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127th MAINE LEGISLATURE |
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LD 633 |
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LR 1188(02) |
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An Act To Improve
the Health of Maine Citizens and the Economy of Maine by Providing Affordable
Market-based Coverage Options to Low-income Uninsured Citizens |
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Fiscal Note for
Bill as Amended by Committee Amendment " " |
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Committee: Health and Human Services |
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Fiscal Note Required: Yes |
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| Fiscal Note |
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FY 2015-16 |
FY 2016-17 |
Projections FY 2017-18 |
Projections FY 2018-19 |
| Net Cost
(Savings) |
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General Fund |
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$0 |
$12,549,248 |
$36,010,365 |
$44,569,453 |
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| Appropriations/Allocations |
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General Fund |
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$0 |
$12,549,248 |
$36,010,365 |
$44,569,453 |
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Federal Expenditures Fund |
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$0 |
$222,859,155 |
$469,552,481 |
$469,882,438 |
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Other Special Revenue Funds |
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$0 |
$4,563,610 |
$6,084,810 |
$6,084,810 |
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| Revenue |
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Federal Expenditures Fund |
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$0 |
$222,859,155 |
$469,552,481 |
$492,882,438 |
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Other Special Revenue Funds |
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$0 |
$4,563,610 |
$6,084,810 |
$6,084,810 |
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| Fiscal Detail
and Notes |
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Part A of this
bill expands medical coverage under the MaineCare program to adults who
qualify under federal law with incomes up to 133% of the nonfarm income
official poverty line (FPL), with the 5% federal income adjustment for family
size. Individuals with income equal to or below 100% FPL would receive
coverage through MaineCare.
Individuals with income over 100% FPL through 138% FPL would receive
coverage through private health insurance plans, through premium assistance
at the same level that would be provided through advanced premium tax
credits. Part A also requires those with income over 100% and equal to or
below 138% FPL who are receiving private health coverage through the Maine
Private Health Insurance Protection Program to pay premiums and cost sharing
up to a maximum of 5% of household income. Part A also allows for the
termination of the program under two scenarios: 1) If the federal share for
individuals eligible under this paragraph is reduced below the amounts
specified in 42 United States Code, Section 1396d(y)(1) or 2) if expanded
coverage is not reauthorized by the legislature by June 30, 2019. The
Department of Health and Human services (DHHS), after consultation with a
stakeholder group, is required to file a waiver to test a full continuum of
substance use disorder treatment. This part also authorizes the DHHS to apply
for and accept private foundation grants to be used to cover the cost of
preparing and submitting any waivers and state plan amendments to the federal
government required as a result of expanding coverage. The DHHS will report
monthly on the status of the waiver and will report no later than June 1,
2017 on the status of implementation of the program. |
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The bill includes
a General Fund appropriation of $1,933,957 in fiscal year 2016-2017 to the
Office of Family Independence - District program in the DHHS for the State
share of the costs of 103 new positions to administer the eligibility
expansion. Funding for the new positions reflects a 75% federal match for the
79 Eligibility Specialist positions and a 50% federal match for other new
positions. The funding for the Eligibility Specialist positions assumes a 700
person caseload for each new position. This is the target caseload the DHHS
has identified for the Eligibility Specialist positions. Although this bill
allows for the DHHS to utilize the federally facilitated marketplace for
eligibility determinations, this estimate assumes that will not occur in the
current or next biennium. |
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The bill includes
a General Fund appropriation of $4,422,964 in fiscal year 2016-17 to the DHHS
for medical costs for the newly eligible childless adult population at or
below 100% of the federal poverty level and a Federal Expenditures Fund
allocation of $84,036,307 in fiscal year 2016-17, as shown below. The
estimated costs assume 95% enhanced federal matching funds through December
31, 2017, 94% enhanced federal matching funds through December 31, 2018 and
93% enhanced federal matching funds through December 31, 2019 for the
childless adult population with incomes less than 100% of the federal poverty
level. |
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FY 2015-16 |
FY 2016-17 |
FY 2017-18 |
FY 2018-19 |
Childless Adults @ or below 100% of FPL
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Estimated Population |
27,937 |
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Est. Annual Cost Per Person |
$6,333 |
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$ 88,459,270 |
$183,995,281 |
$191,355,092 |
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Assumed Federal Match |
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95.0% |
94.5% |
93.5% |
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Federal Share of Costs |
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$ 84,036,307 |
$173,875,541 |
$178,917,011 |
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State Share of Costs |
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$
- |
$
4,422,964 |
$
10,119,740 |
$
12,438,081 |
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The bill includes
a General Fund appropriation of $4,525,464 in fiscal year 2016-17 to the DHHS
for premium and coinsurance costs for the newly eligible childless adult
population from 101% to 138% of FPL on the Private Health Insurance market
and a Federal Expenditures Fund allocation of $85,983,818 in fiscal year
2016-17, as shown below. The estimated costs assume 95% enhanced federal
matching funds through December 31, 2017, 94% enhanced federal matching funds
through December 31, 2018 and 93% enhanced federal matching funds through
December 31, 2019 for the childless adult population with incomes from 101%
to 138% of the federal poverty level. |
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FY 2015-16 |
FY 2016-17 |
FY 2017-18 |
FY 2018-19 |
Childless Adults from 101% to 138% of FPL
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Estimated Population |
31,557 |
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Est. Annual Cost Per Person |
$5,736 |
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$ 90,509,282 |
$194,490,377 |
$208,853,584 |
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Assumed Federal Match |
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95.0% |
94.5% |
93.5% |
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Federal Share of Costs |
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$ 85,983,818 |
$183,793,406 |
$195,278,101 |
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State Share of Costs |
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$
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$
4,525,464 |
$
10,696,971 |
$
13,575,483 |
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The bill also
includes a General Fund appropriation of $20,475,789 in fiscal year 2016-17
for the DHHS for premium and coinsurance costs for the parent population from
101% to 138% of the federal poverty level on the Private Health Insurance
market, as shown below. The below table assumes 15,455 parents who lost
coverage and an additional 4,565 parents who have not had MaineCare in the
past, but will opt for this expansion coverage. Since this group was eligible
under previous rules, they will not be considered newly eligible and the
State will receive the regular Federal Medical Assistance Percentage (FMAP).
