An Act To Expand the MaineCare Program To Cover All Citizens of the State
Maine Legislature, Session 130, LD 1608
Committee Amendment CA_A_H920 (House)

COMMITTEE AMENDlvIENT "ff" to H.P. 1197, L.D. 1608, "An Act To Expand 
the MaineCare Program To Cover All Citizens of the State" 
Amend the bill by striking out the title and substituting the following: 
'An Act To Expand MaineCare Eligibility to All Residents of the State' 
Amend the bill by striking out everything after the enacting clause and inserting the 
following: 
'Sec. 1. 5 MRSA c, 166 is enacted to read: 
CHAPTER166 
PROGRAM TO ALLOW MAINECARE ELIGIBILITY FOR ALL 
§2033. Establishment 
The Program to Allow MaineCare Eligibility for All. referred to in this chapter as "the 
program." is established to provide for the health care eligibility of all residents of this 
State. The program must be designed in accordance with the requirements of this chapter 
and may not be implemented before Janua1y 1, 2023 as provided in this chapter. 
§2034. Design of program 
1. 
Design requirements. 
The Depattment of Health and Human Services, in 
consultation with the Department of Labor and the Department of Professional and 
Financial Regulation, Bureau oflnsurance, shall design the program to provide eligibility 
for coverage for health care services from participating providers within the State if those 
services are necessaty or appropriate for the prevention, diagnosis or treatment of, or 
maintenance or rehabilitation following, injuty, disability or disease. At a minimum, the 
program must provide to any resident who is a MaineCare member the following: 
A. Coverage for the following health care services: 
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COMMITTEE AMENDMENT .ft" to H.P. 1197, L.D. 1608 
(1) Hospital services; 
(2) Medical and other professional services furnished by participating providers: 
(3) Laboratory tests and imaging procedures; 
(4) Home health care for MaineCare members requiring services performed by or 
under the supervision of professional or technical personnel, including, but not 
limited to, home health care for acute illness, personal care attendant services and 
the medical component of home health care for chronic illness; 
(5) Rehabilitative services for MaineCare members receiving therapeutic care; 
( 6) Prescription drugs and devices; 
(7) Mental health services; 
(8) Substance use disorder treatment: 
(9) Primary and acute dental services: 
(10) Vision appliances. including lenses, frames and contact lenses; 
(11) Medical supplies, durable medical equipment and selected assistive devices; 
and 
(12) Hospice care; 
B. Delivery of covered health care services through organized delivery systems; 
C. Payment for covered health care services provided to a member while the member 
is in the State or out of the State. The program must pay for a reasonable amount 
charged for medically necessaiy emergency health care services; and 
D. Fair rates of compensation with participating providers and organized delivery 
systems and negotiation with pharmaceutical companies for similarly classified 
pharmaceuticals. 
§2035. Implementation 
1. Implementation. Upon enactment of authorizing legislation establishing financing 
for the program, the State shall implement the program in phases as required in subsections 
to 5. 
2. Phase 1. In January 2023, the Department of Health and Human Services shall 
convene a committee that shall authorize a request for proposals for a full study of the costs, 
economic benefits and issues, including any federal waivers, related to expanding 
eligibility for coverage through the program for all residents of the State. This request for 
proposals must be self-funded by outside sources unless covered under the normal 
operating budget of existing programs in the State's biennial budget. Upon completion of 
the study. the Department of Health and Human Services shall apply, no later than June 30, 
2024, for all federal waivers determined necessaty by the study. 
3. Phase 2. No later than January 31, 2024, the State shall provide eligibility for 
coverage through the program for a resident of the State who is not eligible for coverage 
under the MaineCare program and who has an income that is below 200% of the federal 
poverty level. 
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COMMITTEE AMENDMENT "K" to H.P. 1197, L.D. 1608 
4. Phase 3. No later than January 31, 2025 or upon receipt of any necessary federal 
waivers, the State shall provide eligibility for coverage through the program for a resident 
of the State who has an income between 200% and 400% of the federal poverty level. 
5. Phase 4. No later than January 31, 2026, the State shall provide eligibility for 
coverage through the program for a resident of the State who has an income above 400% 
of the federal poverty level. 
6. Waiver; request for federal approval. The Department of Health and Human 
Services and any other affected department or agency of the State shall apply for all 
waivers, exemptions and approvals from the Federal Government that are necessary to fully 
implement the program. 
For the purposes of this section, "federal poverty level" means that measure defined 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). 
Sec. 2. MaineCare Eligibility for All Implementation Task Force. The 
MaineCare Eligibility for All Implementation Task Force, referred to in this section as "the 
task force," is established to oversee planning and implementation of the Program to Allow 
MaineCare Eligibility for All, established in the Maine Revised Statutes, Title 5, chapter 
166, as follows. 
