Maine Medicaid Expansion Report - Jan 6 2013 - Draft

download Maine Medicaid Expansion Report - Jan 6 2013 - Draft

of 138

Transcript of Maine Medicaid Expansion Report - Jan 6 2013 - Draft

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    1/138

    !"#$%&%'%() +, -".%/#%. 012#3$%+3

    43."5 (6" 7,,+5.#&'" 8#5" 7/(9

    7 :";%"< =4&>%((". (+ (6"

    -#%3" ?"2#5(>"3( +,

    @"#'(6 A @4>#3 ="5;%/"$

    B3("5%> :"2+5(

    -+3.#)C D#34#5) EC FGHI

    J6" 7'"1#3."5 K5+42C LL8

    "#$%&'()*(+ ,-.-

    "/&01'(02/&1+ "1-

    314/&)56$)+ 7-8-!"#$% '("(% )"*#(+, -./0

    1#23"34 +5 )+$63%778 93#$(7 : 9;+(+63"*;7 8 /?@AB8 C?-

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    2/138

    )3%"(#$6 "$D

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    3/138

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    4/138

    J#&'" +, 8+3("3($

    "15([ &&

    (('(#10 D('&*10 @44&461)*( "(#*()615( \CD@"] --------------------------------------------------------------------------- KY

    D1&)( "#&%16( =(106/ .)4;#1)*( "#(B&;B "#$5#1B \"=."] ----------------------------------------------------------- KK

    .)&6&10 .44;(4 >&6/ ;10&6E --------------------------------------------------------------------------------------------------------------- KZ

    "$0&*E 8/1)5(4 $) 6/( M)&)4;#(' 1)' M)*$B2()416(' 81#( ------------------------------------------------------- KS

    ="/(%+3 V9 :"$4'($ +, (6" !%3#3/%#' -+."'PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP XW

    F%(#%&(> $A C&)1)*&10 D$'(0 --------------------------------------------------------------------------------------------------------- ZY

    "$2;016&$) -------------------------------------------------------------------------------------------------------------------------------------- ZK

    C&4*10 8$46 -------------------------------------------------------------------------------------------------------------------------------------- ZW

    (,-./0 123/.4----------------------------------------------------------------------------------------------------------------------------------- PY

    )56.07-,56 56 89-704- 5: (,6/6.,/0 ;56/ ,&4: C1*6$# ----------------------------------------------------------------------------------------------------------- LG

    "D"D ,&4: C1*6$# -------------------------------------------------------------------------------------------------------------------------- LS

    "#&%16( 7#$2 ,&4: C1*6$# ---------------------------------------------------------------------------------------------------------------- WY

    CD@" ,&4: C1*6$# --------------------------------------------------------------------------------------------------------------------------- WW

    9(46 814( _ 3$#46 814( ?*()1#&$4 ------------------------------------------------------------------------------------------------- SU

    ="/(%+3 VBB9 8+3/'4$%+3 #3. O"1( =("2$ PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP ZT

    722"3.%1 79 =4>>#5) +, -".%/#%.[012#3$%+3 ?"/%$%+3$ &) (6" =(#("$ PPPPPPPPPPPPPPPP ZZ

    722"3.%1 M9 -"(6+.+'+U)C 7$$4>2(%+3$C ?#(#C #3. N(6"5 J"/63%/#'B3,+5>#(%+3 PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP HGZ

    722"3.%1 89 \") 7K J"#> -">&"5$ ]6+ 8+3(5%&4(". (+ J6%$ :"2+5( PPPPPPPPPPPPPPP HHX

    M%&'%+U5#26) PPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP HHZ

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    5/138

    J#&'" +, !%U45"$

    "15([ &&&

    #$%&'(&(1=>8%+&C.NM,V G[",F`V8HV7 [email protected] VO,FQQDVOHD.QQ.FO? FC "V,?FO? ------------------------------------------------------------------------------------------ W

    C.NM,V I[",F`V8HV7 [email protected] Va"VO7.HM,V?.O 9.QQ.FO? FC 7FQQ@,? --------------------------------------------------------------------------------------- S

