Statement from Commissioner Mayhew regarding The Centers for Medicare and Medicaid Services’ response to State Plan Amendment Request

September 4, 2012

"I am disappointed to receive the letter from the Centers for Medicare and Medicaid Services stating that they will not act on our request for an expedited approval of our State Plan Amendment within 30 days, and that we are forced to take legal action to make reductions that were approved by the Maine State Legislature. DHHS will continue its normal course of business, including public hearings and rule-making in order to be ready to implement the reductions as soon the State Plan Amendment is approved or the court orders CMS to pay Maine’s share of the costs while the legal issue is resolved."

DHHS State Plan Amendment Request

Maine Files State Plan Amendment To Implement Medicaid Reductions Enacted by Maine Legislature

Feds Pressed for a Rapid Decision

AUGUSTA – Maine Department of Health and Human Services (DHHS) Commissioner Mary Mayhew and Maine Attorney General William Schneider held a joint news conference today in Augusta to release details regarding Maine’s Medicaid State Plan Amendment Request.

The request was filed Wednesday morning with the Centers for Medicare and Medicaid Services (CMS) Regional Administration, U.S. Department of Health and Human Services, in Boston.  Commissioner Mayhew asked for an expedited approval, so that DHHS can implement Legislatively-mandated reductions in its Medicaid program in October in order to achieve $19.93 million in savings that is critical to balancing Maine’s budget.

In June, the Maine State Legislature approved changes in Maine’s Medicaid program that would eliminate coverage for 19- and 20-year olds, reduce coverage for non-pregnant, non-disabled adults to 100 percent of the Federal Poverty level and impose a 10 percent reduction in the Federal Poverty Level for those enrolled in various categories of the Medicare Savings Plan, which is a Medicaid program for individuals who are dually eligible for Medicaid and Medicare..

In the letter addressed to CMS, the fact that Maine’s Medicaid eligibility standards still exceed federal minimums, and the Supreme Court decision in June that held that the Medicaid expansion under the ACA could not constitutionally be pressed upon the states (National Federation of Independent Businesses v. Sebelius (“NFIB”), ___U.S. ___, 132 S.Ct. 2556 (2012)) are given as reasons why the State plan amendments could be expedited. 

“Like other states, Maine is dealing with the most serious economic downturn since the Great Depression, Mayhew wrote. “The Medicaid reductions passed by the Maine State Legislature clearly reflect the need to balance the budget in a way that provides health care coverage to Maine’s most needy while protecting funding for other non-Medicaid services across the state.”      

At the news conference, Attorney General Schneider outlined Maine’s legal reasoning behind seeking the State Plan Amendment versus a more complicated waiver process.

“Both as part of the mandatory Medicaid expansion struck down by the Supreme Court and as a unilateral, retroactive condition, the maintenance of effort provision fails and cannot be enforced against Maine,” said Attorney General Schneider. “The State Plan Amendment submitted today seeks only to make responsible adjustments in Maine’s Medicaid program that are completely within the State’s authority.”

Maine also offered CMS the option to pay Maine’s share of the cost from October 1 forward until a decision is made on the State Plan Amendment.   If the final decision does not result in approval of the State Plan Amendment, an arrangement would be made to pay back the federal government through a reduction of matching dollars once all legal issues have been resolved. 

  • Commissioner Mayhew's Remarks (Word | PDF)
  • Attorney General Schneider's Remarks (Word | PDF)
  • Frequently Asked Questions (Word | PDF)
  • Amendment Request
    • State Plan Amendment Submission (PDF)
    • Governor’s Letter to Secretary Sebelius (PDF)