MaineCare Recognized as National Leader in Medicaid Innovation for Rate System Reform

November 14, 2022

The Maine Department of Health and Human Services is pleased to share that the Office of MaineCare Services (OMS) was recognized today by the National Association of Medicaid Directors (NAMD) for its work to transform Maine’s rate-setting system to better support the health of members and sustainability of providers.

NAMD honored OMS with a 2022 Spotlight Award, which recognizes innovations in Medicaid that improve the program for Medicaid members and advance the overarching goals of creating healthier communities. NAMD announced the award in a blog post today, noting:

“MaineCare wanted to create a rate setting system that was transparent, consistent, and focused on equity. Their outdated system was none of these things. So, the agency began the difficult task of explaining the value of this change to their legislature and other policy leaders and encouraging them to invest in a new system, employing a multi-year campaign of evaluation and education. Ultimately, they prevailed, putting in place a modern, data-driven system that helps them support their Medicaid members’ needs as well as the entire network of providers.”

NAMD highlighted OMS’ outreach and education campaign spanning three years and its decision to prioritize “building an equitable foundation and a required process to assure payments remain adequate, over time. With this focus, MaineCare ushered in a transparent, systemic reform with benchmarks for improvement.”

In August, Governor Janet Mills signed bipartisan legislation to enshrine into state law this new system for setting MaineCare (Medicaid) payment rates that promotes equity, consistency, and transparency. The bipartisan bill, which was proposed by DHHS and improved by the Legislature’s Health and Human Services Committee, codifies the Department’s sweeping and unprecedented plan to transform MaineCare rate setting.

NAMD additionally noted that the “Office of MaineCare Services did not wait for passage of this bill to initiate its rate reform agenda. The biennial and supplemental budgets passed along with this bill invested $700 million in federal and state funds in MaineCare rates, including rate increases to support 125 percent of minimum wage for direct support worker wages, make one-time COVID-19 supplemental payments, and implement recently concluded rate studies.”

The plan is a culmination of Governor Mills directive to DHHS on her first day in office to expand MaineCare and develop a plan to make the health coverage program for low-income people more accessible, affordable, and sustainable.

NAMD is a bipartisan, nonprofit, professional organization representing leaders of state Medicaid agencies across the country. Read NAMD’s full blog post.