    C.NM,V Y[[email protected] Va"VO7.HM,V? @? ?=@,V FC N7" --------------------------------------------------------------------------------------------------------------- GU

    C.NM,V K[HF" GUQ@,NV?H CV7V,@Q 7VC.8.H? ,@ObV7 .O H3F 3@c? ------------------------------------------------------------------------------------------- GI

    C.NM,V Z[8FD"@,V M?7V9H_N7",@H.F HF VM8FMOH,.V? ----------------------------------------------------------------------------------------------------- GY

    C.NM,V P[HFH@Q FMHQ@c? C,FD CV7V,@Q NFRV,ODVOH IUGGdIUGY ------------------------------------------------------------------------------------------ GZ

    C.NM,V L[?H@HV ,@Ob? CF, ?"VO7.ON FO 9@?.8 [email protected] [email protected] ------------------------------------------------------------------------------------- GW

    C.NM,V W[8FD"@,.ON [email protected] HF H=V [email protected]@Q @RV,@NV CF, D@`F, Va"VO7.HM,V? -------------------------------------------------------------------- GW

    C.NM,V S[8VOH? FO H=V 7FQQ@, [email protected] "@c? ,[email protected] HF ",.R@HV .O?M,V,? 9c ?H@HV-------------------------------------------------------------- IG

    C.NM,V GU[?MDD@,c FC 3=@H H=V ?H@HV? @,V 7F.ON ------------------------------------------------------------------------------------------------------------ IL

    C.NM,V GG[",F`V8HV7 8=@ONV? .O [email protected]? @NV ",FC.QV C,FD IUGIHF IUII --------------------------------------------------------------------------- YZ

    C.NM,V GI["FRV,Hc .? @ 8,.H.8@Q .??MV CF, [email protected] ------------------------------------------------------------------------------------------------------------------ YP

    C.NM,V GY[[email protected] "F"[email protected] @O7 "FRV,Hc H,VO7? CF, cV@,? IUUUdIUGI ---------------------------------------------------------------------------- YP

    C.NM,V GK[ [email protected] "FRV,Hc @? "V,8VOH FC "F"[email protected] ----------------------------------------------------------------------------------------------------------- YL

    C.NM,V GZ[?H@HV 9c ?H@HV DV@O MO=V@QH=c 7@c? .O Q@?H YU7@c? ------------------------------------------------------------------------------------------ YW

    C.NM,V GP[[email protected] 7==?9M7NVH@QQ CMO7? ----------------------------------------------------------------------------------------------------------------------- YS

    C.NM,V GL[[email protected] 7==?9M7NVHNVOV,@Q CMO7 FOQc --------------------------------------------------------------------------------------------------------- YS

    C.NM,V GW[[email protected]@,V @? "V,8VOH FC CMO7.ON ?FM,8V ---------------------------------------------------------------------------------------------------------- KU

    C.NM,V GS[8FD"@,.ON [email protected]@,V HF "M9Q.8 ?8=FFQ? ?M""F,H ---------------------------------------------------------------------------------------------- KG

    C.NM,V IU["V,8VOH ?"VOH FC 9M7NVH@,c CMO7? -------------------------------------------------------------------------------------------------------------------- KG

    C.NM,V IG[HVO cV@, @OOM@Q 9M7NVH N,F3H= 8FD"@,.?FO? -------------------------------------------------------------------------------------------------- KI

    C.NM,V II[OV3 VONQ@O7 ?H@HV?Va"VO7.HM,V? FO [email protected] d"V,8VOH FC HFH@Q-------------------------------------------------------------------- KI

    C.NM,V IY[H=V =.?HF,c FC CD@".O [email protected] --------------------------------------------------------------------------------------------------------------------------- KK

    C.NM,V IK["V,8VOH FC [email protected]? VO,FQQV7 .O =."" ----------------------------------------------------------------------------------------------------------------- KZ

