Maine progresses toward a State-Based Health Insurance Marketplace

Aug 6, 2020

The Maine Department of Health and Human Services (DHHS) continues to advance work to establish a State-Based Health Insurance Marketplace to improve the accessibility and affordability of private health insurance, which is especially important given COVID-19.

As Governor Mills announced last year, becoming a State-Based Marketplace gives Maine more flexibility to improve the shopping experience for the more than 75,000 Mainers who currently purchase health insurance for themselves. It enables Maine to invest resources otherwise going to the federal government in targeted efforts to enroll uninsured Mainers in affordable coverage. This is especially important now with the loss of jobs and job-based health insurance due to COVID-19. The transition is one component of the Made for Maine Health Coverage Act, which Governor Mills signed into law on March 18, 2020 after it was passed unanimously by the Legislature.

Maine submitted is application or “Blueprint” to become a State-Based Marketplace on July 31 ,2020. With federal approval, the State will first begin operating as a State-Based Marketplace on the Federal Platform, effective for the Marketplace’s Open Enrollment period starting on November 1, 2020. During this first phase of the transition, consumers in Maine will still shop for and enroll in health plans through HealthCare.gov, but Maine DHHS will assume more responsibility for outreach, marketing, and consumer assistance. As part of implementing this phase, the Department recently issued a Request for Proposals for “Navigators” for the Marketplace, who will help to ensure Maine people are aware of their coverage options and have the assistance they need to apply and enroll. DHHS will also continue to promote coverage through the CoverME.gov website, and will launch another public awareness campaign to coincide with the Open Enrollment period this fall.

This transition will give Maine DHHS and the Maine Bureau of Insurance direct access to important data about how the Marketplace is working to ensure it best serves Maine residents. This data, along with additional information Maine DHHS plans to gather through another Request for Proposals, will inform the State’s decision about whether to transition to a full State-Based Marketplace for coverage beginning on January 1, 2022. This decision will include an analysis of whether the change will be feasible and beneficial to the people of Maine. Under a full State-Based Marketplace, the State would develop and launch its own enrollment platform, including a website, for Marketplace insurance, to replace the federal HealthCare.gov platform.

Operating a State platform provides greater flexibility and opportunities to customize the Marketplace to Maine’s needs. For example, all but one of the 12 currently operating State-Based Marketplaces opened special enrollment periods in response to the COVID-19 pandemic to allow anyone in need of health insurance coverage to sign up for a plan outside of Open Enrollment. While Governor Mills joined a coalition of Governors from 11 other states in asking the Trump Administration to take similar action through HealthCare.gov, the federal government declined, preventing Maine and 38 other states from easing access to coverage for their residents.

If Maine pursues a full State-Based Marketplace, DHHS would manage the cost of this activity with some of the additional funding from an existing assessment on health insurance companies that will be available to the State as a result of Maine assuming control over the Marketplace. Other states that have pursued a State-Based model have both enrolled more people and lowered health insurance costs.