- Maine submitted its request for a section 1115 Medicaid waiver last week, and it includes work requirements, mandatory premiums and asset testing.
- The application states Maine is trying to “preserve limited financial resources” and encourage individual responsibility for healthcare costs. It also says the plan will “promote financial independence and transitions to employer-sponsored or other commercial health insurance."
- State waiver applications are expected to increase under HHS Secretary Tom Price, who wrote a letter to governors in March stating he is “seeking to provide more flexibility and opportunities for innovation on the state level."
Maine's proposal would almost certainly have failed in President Barack Obama’s administration, but it stands a good chance with the current leadership. It would be one of the most conservative state programs, and health policy experts warn that the restrictions would push out many low-income adults who would otherwise qualify.
Judith Solomon, vice president for health policy at the Center for Budget and Policy Priorities, wrote when the proposal was first announced in April the measures are draconian. “Maine’s new proposal for a Medicaid waiver seeks radical and unprecedented changes to Medicaid, totally disregarding what Medicaid law allows and targeting the state’s lowest-income adults in ways that would likely leave many without access to needed healthcare.”
There are already signs Price's HHS will expand state control over Medicaid programs. Florida's waiver received a five-year extension last week with $1.5 billion given annually. The Obama administration had been pulling back support for that waiver because Florida has continued to refuse to expand Medicaid. In February, CMS approved a waiver for Alabama, which also hasn't expanded Medicaid. That state is moving the majority of Medicaid beneficiaries to regional care organizations. More than 30 states have section 1115 waivers.
Medicaid in general is being threatened at the federal level. Although bills proposing to cut Medicaid by about $800 billion failed last month, there is still interest in major funding reductions. President Donald Trump's proposed budget cuts Medicaid by $610 billion.
In Maine's five-year proposal, the required premiums would range from $10 for those at 51% of the federal poverty level to $40 dollars for anyone at 200% or above. The asset test would be $5,000. Solomon argues asset tests are explicitly prohibited by the ACA and Maine's proposal is unlawful.