Maine is considering expanding Medicaid, but not without some special conditions. Republican Gov. Paul LePage wants the federal government to cover 100 percent of all expansion-related costs for at least 10 years--seven more years than allowed under the reform law.
In a letter to U.S. Department of Health & Human Services Secretary Kathleen Sebelius, Maine Health and Human Services Commissioner Mary Mayhew asked the agency to completely fund the state's Medicaid expansion.
The reform law covers 100 percent of Medicaid expansion costs for the first three years and pays 90 percent of the tab thereafter.
Maine also requested more flexibility to operate the program, including a "global waiver" that lets state officials change how they run the Medicaid program, according to the letter.
"Frankly, even where it is permissible, it is incredibly bureaucratic and administratively burdensome" to change state Medicaid policies, Mayhew told the Bangor Daily News. "We know that health care delivery is changing rapidly and Medicaid's policies need to keep pace."
After expanding Medicaid in 2003, HHS penalized Maine through lower reimbursement rates. "While some argue the state cannot afford to turn down the expansion of Medicaid, the simple truth is that by accepting a lower rate of federal funding than other states are being offered, Maine would continue down an unsustainable and unaffordable path," Mayhew wrote in the letter. "For the expansion of Medicaid to be a viable option to consider, we would need for this penalty to be lifted, creating parity between Maine and the non-expansion states with regards to the federal match rate."