An Act to Offset
Maine Legislature, Session 132, LD 2208
Committee Amendment CA_A_H987 (House)
Amends: 22 MRSA §1730-B, 22 MRSA §3198, 22 MRSA §3199

COMMITTEE AMENDMENT "/^ " to H.P. 1487, L.D, 2208, "An Act to Offset
Federal Cuts to Health Insurance for Certain Maine Families and Seniors"
Amend the bill by striking out everything after the enacting clause and inserting the
following;
'See. 1. 22 MRSA §1730-B is enacted to read;
§1730-8. Rural Health Stabilization Fund
1. Definitions. For the purposes of this section. unless the context otherwise indicates.
the followine tenns have the foUowinR meanings.
A. "Fund" means the Rural Health Stabilization Fund established in subsection 2.
B. "Hospital facility Drice'1 means thetotal amQunt a hospital expects to receive for
health, care services, mcludmg both the amount paid to a hospital bv any insurer or olan
sponsor and any payment received directly from an insured or uninsured individual for
institutional services,
C. "Insurer" has the same meaning as in Title 24-A. section 3952, subsection 6.
D. "Plan sponsor" means any person, other than an insurer, that establishes or
maintams a health plan coverine residents of this State, including, but not limited to.
plans established or maintamed by 2 or more enmlayers or iointlv by one or more
employers and one or more employee oreanizations. associations, committees, ioint
boards of trustees or other similar groups of representatives of the parties that establish
or maintain the plan. "Plan sponsor" does not include the MameCareprogram; the
federal Medicare oroeram; the Civilian Health and Medical Program for the Uniformed
Services, known as TRICARE; the federal Employees Health Benefits program; the
United States Department of Health and Human Services, Indian Health Service; or
any prograEtLRrovidme health benefits administered by the United States Department
of Veterans Affairs.
2. Rural Health Stabilization Fund. The Rural Health Stabilization Fund is
established as a dedicated. nonlapsme fund administered by the department to support the
COMMITTEE AMENDMENT
COMMITTEE AMENDMENT "M " to H,P. 1487, L.D, 2208
department initiatives aooroved under the mral health transformation proeram authorized
by the federal Act to Provide for Reconciliation Pursuant to Title II of H, Con. Res. 14.
Public Law 119-21. Section 71401 that benefit rural health care providers in the State and
that promote access and affordability of health care for residents of the State in rural areas.
The department may receive money from any gift. grant. contribution, leeislative
appropriation, allocation or transferor bond proceeds. Themonev m the funcl maYbe used
only for the purposes described in this subsection and pavme oroeram administration costs.
3, Fundine elieibilitv. As a condition of accepting fandine from the department from
theiund. a hospital or health system shall meet the followme requirements^
A, A hospital or health system that accepts funds must limit the annual growth of
hospital facility DricesJ:o a oercentaee equal to the inuatient orosDective oavment
system hospital market basket index established by the federal Medicare program for
a period of 5 years from the time funds are mitiallv disbursed, A hospital or health
system that accepts funds may not:
(/D Enter into a contract with any insurer or plan sponsor in which the growth of
the allowed amount for any inoatient or outpatient facility service exceeds the
hospital facility price growth limit for that plan year; or
(2) Charge or collect payment for any moatient or outpatient facility service in an
amount that exceeds the wior year s orice for that same service by more than the
hospital facility price growth limit for that plan year. mcludine any amount chareed
to or collected from an insurer, plan sponsor or individual or any other source with
respect to the service,
B. Except as otherwise provided in this subsection, for a period of 5 years fi'om the
disbursement of funds, a hospital or health svstemthataccepts funds may not
0.) Charge or collect payment from any insurer, plan sponsor or patient for any
mpatient or outpatient facility service in an amount that exceeds 200% of the
Medicare rate for the same service in the same geographic area;
{2) Enter into a contract with any insurer or plan sponsor in which the allowed
amount paid for any mpatient or outpatient facility service exceeds 200% of the
Medicare rate for the same service m the same eeograuhic area; or
(3') Charge or collect payment for any amount exceedine the allowed amount for
a covered health care service pursuant to this subsection, except for any aBBlicable
in-network coinsurance. deductible or cooavment amount, includine any amount
diarged to or collected from an insurer, plan sponsor or individual or any other
5 source with respect to the service.
C. Paragraph B does not awlv to;
fl) Charges for services provided to a critical access hospital that accepts funds
under this subsection; or
(2) Charees for services provided to a hospital determined to be fmancially
distressed by the Office of Affordable Health Care, A determination of financial
distress is valid for a period of no less than one year.
