An Act To Expand the MaineCare Program To Cover All Citizens of the State
Maine Legislature, Session 130, LD 1608
Committee: Health and Human Services
Sponsors: SYLVESTER, CHIPMAN, ARFORD, O'NEIL, TALBOT ROSS, TEPLER, JACKSON

Legislative Document
No. 1608
H.P. 1197
House of Representatives, April 27, 2021
An Act To Expand the MaineCare Program To Cover All Citizens 
of the State
Reference to the Committee on Health and Human Services suggested and ordered printed.
ROBERT B. HUNT
Clerk
Presented by Representative SYLVESTER of Portland.
Cosponsored by Senator CHIPMAN of Cumberland and
Representatives: ARFORD of Brunswick, McDONALD of Stonington, O'NEIL of Saco, 
TALBOT ROSS of Portland, TEPLER of Topsham, Senator: President JACKSON of 
Aroostook.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  5 MRSA c. 166 is enacted to read:
CHAPTER 166
MAINECARE FOR ALL PROGRAM
§2033.  Establishment
The MaineCare for All Program, referred to in this chapter as "the program," is 
established to provide for the health care of residents of this State. The program must be 
designed in accordance with the requirements of this chapter and may not be implemented 
before January 1, 2022 as provided in this chapter.
§2034.  Design of program
1.  Design requirements.  The Department of Health and Human Services, in 
consultation with the Department of Labor and the Department of Professional and 
Financial Regulation, Bureau of Insurance, shall design the program to provide coverage 
for health care services from participating providers within the State if those services are 
necessary or appropriate for the prevention, diagnosis or treatment of, or maintenance or 
rehabilitation following, injury, disability or disease. At a minimum, the program must 
provide:
A.  Coverage for the following health care services:
(1)  Hospital services;
(2)  Medical and other professional services furnished by participating providers;
(3)  Laboratory tests and imaging procedures;
(4)  Home health care for residents of the State 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 residents of the State 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 resident while the resident 
is in the State or out of the State.  The program must pay for a reasonable amount 
charged for medically necessary 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 one.  In January 2022, 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 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, 2023, for all federal waivers 
determined necessary by the study.
3.  Phase 2.  No later than January 31, 2023, the State shall provide 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.
4.  Phase 3.  No later than January 31, 2024 or upon receipt of any necessary federal 
waivers, the State shall provide 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, 2025, the State shall provide 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 for All Implementation Task Force.  The MaineCare for 
All Implementation Task Force, referred to in this section as "the task force," is established 
to oversee planning and implementation of the MaineCare for All Program, 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;
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 30 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 
January 15, 2022 to the Second Regular Session of the 130th Legislature to fully implement 
the MaineCare for All Program.  The task force shall include in its recommended legislation 
provisions to:
A.  Transfer responsibility for administering the MaineCare program and the children's 
health insurance program established in the Maine Revised Statutes, Title 22, section 
3174-T from the Department of Health and Human Services to the MaineCare for All 
Program;
B.  Transfer responsibility for administering any other state or federal health care 
program to the MaineCare for All Program;
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 MaineCare for All 
Program;
D.  Transfer to the MaineCare for All Program all state and federal funds associated 
with programs for which the MaineCare for All Program will assume responsibility;
E.  Enable the MaineCare for All Program to receive the appropriate federal fund 
contribution in lieu of the federal premium tax credits, cost-sharing subsidies and small 
business tax credits provided in the federal Patient Protection and Affordable Care Act 
or its successor acts;
F.  Ensure that the State's expenditures for health care services, including the State's 
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;
G.  Effectuate a smooth and efficient transfer of the programs and responsibilities and 
enable affected departments and agencies to assist the MaineCare for All Program in 
the assumption of its duties;
H.  Establish an ongoing revenue stream to adequately fund the MaineCare for All 
Program; and
I.  Establish a rate board to oversee the true cost of providing care for all the State's 
residents.
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 defined 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 other entities that they represent are entitled to receive 
reimbursement of necessary expenses and, upon a demonstration of financial 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.  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 MaineCare for All Program established in Title 5, chapter 166.
SUMMARY
This bill establishes a single-payer health care program in the State that provides health 
care services for Maine residents. The bill 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 Insurance to develop the program.  The bill requires the 
State to implement the program in 4 phases, based on income, beginning in 2023 for those 
residents not already eligible for the MaineCare program. The bill also creates the 
MaineCare for All Implementation Task Force to advise the departments and make 
recommendations to fully implement the single-payer health care program. The program 
may not be implemented in 2023 without prior legislative approval.