    C.NM,V IZ[[email protected] ,V@7D.??.FO ,@HV? 9c DV7.8@Q @,V@ --------------------------------------------------------------------------------------------------------- KPC.NM,V IP[?H@HV @O7 [email protected]@,V ",FN,@D [email protected].?H? ----------------------------------------------------------------------------------------------------------- KL

    C.NM,V IL[@NV 9c [email protected] ?H@H.?H.8? ------------------------------------------------------------------------------------------------------------------------------ KW

    C.NM,V IW[[email protected]@,V VO,FQQDVOHHFH@Q DVD9V,? @O7 "D"D ---------------------------------------------------------------------------------------- KS

    C.NM,V IS[[email protected] MO.O?M,V7 ,@HV? -------------------------------------------------------------------------------------------------------------------------------------- ZU

    C.NM,V YU[@OOM@Q @RV,@NV ",F`V8HV7 N,F3H= ,@HV? ---------------------------------------------------------------------------------------------------------- ZK

    C.NM,V YG[[email protected] @8HM@,.@Q CF,V8@?H FC "V,?FO? .O "FRV,Hc ----------------------------------------------------------------------------------------------- ZK

    C.NM,V YI[9@?VQ.OV VO,FQQDVOH CF,V8@?H? -------------------------------------------------------------------------------------------------------------------------- ZZ

    C.NM,V YY[[email protected]@,V VO,FQQDVOH 3.H= Va"@O?.FO ------------------------------------------------------------------------------------------------------------- ZP

    C.NM,V YK[[email protected]@,V VO,FQQDVOH ?CcIUGKdGZVa"@O?.FO CF,V8@?H ---------------------------------------------------------------------------------- ZL

    C.NM,V YZ[[email protected]@,V VO,FQQDVOH CF,V8@?H? 8FD"@,.?FO -------------------------------------------------------------------------------------------------- ZW

    C.NM,V YP[[email protected]@,V HFH@Q 8F?H CF,V8@?H ------------------------------------------------------------------------------------------------------------------------- PUC.NM,V YL[V?H.D@HV7 ?H@HV 8F?H FC Va"@O?.FO FRV, 9@?VQ.OV ----------------------------------------------------------------------------------------------- PG

    C.NM,V YW[H=V @QVa@O7V, N,FM" C.O@O8.@Q DF7VQ ,V?MQH? -------------------------------------------------------------------------------------------------- PI

    C.NM,V YS[[email protected]@,V @? "V,8VOH FC ?H@HV "F"[email protected] -------------------------------------------------------------------------------------------------------- PY

    C.NM,V KU[[email protected]@,V ?V,R.8V? @O7 9M7NVH N,F3H= 8FD"@,.?FO ---------------------------------------------------------------------------------------- PK

    C.NM,V KG[[email protected]@,V ?V,R.8V? @? "V,8VOH FC [email protected] ?H@HV 9M7NVH 9c CMO7 -------------------------------------------------------------------------- PZ

    C.NM,V KI[[email protected]@,V VO,FQQVV? HF VD"QFcV7 [email protected],? ,@H.F ---------------------------------------------------------------------------------------------- PP

    C.NM,V KY[[email protected]@,V VO,FQQDVOH HF VD"QFcDVOH 8FD"@,.?FO ------------------------------------------------------------------------------------------ PP

    C.NM,V KK[,.?b C@8HF,? [email protected] --------------------------------------------------------------------------------------------------------------------------------------- PS

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    6/138

    J#&'" +, !%U45"$

    "15([ &%

    C.NM,V KZ["FRV,Hc N,F3H= ,.?b C@8HF,? ---------------------------------------------------------------------------------------------------------------------------- LG

    C.NM,V KP["FRV,Hc N,F3H= ,.?b C@8HF, 8=@ONV? HF @??MDV7 D.77QV R@QMV? ---------------------------------------------------------------------- LG

    C.NM,V KL[Va"@O?.FO .D"@8H FC "FRV,Hc N,F3H= ,.?b C@8HF,? -------------------------------------------------------------------------------------------- LG