1. Appointments; composition. The task force consists of members appointed as 
follows: 
A. Four members of the Senate, appointed by the President of the Senate, including 2 
members of the party holding the largest number of seats in the Senate and 2 members 
of the party holding the 2nd largest number of seats in the Senate, of whom at least one 
member is a member of the Joint Standing Committee on Health Coverage, Insurance 
and Financial Services, at least one member is a member of the Joint Standing 
Committee on Health and Human Services and at least one member is a member of the 
Joint Standing Committee on Labor and Housing or the Joint Standing Committee on 
Taxation; and 
B. Five members of the House of Representatives, appointed by the Speaker of the 
House of Representatives, including 2 members of the party holding the largest number 
of seats in the House of Representatives and 2 members of the party holding the 2nd 
largest number of seats in the House of Representatives, of whom at least one member 
is a member of the Joint Standing Committee on Health Coverage, Insurance and 
Financial Services, at least one member is a member of the Joint Standing Committee 
on Health and Human Services and at least one member is a member of the Joint 
Standing Committee on Labor and Housing or the Joint Standing Committee on 
Taxation. 
2. Consultants. The chairs of the task force may appoint the following persons as 
consultants to the task force: 
A. One person representing the interests of hospitals; 
B. Two persons representing the interests of health care providers, including one 
person from an organization representing physicians and one person from an 
organization representing nurses; 
C. Two persons representing the interests of health care consumers; 
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CO"MM.ITIEE AMENDMENT" If< to H.P. 1197, L.D. 1608 
D. One person representing the interests of employers with fewer than 50 employees; 
and 
E. One person representing the interests of employers with 50 or more employees. 
3. Chairs. The first-named Senator is the Senate chair of the task force, and the first-
named member of the House of Representatives is the House chair of the task force. The 
chairs may invite individuals with expertise in health care policy, health care financing or 
health care delivery to assist the task force. 
4. Appointments; convening. All appointments must be made no later than 30 days 
following the effective date of this Act. The appointing authorities shall notify the 
Executive Director of the Legislative Council once all appointments have been made. 
When the appointment of all members has been completed, the chairs of the task force shall 
call and convene the first meeting of the task force. If 3 0 days or more after the effective 
date of this Act a majority of but not all appointments have been made, the chairs may 
request authority and the Legislative Council may grant authority for the task force to meet 
and conduct its business. 
5. Recommendations. The task force shall submit recommended legislation by 
November 2, 2022 to the First Regular Session of the 131st Legislature to fully implement 
the Program to Allow MaineCare Eligibility for All. The task force shall include in its 
recommended legislation provisions to: 
A. Transfer responsibility for administering the MaineCare program and the children1s 
health insurance program established in the Maine Revised Statutes, Title 22, section 
4-T from the Department of Health and Human Services to the Program to Allow 
MaineCare Eligibility for All; 
B. Transfer responsibility for administering any other state or federal health care 
program to the Program to Allow MaineCare Eligibility for All; 
C. Apply for all waivers, exemptions and approvals from State Government and the 
Federal Government that are necessary to transfer health care funding from the Federal 
Government and from any state departments and agencies to the Program to Allow 
MaineCare Eligibility for All; 
D. Transfer to the Program to Allow MaineCare Eligibility for All all state and federal 
funds associated with programs for which the Program to Allow MaineCare Eligibility 
for All will assume responsibility; 
E. Ensure that the State1s expenditures for health care services, including the State1s 
responsibility for providing matching funds for the MaineCare program and other 
federally supported health care programs, do not fall below the expenditure levels for 
health care services in the year preceding the effective date of this Act; 
F. Effectuate a smooth and efficient transfer of the programs and responsibilities and 
enable affected departments and agencies to assist the Program to Allow MaineCare 
Eligibility for All in the assumption of its duties; 
G. Establish an ongoing revenue stream to adequately fund the Program to Allow 
MaineCare Eligibility for All; and 
H. Establish a rate board to oversee the true cost of providing care for all MaineCare 
members. 
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COMMITTEE AMENDMENT" r 
to H.P. 1197, L.D. 1608 
6. Oversight of planning. At every meeting of the task force, the Commissioner of 
Health and Human Services, the Commissioner of Labor and the Superintendent of 
Insurance or their designees shall brief the task force on planning issues, progress, 
challenges and the timeline for implementation. 
