1,026 in county could lose MaineCare

COUNTY — As many as 1,026 Oxford County residents who receive MaineCare benefits will lose assistance March 1 as the state finally enacts cuts to the health care system.

According to Maine Department of Health and Human Services Spokesperson John Martins, 581 low-income parents may lose Medicaid coverage and 445 disabled and elderly could lose or receive reduced benefits under the Medicare Savings Plan.

More than 200 cases are currently being reviewed, so the total number of people who might lose benefits could change, according to Martins.

Last August, DHHS Commissioner Mary Mayhew requested federal approval for Legislature-enacted reductions in MaineCare.

The cuts, including eliminating coverage for 19- and 20-year olds and reducing eligibility only to parents at 100 percent of the Federal Poverty Limit were intended to save the state nearly $20 million.

In early January, the federal Centers for Medicaid and Medicare Services denied most of the state's cuts but approved new restrictions on MSP eligibility and revised income thresholds for MaineCare eligible parents.

According to Martins, the cuts will affect around 20,000 Mainers and save the state about $4 million.

Although the savings are far less than anticipated, the restrictions will have future impact, Martins said on Monday.

"This is a reduction that will continue further," Martins said. "It's a structural change, not a one-time change."

With draw-downs in federal assistance, especially the absence of funding from the American Reinvestment and Recovery Act, MaineCare costs have become unsustainable, Martins said.

The state's payments to MaineCare from the general fund rose 48 percent this year, Martins said – DHHS needed to pursue structural changes, like restricting eligibility, to reign in spending.

"One of the things we've been looking to do is move our state back to what the requirements of the program are in terms of who we cover because we simply can't afford the program as it stands today," Martins said.

Affected groups

Two main groups are affected by the MaineCare changes.

The first category is parents with household income greater than 133 percent of FPL – $31,332 for a family of four.

According to DHHS, about half of the 12,592 parents affected by the cuts may be eligible for 12 months of transitional coverage.

The Medicare Savings Program, also known as the "Medicare buy-in benefit" or "duel benefits"  helps low-income Medicare-eligible people pay for the deductibles and premiums associated with the program.

According to Martins, the changes to MSP will have different effects based on the type of coverage provided to different categories of recipients.

Essentially, people at higher percentages of FLP will lose more than those closer to the poverty line.

Around 2,600 MSP recipients with incomes between 175 and 185 percent of FPL –  between  $2,295 and $2,392 per month for a couple –  will be excluded from the program entirely, Martins said.

According to the anti-poverty group, Maine Equal Justice Partners, MSP beneficiaries stand to lose aid that partially pays for hospitalization, skilled nursing, Medicare deductibles, co-insurance and prescription drug cost coverage.

A U.S. District Court decision on a legal challenge brought against U.S. Department of Health and Human Services by MEJP on behalf of five Maine residents is set to be announced February 28, one day before the changes are set to take place, according to Jack Comart, MEJP's litigation director.

On Monday, Comart said federal law requires states to maintain Medicaid eligibility requirements until 2014, when key elements of the 2010 federal health care overhaul law, like health care exchanges, are set up. 

"There's a limited exception to that for some states, but we don't think Maine falls into that limited exception," Comart said.

Denying Medicaid coverage to people who cannot afford private insurance simply "kicks the can down the road" and may result in higher insurance rates for consumers, Comart argued.

"They end up putting off necessary care, and then they show up in hospitals and they get more expensive and less appropriate care and that cost gets shifted to taxpayers and rate payers in one way or the other," Comart said.

"It's not like you cut this benefit and the need goes away."

Further cuts that would drop coverage for up to 10,000 low-income adults living under 100 percent of FPL are slated for the end of the year, if Maine decides not to extend the 2001 waiver that enacted the program, Comart said.