D, A hospital or health system that accepts funds under this subsection that fails to
comolv with the requirements of paragraph A or B commits a civil violation for which
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COMMITTEE AMENDMENT "i\ " to H.P,1487, L.D,2208
a fme equal to at least 110% and no more than 200% of any charge exceeding the limits
set forth in paragraph A or B may be adiudeed and all fundine granted to the hospital
or health system under this section must be returned to the State.^
4. Rulemakine. The department may adopt rules to unolement this section. Rules
adotrted pursuant to this subsection areroutme technical rules as defined, mj"itle^5, chapter
375. subchaoter 2-A.
Sec. 2. 22 MRSA §3198 is enacted to read:
S3198. Health Care Premium Stabilization Fund
1. Fund established. The Health Care Premium Stabilization Fund, referred to in this
section as "the fund." is established as a dedicated. nonlaosmg fund administered by the
department to maintain coverage foL^esidents of the^tate through_the Ma^^^^^^^^
Insurance Marketplace, established in chapter 1479.
2. Sources of fund. The fund consists of amounts aooronriated or allocated by the
State. The department may receive jnoney from any gift, grant, confa'ibution, legislative
aoDrooriation. allocation or transfer or bond proceeds.
3. Uses of fund. The department shall use the fund to establish a state subsidy to offset
the financial impact of the expiration of the enhanced premium tax credits under the
American Rescue Plan Act of 2021. Public Law 117-2, The subsidy must be used to
increase the amount of assistance available to those previously elirible for subsidies^under
the federal Affordable Care Act. Public Law 111-148 and to expand assistance to those
with an income at or above 400% of the federal poverty level if the recipient's monthly
eremium cost of the second lowest cost silver health plan. as described in theUmted States
Internal Revenue Code of 1986. Section 36Bfby3VB'). would, prior _to_the receipt of a
subsidy under this section. exceed 8.5% of the recipient's monthly household income.
4. State subsidy; treatment for tax purposes. The department shall implement this
section in a manner that minimizes the imoact of any subsidy on a recipient's income for
federal tax purposes to the^reatest extent permissible under federal law and the law of this
State. Notwithstanding any provision of law to the contrary. for Maine mcome tax
purposes, the amount of any subsidy provided to a recipient may not be considered income.
5. Rulemakine. The department may adopt rules to implement this section. Rules
adopted pursuant to this subsection are routme technical rules as defined in Title 5. chapter
375.subchar>ter2-A.
Sec. 3. 22 MRSA §3199 is enacted to read:
§3199. MaineCare Federal Response Fund
^ Fund established. The MaineCare Federal Response Fund, referred to in this
section as "the fund." is established as a dedicated. nonlaosine fund administered by the
department to supplement funding for the MaineCare WQ&ram in_tfie case of funding
revenue shortfalls due to reductions in federal contributions that support the MaineCare
program. The department may use funds m the fund to enhance oroeram outreach and to
address changes to federal requirements related to proeram eligibility and renewals. The
department may not use funds m the fund to expand elieibilitv or services under the
MaineCarejirogram,
COMMITTEE AMENDMENT
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COMMITTEE AMENDMENT "+\ " to H.P. 1487, L,D. 2208
2. Rulemakine. The department may adopt mles to implement this section. Rules
adopted pursuant to this subsection are routine technical rules as defmed in Title 5. chapter
375. subchaoter 2-A.
Sec. 4. Appropriations and allocations. The following appropriations and
allocations are made.
ADMINISTRATIVE AND FINANCIAL SERVICES, DEPARTMENT OF
Miscellaneous Acts and Resolves - Finance 0306
Initiative; Appropriates ongoing funding to be distributed to the Maiae Guaranteed Access
Reinsurance Association to support the reinsurance program.
GENERAL FUND 2025-26 2026-27
AllOther $0 $40,000,000
GENERAL FUND TOTAL $0 $40,000,000
ADMINISTRATIVE AND FINANCIAL
SERVICES, DEPARTMENT OF
DEPARTMENT TOTALS 2025-26 2026-27
GENERAL FUND $0 $40,000,000
DEPARTMENT TOTAL - ALL FUNDS $0 $40,000,000
HEALTH AND HUMAN SERVICES, DEPARTMENT OF
Health Care Premium Stabilization Fund N566
Initiative: Provides one-time funding for the Health Care Premium Stabilization Fund,
including one-time funds for equipment and technology costs. The technology funds will
be used to implement changes in the enrollment and eligibility system for state subsidy
program eligibility determination, as well as changes to premium, coverage and billing
information.
GENERAL FUND 2025-26 2026-27
AllOther $0 $17,300,000
Capital Expenditures $0 $8,000,000
GENERAL FUND TOTAL $0 $25,300,000
4 MaineCare Federal Response Fund N568
Initiative: Provides one-time fundmg to address reductions in federal funding for the
MaineCare program, including funding for technology improvements at the department's
office for family independence and office of MaineCare services to implement federal
8 policy changes. The department may also use these funds to enhance outreach to help with
9 the rollout of new federal requirements related to eligibility and renewals.
