AUGUSTA, Maine — A consumer advocacy group says Maine's Department of Health and Human Services has abruptly ended a contract that helps Mainers navigate the complex health insurance system.
A bipartisan group of lawmakers is denouncing the move, saying it violates both state and federal law and could leave some Mainers without the health coverage they need. A Republican lawmaker has submitted a bill to rectify the issue, but DHHS says it's all a stunt to secure a taxpayer-funded contract.
On June 29, Emily Brostek, executive director of Consumers for Affordable Health Care, says DHHS told her it was terminating the organization's contract to provide what's called "ombudsman services" under MaineCare, effective the next day.
"As you might expect, at the end of June when I heard that our contract would be eliminated the next day, I was extremely concerned," she says. "My biggest concern on that day, and it remains my biggest concern today, was for the people of Maine."
Consumers for Affordable Health Care, or CAHC, is a nonprofit that helps Maine residents access health care. In its role as an ombudsman, CAHC operates a HelpLine and does outreach to help Mainers understand their insurance options and resolve health coverage conflicts and concerns.
It's a resource that Liz Harmon says pulled her out of a desperate situation that started a couple years ago when her son was born with pulmonary stenosis. He needed emergency heart surgery at just 5 weeks old.
"The first two years of his life, we had more doctors and hospital appointments — we lived in the emergency room," she says.
The bills piled up, even though the family had health insurance coverage. But then Harmon's husband lost his job and the couple tried unsuccessfully to get coverage through MaineCare.
One day, as Harmon opened another hospital bill, she saw a phone number for CAHC. She called, and she says the group helped her family get MaineCare coverage.
"They tackled huge and complicated medical bills, complicated DHHS paperwork, hospitals with the sliding scale applications, rejection letters and other problems that we had," she says.
"A lot of people can't navigate this maze without help," says Republican state Rep. Karen Vachon.
She says she knows the complexities of the health system firsthand. She's a licensed insurance agent. And she's upset that DHHS terminated its contract with CAHC.
"Maine is violating federal and state law right now," Vachon says. "This violation is not only denying Mainers the support, guidance and advocacy they need in sourcing the right health care based on their income and family situation, it also puts at risk their health and will likely cost taxpayers more money when all is said and done."
Vachon and other lawmakers, like Democratic state Rep. Linda Sanborn, say they've contacted DHHS to express their concerns, to no avail.
"I was dismissed," Sanborn says.
She says canceling the contract doesn't save the state money, because there's none involved to begin with. CAHC's contract allows it to access up to $300,000 from the feds.
"And in fact, it requires matching private dollars before the federal dollars can be drawn down," Sanborn says.
Supporters of CAHC say federal law requires DHHS to provide outreach services, and state law requires that the department contract with a Maine nonprofit to do so.
DHHS released a statement Wednesday saying that it no longer requires external efforts for outreach services such as "handing out magnets and fliers." But Emily Brostek says DHHS seemed to appreciate their work in the past.
"In fact, DHHS was so pleased with our work that just over a year ago, they actually increased our contract so that we could serve more people," she says.
Brostek says help-line calls alone have increased fourfold, from about 1,600 in 2006 to nearly 7,000 in 2014. But DHHS contends CAHC is trying to strong-arm DHHS into handing over tax dollars.
The department's statement says that it's only required to contract with an ombudsman for Managed Care Programs, which it does not operate. That's a matter of dispute, but a spokesperson for the Centers of Medicare and Medicaid Services says CMS believes Maine is meeting federal requirements.
To settle the issue, Vachon has submitted a bill to clarify the state's obligations. Until that's resolved, Brostek says CAHC will tap into other funding sources to continue to assist Maine consumers with health care issues.
