Maine joins the throng seeking Medicaid work requirements

Maine has become the latest state to announce plans to seek approval from the Trump administration to impose a work requirement on Medicaid beneficiaries.

On Tuesday, the state posted a waiver saying it will ask the CMS for permission to overhaul its Medicaid program. The proposed changes include a provision that will require so-called able-bodied adults to work at least 20 hours a week, or prove that they're searching for work.

Kentucky has a similar pending request at the CMS, and Arizona has announced plans to submit one as well. Florida and Ohio lawmakers are drafting legislation to order their state health departments seek similar waivers that would include work requirement provisions.

As many as 11 million people could lose coverage nationwide if every state imposed work requirements, according to a Health Affairs study earlier this month. Many beneficiaries who would fall under the new requirements may have physical or mental limitations that impede their ability to work, but don't qualify them as disabled. Disabled individuals would be exempt from work requirements, the study found.

Vanessa Santarelli, CEO of the Maine Primary Care Association, which represents the state's community health centers, also raised these concerns after seeing the waiver. She feels the term "abled-body" stigmatizes people who may have legitimate health reasons preventing them from working.

"There are people who have physical and behavioral health conditions that are not necessarily visible," Santarelli said.

Maine's waiver also seeks to impose monthly premiums ranging from $14 a month for people at and below the federal poverty line. Families with dependent children that collectively have incomes at 201% and above the federal poverty level would pay $66 a month.

Medicaid beneficiaries who fail to pay their premiums would be locked out from coverage for at least three months. If the person still hasn't paid their premiums at that point they will continue to be denied coverage.

Santarelli said she worries the waiver will put community health centers at risk as they'll likely see their uncompensated care costs soar.

Maine has asked to eliminate hospital presumptive eligibility determinations for patients, which could affect providers' finances, according to Steven Michaud, president of Maine Hospital Association.

Under Maine's current Medicaid regime, hospital staff will treat uninsured patients who may be eligible for Medicaid and help them apply for coverage. Maine won't pay any claims after a person is formally covered by Medicaid if the waiver is approved.

Depending on when the waiver is approved, hospitals could lose out on payments for care that's already been provided, Michaud said.

Although state officials added a provision that would give providers the option to charge fees for missed appointments, that didn't please Michaud or Santarelli.

"The no show fee may sound good, but the chances of us actually collecting anything is darn close to zero," Michaud said, citing enrollees' low incomes.

It's unclear how many providers would seek permission to impose the fees, Santarelli said, as beneficiaries may miss appointments due to unreliable transportation or other issues.

Maine residents will vote this November on whether to expand Medicaid to childless adults with incomes up to 138% of the federal poverty level, as outlined in the Affordable Care Act.

As many as 56,000 people could become eligible for Medicaid coverage if the measure passes. Republican Gov. Paul LePage has been an adamant opponent of Medicaid expansion.