    C.NM,V KW[,@ONV FC @8HM@,.@Q CF,V8@?H FC "V,?FO? .O "FRV,Hc ------------------------------------------------------------------------------------------- LI

    C.NM,V KS[,@ONV FC @8HM@,.@Q CF,V8@?H FC 8=.Q7,VO .O "FRV,Hc ------------------------------------------------------------------------------------------ LY

    C.NM,V ZU["FRV,Hc ,.?b C@8HF, .D"@8H FO [email protected]@,V VO,FQQDVOH -------------------------------------------------------------------------------------- LK

    C.NM,V ZG["FRV,Hc ,.?b C@8HF, .D"@8H FO [email protected]@,V @? "V,8VOH FC ?H@HV "F"[email protected] LZC.NM,V ZI["FRV,Hc ,.?b C@8HF, .D"@8H FO HFH@Q 8F?H FC [email protected]@,V------------------------------------------------------------------------------------ LP

    C.NM,V ZY["FRV,Hc ,.?b C@8HF, .D"@8H FO HFH@Q 8F?H FC Va"@O?.FO ,[email protected] HF H=V 9@?VQ.OV------------------------------------------------ LL

    C.NM,V ZK["FRV,Hc ,.?b C@8HF, .D"@8H FO ?H@HV 8F?H FC Va"@O?.FO ,[email protected] HF H=V 9@?VQ.OV------------------------------------------------ LW

    C.NM,V ZZ["D"DN,F3H= ,.?b C@8HF, ------------------------------------------------------------------------------------------------------------------------------- LS

    C.NM,V ZP["D"D,.?b C@8HF, HF @??MDV7 D.77QV R@QMV? --------------------------------------------------------------------------------------------------- LS

    C.NM,V ZL[Va"@O?.FO .D"@8H FC "D"D,.?b C@8HF,? ----------------------------------------------------------------------------------------------------------- LS

    C.NM,V ZW["D"D,.?b C@8HF, .D"@8H FO HFH@Q 8F?H FC [email protected]@,V ------------------------------------------------------------------------------------- WU

    C.NM,V ZS["D"D,.?b C@8HF, .D"@8H FO HFH@Q 8F?H FC Va"@O?.FO ,[email protected] HF H=V 9@?VQ.OV------------------------------------------------- WG

    C.NM,V PU[ "D"D,.?b C@8HF, .D"@8H FO ?H@HV 8F?H FC Va"@O?.FO ,[email protected] HF H=V 9@?VQ.OV------------------------------------------------- WI

    C.NM,V PG[7,F""V7 ",.R@HV .O?M,@O8V ,.?b C@8HF, -------------------------------------------------------------------------------------------------------------- WY

    C.NM,V PI[",.R@HV 7,F" ,.?b C@8HF, 8=@ONV? HF @??MDV7 D.77QV R@QMV? ---------------------------------------------------------------------------- WY

    C.NM,V PY[Va"@O?.FO .D"@8H FC ",.R@HV 7,F" ,.?b C@8HF,? -------------------------------------------------------------------------------------------------- WY

    C.NM,V PK[",.R@HV 7,F" ,.?b C@8HF, .D"@8H FO VO,FQQDVOH ------------------------------------------------------------------------------------------------ WK

    C.NM,V PZ[",.R@HV 7,F" ,.?b C@8HF, .D"@8H FO [email protected]@,V @? @ "V,8VOH FC ?H@HV "F"[email protected] WZ

    C.NM,V PP[",.R@HV 7,F" ,.?b C@8HF, .D"@8H FO HFH@Q 8F?H FC [email protected]@,V ,[email protected] HF H=V 9@?VQ.OV--------------------------------------- WP

    C.NM,V PL[",.R@HV 7,F" ,.?b C@8HF, .D"@8H FO ?H@HV 8F?H FC Va"@O?.FO ,[email protected] HF 9@?VQ.OV----------------------------------------------- WL

    C.NM,V PW[CD@",.?b C@8HF,? -------------------------------------------------------------------------------------------------------------------------------------------- WW

