President Trump's big, beautiful budget bill that's making its way through Congress proposes cutting billions from Medicaid. The program, which is funded through both federal and state dollars, covers medical care and other services for low income Americans. Here in Maine, state officials, health care providers, and advocates say the proposed cuts would have drastic consequences. To get a better understanding of how Maine could be affected, Maine Public’s Patty Wight sat down with All Things Considered Host, Nicole Ogrysko.
Ogrysko: One of the major proposals in this budget is to institute work requirements in the Medicaid program. So what are these requirements and who would be subject to them?
Wight: The work requirements would apply to adults up to age 64 who are enrolled in MaineCare - which is what we call the Medicaid program in Maine. That would be about 86,000 people, according to state officials. And they would be required to work at least 80 hours a month or be enrolled in an educational program, unless they qualify for an exemption. Generally speaking, that could include parents of young children and people who are considered medically frail.
NO: So this is aimed at Medicaid recipients who are able to work, so why are some people concerned about these requirements?
PW: Well, critics of this point out that most adults enrolled in Medicaid who are under 65 already work or would be exempt. And they say a couple of other states have tried imposing work requirements and they haven't boosted employment of people enrolled in Medicaid. In one of those states, Arkansas, 18,000 people lost coverage. And research has found it wasn't because they weren't eligible. It was primarily because they had trouble filing the necessary documents to show that they worked. The process was just onerous and confusing. Here in Maine, Sara Gagné Holmes, who's the commissioner of Maine's Department of Health and Human Services, estimates that more than 30,000 Mainers who are eligible for Medicaid would likely lose coverage because of red tape.
Sara Gagné-Holmes: "You're going to have to provide your paycheck stub to the Department of Health and Human Services every six months to show that you've been working. And that may sound simple for some of us who have one job and one payment stub, but if you're working multiple jobs and you've got to continually provide that information on a regular basis to the department to ensure that your coverage doesn't end, it can get complicated."
NO: Ok, and what would the proposed change mean for people who would be exempt from work requirements?
PW: It's not totally clear who will be exempt, but it's likely going to include people with disabilities, people with substance use disorder who are trying to get treatment, and potentially people who are direct caregivers to older family members. But there are similar concerns among critics — that this would impose significant barriers on people who need to prove that they're exempt. And Jess Maurer of the Maine Council on Aging says it's important to remember that caregivers actually save the government money by keeping people out of nursing homes.
Jess Maurer: "The reason you're out of work is intentional, to take care of an older person or a spouse. And that is what we want people to do. We want to incentivize them to take care of people so that, so that the public isn't paying for that."
NO: How much is it expected to cost Maine to implement work requirements?
PW It's going to cost millions, Nicole. According to Maine's Department of Health and Human Services, it's going to cost an estimated 8 million dollars to get the program up and running between technology and staffing costs, and then 5 and a half million dollars each year after.
NO: Aside from work requirements, what other changes to Medicaid does the budget bill propose?
PW: Well, on the subject of cost, Maine stands to lose federal money because of penalties and other changes. States like Maine that provide Medicaid coverage to non-citizen children would see a reduction in federal matching funds. The state estimates that would be about $77 million dollars a year. There's also a provision that would put a moratorium on something called provider taxes. Basically, provider taxes are a way for states to tax hospitals to bring in more federal Medicaid funding. And so capping that provider tax means Maine and other states will have to keep it at current levels and can't adjust as costs go up.
NO: So the state isn't too happy about these changes....What are supporters saying?
PW: Proponents are saying that these cuts are needed because the Medicaid program has just become too big. Paul Winfree of the Economic Policy Innovation Center recently told the public radio program On Point that spending is projected to increase by more than a trillion dollars over the next decade.
Paul Winfree: "And a lot of the reasons for that is that there are all of these incentives baked into the financing structure of Medicaid that encourage states to look for loopholes to bring more money to the state coffers to finance the Medicaid program but also to finance other budget shortfalls at the state level."
PW: And Winfree pointed to that provider tax as one example.
NO: What about providers? How would they be affected?
PW: Some would be directly affected - specifically those who provide abortion care, because they would not be allowed to participate in Medicaid. So we're talking about Planned Parenthood and Maine Family Planning clinics that offer a lot of other health services. And they say it's actually an attempt to close these clinics.
And for hospitals, it could mean having to absorb a lot more charity care, because of the more than 30,000 Mainers who could lose Medicaid coverage. And a lot of Maine hospitals are already struggling financially and are cutting services. Inland Hospital in Waterville just closed. The Maine Hospital Association says that's just going to continue. And Sara Gagné-Holmes with Maine's Department of Health and Human Services says that affects everyone.
Sara Gagné-Holmes: "If these provisions go through, health care as we know it in the state of Maine is going to change substantially, and it will impact every single person in this state and their communities.
PW: She's among critics who say this bill does not, as the Trump administration claims, save money by addressing waste, fraud, or abuse. It saves money, she says by setting up barriers to disenroll people from Medicaid.
NO: Alright, and I know we're going to hear more reporting on this from you over the next two days - how it could affect people with disabilities and those who get health coverage through the insurance marketplace.
