What Trump’s Medicaid work rule change means for Maine

Good morning from Augusta, where major news out of Washington has provided a shot in the arm to Gov. Paul LePage’s long-held goal of requiring more from participants in Medicaid, the taxpayer-funded health care program.

The Trump administration has opened the door for states to require Medicaid recipients to work or at least look for jobs. The guidance from the feds was issued early Thursday in the form of letters to state Medicaid directors and marks the first time in Medicaid’s 50-year history that participants could be subject to the new requirements. It means that states will be allowed to end Medicaid benefits unless recipients have a job, are in school, are a caregiver or participate in some other approved form of “community engagement,” according to the Washington Post. Maine and other states have attempted to do this in past year but were firmly rebuffed by the administration of Democratic President Barack Obama. Ten states, including Maine, are already waiting for federal permission.

Maine applied to impose work requirements and co-pays in its Medicaid program in August. The Department of Health and Human Services wants to require MaineCare recipients to work 20 hours per week, pay monthly premiums and chip in $10 if they go to an emergency department for a non-emergency issue. DHHS held hearings on the issue in the spring of 2017. The proposal met stiff resistance from advocates who said Medicaid recipients are already unable to afford even the basics of survival and that even modest premiums or copays would push too many people away from health care.

In its final application for what is known as a 1115 waiver, DHHS lowered monthly premiums to a maximum of $40 per month versus nearly $70. It expanded the pool of people who would be exempt from work requirements. The department also removed a penalty to pay for missed appointments.The Maine Primary Care Association and Maine Hospital Association say the narrowing of eligibility requirements under LePage, which have gone down by 76,000 people in the past five years, have led to a $124 million increase since 2011 in uncompensated care provided by hospitals.

This could have ramifications for Maine’s efforts to expand Medicaid eligibility. As you know unless you just got back from Uranus, Mainers voted last year to expand Medicaid under the provisions of the Affordable Care Act but there’s significant opposition from LePage and many legislative Republicans on the grounds that it is too expensive and taxpayer resources should be routed to the “most needy,” not “able-bodied” adults without children in the Medicaid program. Congressional efforts to repeal the ACA and the Trump administration’s general stance in favor of cutting welfare programs are already potent arguments against Maine taking the leap.

It’s hard to say how Trump’s announcement will affect the debate. LePage’s office and DHHS did not immediately respond to questions this morning but it’s possible that implementing work requirements in tandem with offering benefits to new people could make expansion more palatable to lawmakers who wouldn’t consider it before. But it could also drive away Democrats who have staunchly opposed the concept. This issue becomes more complicated by the day and the stakes could hardly be higher for low-income Mainers or the state budget.

LePage blasts biomass bonds

The Republican governor made a rare appearance before a legislative committee on Wednesday when he showed up to weigh in on state borrowing. LePage told the Appropriations Committee that he opposes two bond bills that aim to benefit Maine’s biomass industry. Biomass is basically low-grade wood products that are burned to produce energy. LePage said it’s not efficient enough to make sense for electricity generation because it produces energy that costs more than market rates. He signed a $13.5 million biomass industry bailout in 2016, but he has since said that he felt coerced into approving it.

“Biomass as a standalone has never worked and never will work,” said LePage, who suggested that the state should be instead investing in co-generation, in which energy used in manufacturing or industry is re-used to produce heat or electricity. As he has in the past, LePage advocated for a “commercialization” bond, which he said would make state financial aid available to a broad spectrum of businesses.

The committee is working on recommendations for a bond package that could be considered by LePage and the full Legislature, followed by voters at a referendum. The committee, — which also spent Wednesday sorting through other bond proposals, including for broadband expansion — will hear from a stream of witnesses on six additional bond bills this afternoon. Most borrowing requests die at the budget committee level, which will likely be the fate for this year’s bond proposals as well.

Today in A-town

The House and Senate return this morning for abbreviated sessions, mostly for shuffling bills to committees. One interesting bill on the House calendar today in LD 1783, a governor’s bill that would make aggravated trafficking of the opioid fentanyl a Class A crime. In the Senate, a resolution recognizing this week as Human Trafficking Awareness Week will be considered. As is usually the case this time of year, legislative committees are humming. In addition to the aforementioned bond discussions in the budget committee, the Health and Human Services Committee is considering bills around hot-button issues, such as how to support home health services, how to protect infants from drugs and how to fund General Assistance.

Reading list

  • Trump’s voter fraud commission documents will be destroyed. Attorneys for the now-dissolved Presidential Advisory Commission on Election Integrity said during a conference call Wednesday that the information, which Maine Secretary of State Matthew Dunlap has sued to see, won’t be handed off to anyone, including other federal agencies. That’s after a federal judge ordered the commission to reveal the information in response to a Freedom of Information Act request from Dunlap, a Democrat who was on the panel.
  • People working to preserve a Lubec landmark that floated away after the recent blizzard says it is being torn apart by Canadian scavengers. The brining shed at the former McCurdy Smokehouse — the last traditional smoked herring facility in the U.S. — is stuck on Campobello Island in Canada. An official with the nonprofit that owns it said Canadians using chainsaws have torn wood from it and that the Canadian government hasn’t allowed her contractors to begin salvaging the shed. She has appealed to independent U.S. Sen. Angus King for help.

Owl’s well that ends well

The annual Maine owl attack warning has sounded. This year, it’s at Pineland Farms in New Gloucester, where cross-country skiers have been warned about a “dive-bombing” snowy owl.

I used to work at Pineland. The owls were always friendly then. I’m sure it’s all a misunderstanding. Clearly, this bird is trying to deliver letters from Hogwarts.

Here is New Gloucester’s soundtrack. And here is a soundtrack for those skiers who need an owly warning system. — Robert Long

Today’s Daily Brief was written by Christopher Cousins and Michael Shepherd and edited by Robert Long. If you’re reading it on the BDN’s website or were forwarded it, click here to get Maine’s only newsletter on state politics via email on weekday mornings.

Christopher Cousins

About Christopher Cousins

Christopher Cousins has worked as a journalist in Maine for more than 15 years and covered state government for numerous media organizations before joining the Bangor Daily News in 2009.