    C.NM,V PS[CD@",.?b C@8HF, 8=@ONV? HF @??MDV7 FC D.77QV R@QMV? ---------------------------------------------------------------------------------- WW

    C.NM,V LU[Va"@O?.FO .D"@8H FC CD@",.?b C@8HF,? ------------------------------------------------------------------------------------------------------------ WW

    C.NM,V LG[CD@",.?b C@8HF, .D"@8H FO ?H@HV 8F?H FC Va"@O?.FO ,[email protected] HF H=V 9@?VQ.OV--------------------------------------------------- WS

    C.NM,V LI[9V?H @O7 3F,?H 8@?V ?8VO@,.F? -------------------------------------------------------------------------------------------------------------------------- SU

    C.NM,V LY[9V?H @O7 3F,?H 8@?V ,.?b C@8HF, 8=@ONV? HF @??MDV7 D.77QV R@QMV? ---------------------------------------------------------------- SU

    C.NM,V LK[Va"@O?.FO .D"@8H FC 9V?H 8@?V @O7 3F,?H 8@?V ,.?b C@8HF,? ------------------------------------------------------------------------------ SU

    C.NM,V LZ[9V?H 8@?V _3F,?H 8@?V ,.?b C@8HF, .D"@8H FO VO,FQQDVOH--------------------------------------------------------------------------------- SG

    C.NM,V LP[9V?H 8@?V _3F,?H 8@?V ,.?b C@8HF, .D"@8H FO [email protected]@,V @? @ "V,8VOH FC ?H@HV "F"[email protected] SI

    C.NM,V LL[9V?H 8@?V _3F,?H 8@?V ,.?b C@8HF, .D"@8H FO HFH@Q 8F?H? FC [email protected]@,V----------------------------------------------------------- SY

    C.NM,V LW[9V?H 8@?V _3F,?H 8@?V ,.?b C@8HF, .D"@8H FO HFH@Q 8F?H FC Va"@O?.FO ,[email protected] HF H=V 9@?VQ.OV------------------------- SK

    C.NM,V LS[9V?H 8@?V _3F,?H 8@?V ,.?b C@8HF, .D"@8H FO ?H@HV 8F?H FC Va"@O?.FO ,[email protected] HF H=V 9@?VQ.OV------------------------- SZ

    C.NM,V WU["F"[email protected] N,F3H= C@8HF,?---------------------------------------------------------------------------------------------------------------------------- GGG

    C.NM,V WG[@8HM@Q "D"D? "V, 8@HVNF,c -------------------------------------------------------------------------------------------------------------------------- GGI

    C.NM,V WI[@??MDV7 CD@",@HV? -------------------------------------------------------------------------------------------------------------------------------------- GGY

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    7/138

    L%$( +, 7/5+3)>$

    "15([ %

    $1+ &'(& )8?'*?;+&@8@ @AA$#'1J0( 81#( @*6 $A IUGU

    @N H/( @0(

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    8/138

    L%$( +, 7/5+3)>$

    "15([ %&

    DD.? D('&*1&' D1)15(B()6 .)A$#B16&$) ?E46(B4

    O@?9F O16&$)10 @44$*&16&$) $A ?616( 9;'5(6 FAA&*(#4

    OC.9 O16&$)10 C('(#16&$) $A .)'(2()'()6 9;4&)(44

    F@7? Maines Office of Aging and Disability Services

    FD? FAA&*( $A D1&)(81#( ?(#%&*(4

    "=." D1&)( "#&%16( =(106/ .)4;#1)*( "#(B&;B "#$5#1B

    "D"D @%(#15( *$46+ "(#dD$)6/ "(#dD(BJ(#

    ?@."V ?B100 @#(1 .)*$B( 1)' "$%(#6E V46&B16(4

    ?Cc ?616( C&4*10 c(1#

    ?8=." States Children Health Insurance Program. Also known as CHIP.

