In Senate, January 24, 2017
An Act To Protect and Improve the Health of Maine Citizens and 
the Economy of Maine
(EMERGENCY)
Reference to the Committee on Health and Human Services suggested and ordered printed.
HEATHER J.R. PRIEST
Secretary of the Senate
Presented by Senator SAVIELLO of Franklin.
Emergency preamble. Whereas, acts and resolves of the Legislature do not 
become effective until 90 days after adjournment unless enacted as emergencies; and 
Whereas, over 74,000 people in this State are at risk of losing access to affordable 
health care due to actions being considered by Congress; and 
Whereas, cancer, heart disease and stroke are among the leading causes of death in 
this State and among the most common and costly, yet preventable, of all health 
problems; and 
Whereas, drug overdose deaths during the first 9 months of 2016 in this State 
surpassed the total for all of 2015, with at least 286 deaths, nearly one death every day, 
reported by the end of September; 
Whereas, between 25,000 and 30,000 people seeking long-term drug treatment in 
this State last year were unable to get treatment, according to the United States 
Department of Health and Human Services, Substance Abuse and Mental Health Services 
Administration; 
Whereas, federal health care funds are available to pay for cancer prevention and 
treatment, cardiovascular treatment and many other life-saving preventative health care 
services; and 
Whereas, federal health care funds are available to pay for prevention, treatment 
and recovery services for uninsured individuals and people with low income; and 
Whereas, immediate enactment of this legislation is necessary to ensure that people 
in this State are protected from changes that would affect their access to preventative 
health care and treatment services and will continue to have access to affordable health 
care; and 
Whereas, in the judgment of the Legislature, these facts create an emergency within 
the meaning of the Constitution of Maine and require the following legislation as 
immediately necessary for the preservation of the public peace, health and safety; now, 
therefore, 
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 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.; and 
Sec. A-3.  22 MRSA §3174-G, sub-§1, ¶H is enacted to read: 
H.  No later than 180 days after the effective date of this paragraph, a person who is 
not otherwise eligible for assistance under this chapter and who is under 65 years of 
age, not pregnant, not entitled to or enrolled for benefits under Part A of subchapter 
XVIII, Title 18 of the Social Security Act or enrolled for benefits under Part B of 
subchapter XVIII, Title 18 of the Social Security Act when the person's income is at 
or below 133% plus 5% of the nonfarm income official poverty line for the 
applicable family size.  The department shall provide to such person, at a minimum, 
the same scope of medical assistance as is provided to a person described in 
paragraph E. 
(1)  Cost sharing, including copayments, for coverage established under this 
paragraph may not exceed the maximum allowable amounts authorized under 
section 3173-C, subsection 7. 
(2)  The department may, upon obtaining any necessary federal or state 
approvals, limit eligibility under this paragraph for medical assistance to persons 
with income that does not exceed 100% plus 5% of the nonfarm income official 
poverty line for the applicable family size if the department uses any available 
federal and state allocations, appropriations or other available funding achieved 
through the limiting of eligibility to the extent available to ensure that persons 
otherwise described in this paragraph, with income between 100% plus 5% and 
133% plus 5%, of the nonfarm income official poverty line for the applicable 
family size, have access to medical assistance at a cost for premiums that does 
not exceed 2% of family income and a cost for copayments, coinsurance 
deductibles and any other cost sharing that does not exceed 5% of the family's 
income. 
(3)  The department shall adopt rules, including emergency rules pursuant to Title 
5, section 8054, if necessary, to implement this paragraph in a timely manner to 
ensure that the persons described in this paragraph are enrolled for and eligible to 
receive services no later than 180 days after the effective date of this paragraph.  
Rules adopted pursuant to this subparagraph are routine technical rules as defined 
by Title 5, chapter 375, subchapter 2-A except that rules adopted to implement 
subparagraph (2) are major substantive rules as defined by Title 5, chapter 375, 
subchapter 2-A. 
(4)  The department may contract with health insurance 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. 
PART B 
Sec. B-1.  Waivers, state plan amendments or other approvals.  Within 90 
days of the effective date of the Maine Revised Statutes, Title 22, section 3174-G, 
subsection 1, paragraph H, the Commissioner of Health and Human Services shall submit 
any necessary waivers and state plan amendments or seek other necessary approvals to 
implement Title 22, section 3174-G, subsection 1, paragraph H. The commissioner shall 
act expeditiously to achieve implementation of Title 22, section 3174-G, subsection 1, 
paragraph H.  Any waiver, state plan amendment or other method of approval submitted 
pursuant to this section must include provisions to achieve the following: 
1.  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; 
2.  Prevention initiatives to address chronic health conditions, including adequately 
informing newly eligible persons under Title 22, section 3174-G, subsection 1, 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 preventative visits, annual wellness exams and 
preventative 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; 
3.  A mechanism by which the Department of Health and Human Services may 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; 
4.  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. 