GENERAL FUND 2025-26 2026-27
AllOther $0 $105,000,000
COMMITTEE AMENDMENT
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COMMITTEE AMENDMENT"^ "toH.P. 1487, L.D. 2208
GENERAL FUND TOTAL $0 $105,000,000
Rural Health Stabilization Fund N567
Initiative: Provides one-time funding to support approved department initiatives under the
federal rural health transformation program,
GENERAL FUND 2025-26 2026-27
AllOther $0 $50,000,000
GENERAL FUND TOTAL $0 $50,000,000
HEALTH AND HUMAN SERVICES,
DEPARTMENT OF
DEPARTMENT TOTALS 2025-26 2026-27
1314 GENERAL FUND $0 $180,300,000
DEPARTMENT TOTAL-ALL FUNDS $0 $180,300,000
SECTION TOTALS 2025-26 2026-27
GENERAL FUND $0 $220,300,000
SECTION TOTAL-ALL FUNDS $0 $220,300,000
Amend the bill by relettering or renumbermg any nonconsecutive Part letter or section
number to read consecutively.
SUMMARY
This amendment, which is the majority report of the committee, replaces the bill and
does the following.
1. It establishes the Rural Health Stabilization Fund to provide $50 million in one-time
funding to support the Department of Health and Human Services' initiatives approved
under the rural health transformation program authorized by the federal Act to Provide for
Reconciliation Pursuant to Title D: of H. Con. Res, 14, Public Law 119-21, Section 71401
that benefit rural health providers in the State and that promote access and affordability of
health care for residents of the State in rural areas. As a condition of accepting a grant by
the department from the fund, a hospital or health system that accepts funds must limit the
annual growth of hospital facility prices to a percentage equal to the inpatient prospective
7 payment system hospital market basket index established by the federal Medicare program
for a period of 5 years from the tune funds are initially disbursed. A participating hospital
or health system may not charge or collect payment from any insurer, plan sponsor or
patient for any inpatient or outpatient facility service in an amount that exceeds 200% of
the Medicare rate for the same service in the same geographic area. The conditions do not
apply to critical access hospitals or hospitals determined to be financially distressed by the
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COMMITTEE AMENDMENT « H-" to H.P. 1487, L.D, 2208
Office of Affordable Health Care. A participating hospital or health system that fails to
comply with the requirements commits a civil violation for which a fme may be adjudged
and is required to return all funding granted to the hospital or health system to the State.
2. It establishes the Health Care Premium Stabilization Fund to provide $17.3 million
in one-time funding to establish a state subsidy to offset the financial impact of the
expiration of the enhanced premium tax credits under the American Rescue Plan Act of
2021 to those residents of the State who receive health care coverage under the Maine
Health Insurance Marketplace who were previously eligible for subsidies under the federal
Affordable Care Act.
3. It establishes the MaineCare Federal Response Fund to provide $ 105 million in one-
time funding to supplement funding for the MaineCare program in the event of fundmg
revenue shortfalls due to reductions in federal contributions that support the MaineCare
program. It provides that the funding is not intended to be used to expand eligibility or
services for the MaineCare program.
4. It provides ongoing funding of $40 million to the Maine Guaranteed Access
Reinsurance Association to increase the reinsurance program.
FISCAL NOTE REQUIRED
(See attached)
COMMITTEE AMENDMENT
Approved: 04/02/26 t-Kt-
LD 2208 LR 2772(02)
An Act to Offset Federal Cuts to Health Insurance for Certain Maine Families and Seniors
Fiscal Note for Bill as Amended by Committee Amendment ^-f'
Committee: Health Coverage, Insurance and Financial Services
Fiscal Note Required: Yes
Fiscal Note
Projections Projections
FY 2025-26 FY 2026-27 FY 2027-28 FY 2028-29
Net Cost (Savings)
General Fund $0 $220,300,000 $40,000,000 $40,000,000
|)propriations/Allocations
General Fund $0 $220,300,000 $40,000,000 $40,000,000
Fiscal Detail and Notes
The bill includes General Fund appropriations to the Department of Administrative and Financial Services of
$40,000,000 in fiscal year 2026-27 to be distributed to the Maine Guaranteed Access Reinsurance Association.
This bill also includes a one-time General Fund appropriation to the Department of Health and Human Services of
$180,300,000 in fiscal year 2026-27 to implement the provisions of the bill.
The Department of Health and Human Services has estimated that $150,000,000 would be required to completely
restore the loss of federal subsidies.
LR2772(02) - Fiscal Note - Page 1 of 1