    ?"@ ?616( "01) @B()'B()6

    M?7==? M)&6(' ?616(4 7(21#6B()6 $A =(106/ 1)' =;B1) ?(#%&*(4

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    9/138

    !+5"( /1%( #(%&(>(' 6/( B$46 410&()6 142(*64 $A (

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    10/138

    !+5"( &)*$#2$#16('

    6/$4( #(*$BB()'16&$)4 A#$B 6/( '(21#6B()6 6/16 >( J(0&(%(' &B2#$%(' 6/( #(2$#6 J(A$#(

    4;JB&66&)5 6/&4 A&)10 %(#4&$)- 3/&0( >( 1#( &)'((' 5#16(A;0 A$# 6/( 144&461)*( $A 6/( '(21#6B()6+ 6/(

    @0(( 1#( 2#(21#(' 6$ 4;22$#6 (%(#E

    4616(B()6 B1'( 6/(#(&)- .A 1)E A1*6;10 (##$#4 1#( A$;)'+ >( 61:( A;00 #(42$)4&J&0&6E 1)' >&00

    &44;( *$##(*6&%( 4616(B()64+ &A )(*(441#E-

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    11/138

    01"/4(%;" =4>>#5)

    "15([ &$;0' 5#$> 6$ iWYU-S J&00&$) &) CCc IUIG+ 1) &)*#(14(

    $A SK-Kh- H/( 1*6;1#&(4 )$6(' 6/16 (%() &A $)0E 6/$4( 4616(4 *$B2#&4&)5 PZh $A 6/( D('&*1&'

    2$2;016&$) '(*&'( 6$ ($;0' *$B2#&4( Y-Ih $A N7"+ ;2 A#$B I-Wh &) IUGG-

    C$# 4616(4+ D('&*1&' /14 J(*$B( 6/( 01#5(46 (&00&)5 6$ 1**(26 )(> D('&*1&' 216&()64+ 1)' (B2&*10 46;'&(4 $) /(106/d*1#(

    T;10&6E /1%( *$)4&46()60E #1):(' D('&*1&' $) 6/( J$66$B #(016&%( 6$ D('&*1#( 1)' *$BB(#*&10

    *$%(#15(- C&)100E+ A('(#10 D('&*1&' 2$0&*E /14 /&46$#&*100E A1%$#(' *$460E &)46&6;6&$)10 *1#(+ (%() &)

    *14(4 >/(#( &)'&%&';104 >$;0' J( B$#( 122#$2#&16(0E 4(#%(' &) 0(44d#(46#&*6&%( /$B(d 1)'

    *$BB;)&6Ed4(66&)54-

    G5A&+4/49-& @9&H9.,()6EdA&%( 4616(4 1#(

    (&6/ ,(2;J0&*1)

    5$%(#)$#4 1)' NF"d*$)6#$00(' 0(5&4016;#(4[ GW 1#( )$6 (

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    12/138

    01"/4(%;" =4>>#5)

    "15([ 6/+ 6/( B$'(0 2#('&*64 1 4&5)&A&*1)6 5#$>6/ &) 6/( 914(0&)(- H/;4+ (%()

    >&6/$;6 ( JE 1) 1));10 1%(#15( #16(

    $A I-Wh- F%(# )&)( E(1#4+ 6/&4 5#$>6/ #16( &4 1 6$610 &)*#(14( $A )(1#0E ISh+ >/&*/ >$;0' 1'' LS+GYZ

    2(#4$)4 6$ 6/( ()#$00B()6+ J#&)5&)5 6/( ?Cc IUIYdIK 914(0&)( ()#$00B()6 6$ YZK+SGW-

    M)'(# 6/( V6/ A$# ()#$00B()6 &4 (46&B16(' 6$ J( Z-Lh

    $%(# 6() E(1#4+ >/&*/ &4 6$610 &)*#(14( $A LK-Lh- H/&4 >$;0' 1'' 1 6$610 $A IUK+WUU 2(#4$)4 $)6$ 6/(

    #$004 $%(# 6/( 6() E(1# 2(#&$'+ &)*0;'&)5 6/( ()#$00B()6 5#$>6/ A$# 6/( 914(0&)(-

    H/( @N C&)1)*&10 D$'(0 4/$>4 6/( 6$610 *$46 \100 4616( A;)'4 20;4 A('(#10 A;)'4] A$# 6/( 914(0&)( 1)'