Sec. B-2.  Reduction of federal medical assistance percentage.  Upon 
notification to the Department of Health and Human Services 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 persons newly 
eligible 
for 
Medicaid 
described 
in 
United 
States 
Code, 
Section 
1396a(a)(10)(A)(i)(VIII) is reduced below the amounts specified in 42 United States 
Code, Section 1396d(y)(1), the Commissioner of Health and Human Services shall notify 
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 appropriations and financial affairs.  The commissioner shall propose a plan to 
maintain coverage of those persons described in the Maine Revised Statutes, Title 22, 
section 3174-G, subsection 1, paragraph H to the greatest extent feasible.  The 
committees of jurisdiction may propose any necessary legislation to address any decrease 
in funding or other necessary changes. 
Sec. B-3.  Interim reporting.  Between the effective date of the Maine Revised 
Statutes, Title 22, section 3174-G, subsection 1, paragraph H and the dates of approval of 
any federal or state approvals 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. B-4.  Reporting on implementation status.  No later than one year after 
the effective date of the Maine Revised Statutes, Title 22, section 3174-G, subsection 1, 
paragraph H, the Commissioner of Health and Human Services shall report 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 status of implementation of Title 22, section 
3174-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. B-5.  Reporting of revenues.  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 60 days following the end of the first 12 months of enrollment under the Maine 
Revised Statutes, Title 22, section 3174-G, subsection 1, paragraph H regarding any new 
revenues, including any increase in federal medical assistance payments resulting from 
coverage provided under Title 22, section 3174-G, subsection 1, paragraph H.  Prior to 
the end of fiscal year 2018-19, the State Controller shall transfer any amounts identified 
under this section to the MaineCare Stabilization Fund established under Title 22, section 
3174-KK. 
Sec. B-6.  Evaluation by legislative office.  Within 90 days after the end of the 
first 12 months of enrollment under the Maine Revised Statutes, Title 22, section 3174-G, 
subsection 1, paragraph H, the Office of Fiscal and Program Review shall independently 
review reports required pursuant to sections 5 and 7 of this Part and report to 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 
appropriations and financial affairs on its determination of the savings and new revenues, 
if any, resulting from implementation of 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. 
Sec. B-7.  Report.  The Commissioner of Health and Human Services, the 
Commissioner of Corrections and any state agency that recognizes savings as a result of 
implementation of the Maine Revised Statutes, Title 22, section 3174-G, subsection 1, 
paragraph H shall report within 60 days prior to the end of the first 12 months of 
enrollment under Title 22, section 3174-G, subsection 1, paragraph H 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 to individuals awaiting a 
MaineCare program disability determination for whom the applications are subsequently 
granted; services provided to individuals who previously would have pursued a disability 
determination to qualify for coverage; 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 that fiscal year and the 
preceding fiscal year 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-8.  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 Act. 
Emergency clause.  In view of the emergency cited in the preamble, this 
legislation takes effect when approved. 
SUMMARY 
This bill 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 for the applicable family size.  Persons with incomes equal to 
or below 100% of the nonfarm income official poverty line receive coverage through the 
MaineCare program.  The Commissioner of Health and Human Services is authorized to 
seek approval to provide that persons with income levels over 100% of the federal 
poverty line and up to 133% of the federal poverty line may receive coverage from a 
private health insurance plan or other mechanisms. In the event that the commissioner 
uses this authority, any funds made available from unexpended state matching funds must 
be used to help ensure that those persons with income levels between 100% and 133% of 
the federal poverty line receive affordable and comprehensive health coverage. 
The bill provides for measures to be taken in the event that federal funding, as 
established under federal law, is reduced, so that the Legislature may act promptly to 
address the consequences of this action. The bill also 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 bill sets forth time standards for the start of the expansion of health care 
coverage, for submission of requests to obtain necessary federal approvals and for 
ongoing reporting to the Legislature during the start-up phase of this expansion.  Further 
reporting is required on the status of any savings generated to state-funded programs as a 
result of this expansion.  It requires the Department of Administrative and Financial 
Services, Maine Revenue Services to report no later than 60 days following the end of the 
first 12 months of enrollment under the expansion 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 within 90 days after the end of the first 12 months of 
enrollment under the expansion.  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 health and human services matters and to the joint standing committee having 
jurisdiction over appropriations and financial affairs. 
The bill authorizes the Department of Health and Human Services 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 health care coverage.