7. Compensation. The legislative members of the task force are entitled to receive the 
legislative per diem, as def med in the Maine Revised Statutes, Title 3, section 2, and 
reimbursement for travel and other necessary expenses related to their attendance at 
authorized meetings of the task force. Those persons appointed as consultants not otherwise 
compensated by their employers or in their contract or by other entities that they represent 
are entitled to receive reimbursement of necessary expenses and, upon a demonstration of 
fmancial hardship, a per diem equal to the legislative per diem for their attendance at 
authorized meetings of the task force. 
8. Quorum. A quorum is a majority of the members of the task force. 
9. Staffing. The Legislative Council shall provide staff support for the task force. To 
the extent needed when the Legislature is in session, the Legislative Council may contract 
for such staff support if sufficient funding is available. 
10. Experts; additional staff assistance. The task force may solicit the services of 
one or more outside experts to assist the task force to the extent resources are available. 
Upon request, the Department of Health and Human Services, the Department of 
Professional and Financial Regulation, Bureau of Insurance and the Department of Labor 
shall provide any additional staffing assistance to the task force to ensure the task force has 
the information necessary to make the recommendations required by subsection 5. 
Sec. 3. Contract limitation. A contract chosen in response to the request for 
proposals issued pursuant to the Maine Revised Statutes, Title 5, section 2035, subsection 
must be no more than $200,000. 
Sec. 4. Contingent effective date. The Maine Revised Statutes, Title 5, section 
2035, subsections 3, 4 and 5 take effect only upon the enactment into law of legislation 
providing financing for the Program to Allow MaineCare Eligibility for All established in 
Title 5, chapter 166.' 
Amend the bill by relettering or renumbering any nonconsecutive Part letter or section 
number to read consecutively. 
SUMMARY 
This amendment, which is the minority report of the committee, replaces the bill. 
Rather than establishing a single-payer health care program in the State that provides health 
care services for Maine residents as in the bill, the amendment establishes the Program to 
Allow MaineCare Eligibility for All. It allows any resident of the State to enroll as a 
MaineCare member rather than providing a single program ofMaineCare for all residents 
of the State. The amendment uses the same process as the bill to implement the program 
in 4 phases based on income beginning in 2024 for those residents not already eligible for 
the MaineCare program. The amendment changes the name of the implementation task 
force to the MaineCare Eligibility for All Implementation Task Force. The amendment 
changes all dates in the bill to one year later than in the bill. It also clarifies that the contract 
chosen in response to the request for proposals must be no more than $200,000 and that 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT •ff to H.P. 1197, L.D. 1608 
consultants who are compensated through a contract are not entitled to other compensation 
for participating in the implementation task force. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 03/31/22 feae 
LD 1608 
LR912(02) 
An Act To Expand the MaineCare Program To Cover All Citizens of the State 
Legislative Cost/Study 
Fiscal Note for Bill as Amended by Committee Amendment ~"{_ff ,,q?---o) 
Committee: Health and Human Services 
Fiscal Note Required: Yes 
Fiscal Note 
Legislative Cost/Study 
The general operating expenses of this study are projected to be $7,000 in fiscal year 2022-23. The Legislature's 
budget for the 2022-2023 biennium includes an estimated $6,108 in fiscal year 2021-22 and $10,000 in fiscal year 
2022-23 for the costs of legislative studies, as well as $31,260 of balances carried over from prior years for this 
purpose. Whether these amounts are sufficient to fund all studies will depend on the number of studies authorized by 
the Legislative Council and the Legislature. The additional costs of providing staffing assistance to the study during 
the interim can be absorbed utilizing existing budgeted staff resources. The bill authorizes the Legislative Council to 
contract for staff support during the session if sufficient funds are available. 
Fiscal Detail and Notes 
This bill establishes a Program to Allow MaineCare Eligibility for all. It directs the Department of Health and Human 
Services to consult with the Department of Labor and the Department of Professional and Financial Regulation, 
Bureau of fusurance to develop the program. The bill requires the State to implement the program in 4 phases, based 
on income, beginning in 2024 for those residents not already eligible for the MaineCare program. The bill also creates 
the MaineCare Eligibility for All Implementation Task Force to advise the departments and make recommendations to 
fully implement the program. The program may not be implemented in 2024 without prior legislative approval. After 
full implementation of the program on January 31, 2026, itis estimated that the program will cover 45% of newly 
eligible Mainer's, over 356,000 new members, at an annual General Fund cost of $6,140,348,796. • 
The additional costs to the Department of Health and Human Services, the Department of Professional and Financial 
Regulation, Bureau of Insurance and the Department of Labor to provide assistance to the Task Force if requested can 
be absorbed using exiting budgeted resources. 
LR0912(02) - Fiscal Note - Page 1 of 1