An Act To Move Maine Toward Affordable Health Care for Everyone
Maine Legislature, Session 129, LD 1755
Committee: Health and Human Services
Sponsors: JACKSON
Amends: 22 MRSA §3173-J

Legislative Document
No. 1755
S.P. 586
In Senate, May 16, 2019
An Act To Move Maine Toward Affordable Health Care for 
Everyone
Reference to the Committee on Health and Human Services suggested and ordered printed.
DAREK M. GRANT
Secretary of the Senate
Presented by President JACKSON of Aroostook.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  22 MRSA §3173-J is enacted to read:
§3173-J.  MaineCare purchase option
1.  Federal waiver request.  The commissioner shall seek necessary federal waiver 
authority under Section 1332 of the federal Patient Protection and Affordable Care Act to 
establish a MaineCare purchase option that allows individuals who are residents of the 
State and who are above the maximum income eligibility limits for the MaineCare 
program established in section 3174-G or otherwise ineligible for the MaineCare program 
the option of purchasing coverage through the MaineCare program instead of purchasing 
a qualified health plan on the federal exchange or any individual health plan offered 
outside of the federal exchange.  The waiver must include authority for individuals who 
qualify for subsidies for purchasing insurance on the federal exchange and choose to 
purchase coverage through the MaineCare program pursuant to this section to use 
advance tax credits and cost-sharing credits, if the individuals are eligible for those 
credits, to purchase coverage through the MaineCare program.
2.  Administration.  The MaineCare purchase option under subsection 1 is 
administered by the department through the MaineCare program.  Individuals purchasing 
coverage through the MaineCare purchase option are entitled to receive the same services 
as any other eligible MaineCare member.
3.  Premiums; financial sustainability.  The commissioner shall seek to implement 
mechanisms to ensure the long-term sustainability of the MaineCare purchase option 
under subsection 1.  These mechanisms must address issues related to minimizing 
adverse selection, the State's financial risk and contribution and negative effects on 
premiums in the individual and group insurance markets, including any insurance 
companies based in the State offering coverage to residents of this State on the federal 
exchange.  Premium rates established by the department for individuals in the MaineCare 
purchase option are determined actuarially.  The department shall also limit the annual 
enrollment period to the same annual open enrollment periods established for purchasing 
insurance coverage on the federal exchange.
4.  Rulemaking.  The department is authorized to adopt rules to implement this 
section.  Rules adopted pursuant to this subsection are major substantive rules as defined 
in Title 5, chapter 375, subchapter 2-A.
5.  Annual reports.  The commissioner shall submit annual reports no later than 
February 15th of each year beginning in 2020 to the joint standing committees of the 
Legislature having jurisdiction over health and human services matters and insurance 
matters regarding the numbers of individuals participating in the MaineCare purchase 
option under subsection 1, premium levels, the fiscal health of the MaineCare purchase 
option and any actuarial information related to the MaineCare purchase option.
Sec. 2.  Waiver report.  No later than January 1, 2020, the Commissioner of 
Health and Human Services shall submit to the joint standing committees of the 
Legislature having jurisdiction over health and human services matters and insurance 
matters a progress report on the request for the federal waiver pursuant to the Maine 
Revised Statutes, Title 22, section 3173-J and the results from actuarial and economic 
analyses that are necessary for a waiver proposal as well as any recommendations for 
legislation necessary to implement the MaineCare purchase option under Title 22, section 
3173-J.
SUMMARY
This bill requires the Commissioner of Health and Human Services to submit a 
waiver under Section 1332 of the federal Patient Protection and Affordable Care Act to 
establish a MaineCare purchase option so that residents of Maine who are not otherwise 
eligible for the MaineCare program may participate in the program.  The waiver must 
include authority for individuals who qualify for advance tax credits and cost-sharing 
credits to use them to purchase coverage through the MaineCare program.  Individuals 
participating in the MaineCare purchase option may access the same services as other 
MaineCare members.  The commissioner is required to implement mechanisms to ensure 
the long-term sustainability of the MaineCare purchase option.  Rates are set by the 
Department of Health and Human Services and determined actuarially, and the open 
enrollment period is the same as the period for individuals purchasing insurance on the 
federal exchange.  The department is required to submit a progress report on the request 
for the waiver as well as annual reports to the joint standing committees of the 
Legislature having jurisdiction over health and human services matters and insurance 
matters.