An Act To Implement the State's Recently Approved Request for a Section 1115 Demonstration for MaineCare
Maine Legislature, Session 129, LD 0981
Committee Amendment CA_A_H216 (House)

COMMITTEE AMENDMENT ,4 ,, to H.P. 736, L.D. 981, Bill, "An Act To 
Implement the State's Recently Approved Request for a Section 1115 Demonstration for 
MaineCare" 
Amend the bill by striking out the title and substituting the following: 
'Resolve, To Submit a Request for a Section 1115 Waiver To Require Work 
Participation for MaineCare Eligibility' 
Amend the bill by striking out everything after the title and inserting the following: 
'Sec. 1. Department of Health and Human Se1·vices to submit Section 
1115 waiver. Resolved: That, no later than January 1, 2020, the Department of 
Health and Human Services shall submit a waiver request to the United States 
Department of Health and Human Services, Centers for Medicare and Medicaid Services 
to implement a Medicaid demonstration that does the following: 
1. Community engagement and work requirements. As a condition of eligibility 
for MaineCare, certain adult beneficiaries 19 to 64 years of age shall participate in 20 
hours per week of community engagement activities such as employment, education, job 
skills training, job search activities and community service. 
To remain eligible for 
MaineCare, a nonexempt recipient may have no more than 3 months of noncompliance 
within a 36-month period. Adult beneficiaries exempt from this subsection are: women 
who are pregnant or 60 days postpartum; individuals receiving temporary or pe1manent 
disability benefits; individuals who are physically or mentally unable to participate in 
community engagement or work requirements for 20 hours a week as determined by a 
medical provider; individuals who reside in a residential facility where the individual is 
participating in a residential substance use disorder treatment and rehabilitation program; 
designated caretakers of a child under 6 years of age; caregivers who are responsible for 
the care of an incapacitated individual; and individuals who have a disability as defined 
by federal disabilities rights laws; and 
2. Premiums and cost sharing. As a requirement of eligibility for MaineCare, 
adult beneficiaries 19 to 64 years of age are subject to monthly premiums that may not 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT "A" to H.P. 736, L.D. 981 
exceed 2% of household income except that individuals with income at or below 50% of 
the federal poverty level are not subject to premiums. For MaineCare members earning 
above 50% but not more than 100% of the federal poverty level, the premium is $10 per 
month. For MaineCare members earning above 100% but not more than 150% of the 
federal poverty level, the premium is $20 per month. For MaineCare members earning 
above 150% but not more than 200% of the federal poverty level, the premium is $30 per 
month. For MaineCare members earning above 200% of the federal poverty level, the 
premium is $40 per month. 
Upon approval of the waiver, the department shall implement the provisions of the waiver 
within 6 months of approval. 
Sec. 2. Participation in the marketplace exchange for certain populations. 
Resolved: 
That the Department of Health and Human Services shall examine the 
possibilities for MaineCare members who earn between 100% and 138% of the federal 
poverty level to purchase private insurance, including on the federal marketplace 
exchange established pursuant to the federal Patient Protection and Affordable Care Act, 
and take all practicable steps to assist MaineCare members at this income level to 
purchase private insurance, including on the exchange. 
Sec. 3. Appropriations and allocations. Resolved: 
That the following 
appropriations and allocations are made. 
HEALTH AND HUMAN SERVICES, DEPARTMENT OF 
Medical Care - Payments to Providers 0147 
Initiative: Deappropriates and deallocates funds to account for premium payments from 
members. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
FEDERAL EXPENDITURES FUND 
All Other 
FEDERAL EXPENDITURES FUND TOTAL 
2019-20 
($208,489) 
($208,489) 
2019-20 
($462,619) 
($462,619) 
2020-21 
($423,353) 
($423,353) 
2020-21 
($918,862) 
($918,862) 
Amend the bill by relettering or renumbering any nonconsecutive Part letter or 
section number to read consecutively. 
SUMMARY 
This amendment replaces the concept draft and is the minority report of the 
committee. The amendment requires the Department of Health and Human Services to 
submit a request for a Section 1115 waiver similar to the waiver that was approved in 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT ·A "to H.P. 736, L.D. 981 
2018 and withdrawn in January 2019. The waiver would require MaineCare members 19 
to 64 years of age who are considered able bodied to participate in work or similar 
activities for 20 hours a week and pay monthly premiums based on income. 
The 
department is required to examine the possibilities for MaineCare members earning 100% 
to 138% of the federal poverty level to purchase private health insurance, including on 
the federal marketplace exchange established under the Patient Protection and Affordable 
Care Act, and take all practicable steps to assist those members to purchase private 
insurance. The amendment also adds an appropriations and allocations section. 
FISCAL NOTE REQl1TRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 05/03/19 .::Wac:.. 
LD981 
LR1808(02) 
An Act To Implement the State's Recently Approved Request for a Section 1115 Demonstration for 
MaineCare 
Fiscal Note for Bill as Amended by Committee Amendment /:J { //- ;)J 9 
Committee: Health and Human Services 
Fiscal Note Required: Yes 
Fiscal Note 
Projections 
Projections 
FY2019-20 
FY 2020-21 
FY 2021-22 
FY2022-23 
Net Cost (Savings) 
General Fund 
($208,489) 
($423,353) . 
($423,574) 
($423,574) 
Appropriations/ Allocations 
General Fund 
($208,489) 
($423,353) 
· ($423,574) 
($423,574) 
Federal Expenditures Fund 
($462,619) 
($918,862) 
($918,641) 
($918,641) 
Revenue 
Federal Expenditures Fund 
($462,619) 
($918,862) 
($918,641) 
($918,641) 
Fiscal Detail and Notes 
The bill includes General Fund deappropriations to the Department of Health and Human Services of $208,489 in 
fiscal year 2019-20 and $423,353 in fiscal year 2020-21 to account for premium payments from members. Federal 
Expenditures Fund deallocations are also included for the FMAP match. 
LRl 808(02) - Fiscal Note - Page I of 1