Who is eligible
Children up to 1 year old with household income up to 191% of FPL. Children ages 1-18 with household income up to 157% of FPL; children with family income up to 208% of FPL qualify for the Children’s Health Insurance Program. 19 and 20-year-olds with household income up to 156% of FPL; pregnant women with household income up to 209% of FPL; parents and other caretakers with household income up to 100 percent of FPL.
- healthinsurance.org contributor
- September 29, 2016
Democrats in the Maine Legislature again pushed for Medicaid expansion during the 2016 session, but could not overcome Gov. Paul LePage’s ongoing opposition on the issue. LePage has vetoed five previous Medicaid expansion bills, and the 2016 bill, LD633, passed but only by one vote — far from a veto-proof majority. It was tabled and died at the end of the 2016 legislative session.
Medicaid has been a political battle in Maine. Not only has LePage rejected Medicaid expansion, he also cut existing coverage through eligibility changes that went into effect March 1, 2013, and Jan. 1, 2014. And many Republicans in the legislature have also opposed Medicaid expansion, preventing the legislature from getting enough votes to overcome LePage’s vetoes.
The 2014 gubernatorial campaign offered hope for a turnaround on Medicaid expansion. The issue was a factor in the three-way governor’s race, and LePage was considered vulnerable in his re-election bid. However, LePage was re-elected, winning by about 48 percent of the vote.
The next election is scheduled for 2018, but there were rumors in 2016 that LePage might resign following a threatening, profanity-laced tirade that he directed at a state lawmaker. At the end of August, LePage confirmed that he intended to remain in office, but there have been continued calls for his resignation. If LePage remains in office, Medicaid expansion legislation in 2017 or 2018 would have to pass with a veto-proof majority in order to be successful.
Without expansion, about 38,000 low-income adult Mainers are not eligible for Medicaid and about 24,000 are in the coverage gap according to the Kaiser Family Foundation.
Eligibility guidelines for Maine Medicaid
As of July 1, 2014, Maine residents who meet the following income limits qualify for Medicaid:
- Children up to 1 year old: 191 percent of the federal poverty level (FPL)
- Children ages 1 to 18: 157 percent of FPL; children with family income up to 208 percent of FPL qualify for the Children’s Health Insurance Program
- 19 and 20 year olds: 156 percent of FPL
- Pregnant women: 209 percent of FPL
- Parents and other caretakers: 100 percent of FPL
Apply for MaineCare
Maine’s Medicaid program is called MaineCare. If you think you may qualify, here is how you can submit an application.
- Go to MyMaineConnection to apply online.
- Print an application and mail it 114 Corn Shop Lane, Farmington, ME 04938.
- Call 1-855-797-4357 to enroll by phone.
- Visit your local Office for Family Independence (OFI) to enroll in person.
Reversal in Maine’s approach
Gov. LePage has reversed the course on Medicaid set by former Gov. John Baldacci. Baldacci authorized Dirigo Health in 2003. The program expanded Medicaid and subsidized private health insurance for middle-income residents. However, the program faced several financial difficulties as about 25 percent of the state’s residents enrolled in Medicaid by 2010 and Medicaid spending consumed nearly 30 percent of the state budget. The state fell behind in Medicaid reimbursements to hospitals, which were due nearly $500 million in state and federal payments.
LePage took office in 2011 and has since led efforts to cut the state’s Medicaid program. First, he reduced the eligibility limits for adults with dependents and reduced benefits for elderly Medicaid beneficiaries. Second, Maine ended coverage for adults without dependents, effective Jan. 1, 2014. The stricter eligibility limits resulted in about 25,000 people losing Medicaid eligibility. Third, the LePage administration petitioned the federal government for approval to end coverage for 19- and 20-year olds.
When the federal government rejected the request, the administration appealed the decision in circuit court with the help of outside counsel. The state’s attorney general declined to represent the state, saying the appeal had lacked merit. The 1st Circuit Court of Appeals in November 2014 upheld the federal government’s decision. The state petitioned to have the case heard by the Supreme Court, but the petition was denied in June 2015. Since the Supreme Court won’t hear Maine’s case, the lower court’s decision stands, and Maine has continued to provide Medicaid coverage for roughly 6,500 eligible 19 and 20-year-olds.
As of October 2014, about 291,000 people were enrolled in MaineCare. By July 2016, enrollment had decreased to 270,827. Nationwide, Medicaid/CHIP enrollment has grown by 27 percent since the end of 2013, including states that have expanded Medicaid as well as those that have not.