The bill also includes a Federal Expenditures Fund allocation for the parents
totaling $36,943,699 in fiscal year 2016-17, as shown below, for the regular
FMAP matching funds. |
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FY 2015-16 |
FY 2016-17 |
FY 2017-18 |
FY 2018-19 |
| Parents (Between 101 and 133% of the FPL) |
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Estimated Population |
20,020 |
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Est. Annual Cost Per Person |
$5,736 |
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$ 57,419,488 |
$123,385,553 |
$132,497,635 |
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Assumed Federal Match |
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64.34% |
64.34% |
64.34% |
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Federal Share of Costs |
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$ 36,943,699 |
$
79,386,265 |
$
85,248,978 |
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State Share of Costs |
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$ 20,475,789 |
$
43,999,288 |
$
47,248,657 |
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The bill also
includes a General Fund appropriation of $193,711 in fiscal year 2016-17 for
the DHHS for medical costs for the children who have not had MaineCare in the
past, but whose family will opt for MaineCare coverage after expansion. Since
these children were eligible under previous rules, they will not be
considered newly eligible and the State will receive the enhanced Children's
Health Insurance Program (CHIP) FMAP. The bill also includes Federal
Expenditures Fund allocations for children totaling $9,843,135 in fiscal year
2016-17, as shown below, for the enhanced CHIP FMAP matching funds. |
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FY 2015-16 |
FY 2016-17 |
FY 2017-18 |
FY 2018-19 |
| Crowd-out Children (Between 101 and 133% of the FPL) |
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Estimated Population |
4,565 |
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Est. Annual Cost Per Person |
$4,397 |
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$ 10,036,846 |
$
21,077,239 |
$
22,131,183 |
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Assumed Federal Match |
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98.07% |
98.07% |
98.07% |
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Federal Share of Costs |
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$
9,843,135 |
$
20,670,448 |
$
21,704,051 |
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State Share of Costs |
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$
193,711 |
$
406,791 |
$
427,132 |
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The bill also
includes deappropriations for the remaining funding in the MaineCare baseline
for the costs of coverage for the parents population from 101% to 138% of the
FPL. This group was covered through December 31, 2013, with the possibility
of transitional coverage extending through December 31, 2014. The DHHS
identified, as of May 2014, an annual General Fund total in the baseline for
spending on this population of $16,936,665. Of this amount, $10,000,000 was
deappropriated in PL 2013, c. 595 to fund Sections 21 and 29 waitlist members
and to increase nursing facility reimbursement rates. Since there were no
subsequent MaineCare appropriations or deappropriations affecting this
population during the 126th Legislature or the 1st Regular Session of the
127th Legislature, continued funding for this population is included in the
2016-2017 MaineCare biennial budget baseline. This bill deappropriates the
remaining $6,936,665 that is in the baseline. |
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Part B of the
bill includes a General Fund deappropriation of $13,000,000 in fiscal year
2016-17 in the Executive Branch Departments and Independent Agencies
-Statewide program in the Department of Administrative and Financial Services
for savings to be identified by the State Budget Officer in existing programs
as a result of the expansion of eligibility. Part B also requires Maine
Revenue Services to report by April 30, 2017 and April 30, 2018 regarding
revenues generated as a result of expanded coverage. It requires that savings
and revenues be verified by the Office of Fiscal and Program Review by March
15, 2017 and May 15, 2018. It also requires the Office of Fiscal and Program
Review to report its findings to the joint standing committee having jurisdiction
over appropriations and financial affairs and to the joint standing committee
having jurisdiction over government oversight and authorizes the latter
committee to request further review and reporting by the Office of Program
Evaluation and Government Accountability on the effectiveness of providing
coverage through expanded MaineCare coverage. The specific programs and
amount of savings that will be realized and distributed to each program
cannot by determined at this time. As a benchmark, a review was done of a
report on potential savings created by an outside consulting group familiar
with Medicaid expansions. While that group's overall savings identified
appear to be on the high side, the review does support a reasonable
expectation of greater than $20,000,000 million in savings annually with the
full implementation of the expansion. |
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Additional costs
for the Legislature's Office of Fiscal and Program Review can be absorbed
within existing budgeted resources. Additional costs for the Legislature’s
Office of Program Evaluation and Government Accountability to conduct a
review can be absorbed within existing budgeted resources but may affect the
resources available to perform other assigned reviews. |
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