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Section 1115 Demonstration Waiver-MaineCare Reform

Overview

The Department of Health and Human Services (DHHS) intends to submit an application to the Centers for Medicare and Medicaid Services (CMS), requesting flexibilities necessary to implement critical reforms to the MaineCare program. Overall, these initiatives are designed to preserve limited financial resources for Maine's neediest individuals, promote financial independence and transitions to employer sponsored or other commercial health insurance, and encourage individual responsibility for one's health and healthcare costs. DHHS must obtain approval from CMS before these changes can take effect.

Section 1115 waivers allow states to test new or existing ways to deliver and pay for healthcare services in Medicaid and the Children's Health Insurance Program (CHIP). Learn more about the 1115 waiver authority.

This waiver application has been submitted to CMS. Please visit the State Waiver List website for updates on the federal public comment and review process.

Proposed Changes

Proposed changes in this application include certain provisions specific to able-bodied adults* in the MaineCare program and others that would apply to all MaineCare members or applicants:

Proposed changes for able-bodied adults:

Community Engagement and Work Requirements: Requiring able-bodied adults to meet community engagement and work requirements.

This initiative ensures members are building the skills and gaining the experience necessary to improve their financial standing and achieve self-sufficiency. It delivers a consistent message to the people of Maine about the role of social services in our state and the value of work and gainful employment. Members may meet these requirements by working, attending school, participating in a work program, volunteering, providing caregiver services for a non-dependent person, or complying with the work requirements of another DHHS social service program. Members who fail to comply with the community engagement and work requirements will be disenrolled from MaineCare until they achieve compliance.

Monthly Premiums: Requiring able-bodied adults to pay monthly premiums as an individual contribution towards their health care costs.

Premium amounts will be tiered based on three income brackets. Premiums will be due for each month that a member has MaineCare eligibility. Members who fail to make timely premium payments will be disenrolled from MaineCare. This provision will not affect members who already pay premiums

Proposed changes for all MaineCare members and applicants:

Co-payments for Inappropriate Emergency Department Use: Requiring members to pay a $20 co-payment for non-emergency use of the emergency department as incentive to seek care in more appropriate settings.

For each visit that does not result in inpatient admission, DHHS will send a bill to the member that includes information regarding the cost of their care to the taxpayers of Maine. These copayments will not result in a decrease to provider payments.

Missed Appointments: Allowing providers to charge MaineCare members for missed appointments.

DHHS values providers who include MaineCare members in their practice panels. The Department believes that allowing providers to charge members for missed appointments will offer some financial relief to providers who elect to treat MaineCare members and will incentivize members to keep scheduled appointments. Providers may only charge MaineCare members in accordance with standard office policy, except that the fee may not exceed the anticipated MaineCare reimbursement amount for the service that would have been delivered.

Asset Tests and Medicaid-compliant Annuities: Applying a reasonable asset test to MaineCare eligibility determinations for members not otherwise subject to asset tests; waiving the prohibition of imposing a transfer penalty for the purchase of Medicaid-compliant annuities for long-term care coverage determinations; and instituting reasonable minimum payout periods for the annuitant.

MaineCare will apply a $5,000 asset test to each member's household Modified Adjustment Gross Income (MAGI). Assets that are not excluded as part of the existing State Plan will count in the determination of MaineCare eligibility. These provisions require individuals to apply personal finances and assets to their own health care costs in order to preserve MaineCare funding for the neediest members.

Retroactive Coverage: Ceasing to provide retroactive MaineCare coverage in alignment with how health insurance operates in the private market.

DHHS believes that Maine taxpayers should not be responsible for paying medical bills that a member incurred prior to the time that member sought MaineCare coverage.

Hospital Presumptive Eligibility: Eliminating the option for hospitals to make presumptive eligibility determinations.

This will help ensure that taxpayer dollars are used only for appropriate health care coverage and encourage members to complete applications in a timely manner.

* For the purposes of this waiver, able-bodied adults are individuals between the ages of 19-64 who fall within a limited number of eligibility groups and who do not meet the proposed individual exemptions.

Public Hearings

In accordance with 42 CFR Part 431.408, notice is hereby given that DHHS will host two public hearings on the DHHS 1115 waiver application. In addition, the 30 day public comment period begins on April 25, 2017 and ends at 11:59 PM on May 25, 2017. You may provide comments through written or verbal statements made during the public hearings listed below.

Hearing 1: Portland Public Hearing
Date: May 17, 2017
Time: 9:00AM
Location: Cross Insurance Arena
  45 Spring Street
  Portland, Maine 04101
Conference Line: 1-877-455-0244
Passcode: 7319892834
   
Hearing 2: Augusta Public Hearing
Date: May 18, 2017
Time: 9:00 AM
Location: Augusta Civic Center
  76 Community Drive
  Augusta, Maine 04330
Conference Line: 1-877-455-0244
Passcode: 7319892834

Waiver Documents

Copies of waiver documents are posted above for you to download at no charge. The public may review these documents at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are, call 1-800-452-1926.

Written Comments

Written comments on the proposed changes are welcome and will be accepted from April 25, 2017, through 11:59PM on May 25, 2017. Written comments may be submitted in the following ways:

By email to: Policy.DHHS@maine.gov
By mail to: Division of Policy/MaineCare Services, 242 State St. 11 State House Station, Augusta, Maine 04333-0011.


Section 1115 Demonstration Waiver - HIV

Overview

The State of Maine will be submitting a 5-year renewal application to the Centers for Medicare and Medicaid Services (CMS) for its Section 1115 Health Care Reform Demonstration for Individuals with HIV/AIDS. The purpose of this waiver is to provide limited Medicaid coverage to Maine citizens living with HIV/AIDS, including tribal community members.

Section 1115 waivers allow states to test new or existing ways to deliver and pay for healthcare services in Medicaid and the Children's Health Insurance Program (CHIP). Learn more about the 1115 waiver authority.

HIV Public Hearings

In accordance with 42 CFR Part 431.408, notice is hereby given that DHHS will host three public hearings on the HIV waiver extension application. In addition, the 30 day public comment period begins on March 1, 2018 and ends at 11:59 PM on March 31, 2018. You may provide comments through written or verbal statements made during the public hearings listed below.

Hearing 1:Augusta Monthly HIVAC Meeting
Date:March 13, 2018
Time:10:00 AM
Location:Room 103 Burton Cross Building
 111 Sewall Street
 Augusta, ME 04330
Conference Line:877-455-0244
Passcode:2076246687
Hearing 2:Augusta Public Hearing
Date:March 20, 2018
Time:9:30 AM
Location:Room 600 Burton Cross Building
 111 Sewall Street
 Augusta, ME 04330
Conference Line:877-455-0244
Passcode:7155869880
Hearing 3:Bangor Public Hearing
Date:March 21, 2018
Time:9:30 AM
Location:DHHS Bangor
 396 Griffin Road
 Bangor, ME 04401
Conference Line:877-455-0244
Passcode:7155869880

HIV Waiver Documents

Copies of waiver documents are posted above for you to download at no charge. The public may review these documents at any Maine DHHS office in every Maine county. For additional information about Maine DHHS office locations, please call 1-800-452-1926.

HIV Written Comments

Written comments on the proposed changes are welcome and will be accepted from March 1, 2018, through 11:59PM on March 31, 2018. Written comments may be submitted in the following ways:

By email to: Policy.DHHS@maine.gov
By mail to: Division of Policy/MaineCare Services, 242 State St. 11 State House Station, Augusta, Maine 04333-0011.

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