    V&00 J( 4&5)&A&*1)6- C$# 6/( 914(0&)(+ 6$610 *$464 >&00 &)*#(14( $) 1%(#15( $A Z-Yh

    2(# E(1#+ >/&*/ &)*#(14(4 6/( 6$610 *$46 JE PL-Ih $%(# 1 6()dE(1# 2(#&$'- M)'(# 6/( 914(0&)(+ 6/(

    6$610 *$46 A$# D1&)(81#( &)*#(14(4 JE iG-W J&00&$)+ A#$B iI-L J&00&$) &) ?Cc IUGYdGK 6$ iK-Z J&00&$) &)

    ?Cc IUIYdIK-

    C$# 6/( V&00 5#$> 6$ IZ-Kh JE ?Cc IUIYdIK ;)'(# 6/( 914(0&)(- M)'(# 6/( V(%(#+ YK-Yh $A 6/( $%(#100 4616( 2$2;016&$) >&00 J( ()#$00(' &) D('&*1&'+ $# $)( &) (%(#E 6/#((

    2(#4$)4- H/(4( 2(#*()615(4 '$ )$6 &)*0;'( 6/( 122#$/$ #(*(&%( 21#6&10

    J()(A&64 A#$B D1&)(81#(-

    .) 6(#B4 $A 4616( A;)'4+ 6/( J;'5(6 A$# D1&)(81#( 4(#%&*(4 /14 J(() 5#$>&)5 A146(# 6/1) 6/( #(46 $A

    6/( 4616( J;'5(6 \P-Uh 1%(#15( 1));10 5#$>6/ %(#4;4 I-Ih]- H/( @N C&)1)*&10 D$'(0 A$#(*1464 6/16

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    13/138

    01"/4(%;" =4>>#5)

    "15([ 6/ #16( >&00 J( Z-Ih- =$>(%(#+ &A D1&)( (0(*64 6$ (6/ #16( J(*$B(4 Z-Sh-

    H/( 2(#*()615( $A 6/( N()(#10 C;)' J;'5(6 '('&*16(' 6$ D1&)(81#( 4(#%&*(4 &4 2#$f(*6(' 6$ 5#$>

    A#$B IK-Ih &) ?Cc IUGIGY 6$ YZ-Uh ;)'(# 6/( 914(0&)(- M)'(# 6/( V(%(#+

    D1&)(81#( >&00 #(T;( YL-Kh $A 6/( N()(#10 C;)' J;'5(6- C$# 6/( $%(#100 J;'5(6+ &)*0;'&)5 A('(#10A;)'4+ D1&)(81#( >&00 #(T;( KK-Ph $A 6/( 6$610 J;'5(6 ;)'(# (1E 6$ (%10;16( 6/( (*$)$B&* &B21*6 &4 6$ *$B21#( D1&)(81#( ()#$00B()6 6$

    (B20$EB()6- .) ?Cc IUGIGY+ 6/( #16&$ >14 G 6$ I-U+ B(1)&)5 6/16 (1*/ 2(#4$) $) D1&)(81#( >14

    4;22$#6(' JE I (B20$E(' 2(#4$)4- H/16 #16&$ >&00 '#$2 6$ G 6$ G-K &) IUIU ;)'(# 6/( V/16 6#()'4 >&00 2#(%1&0 &) 6/( A;6;#(- V1*/ %10;( */$4() >14 &) 6/(

    B&''0( $A 1) (&00 A100 6$>1#' (&6/(# ()' $A 6/( #1)5(4 14 $22$4(' 6$ &) 6/( B&''0(- Q$>d

    ()' %10;(4 1#( '(A&)(' 14 6/$4( %10;(4 6/16 >$;0' *1;4( ()#$00B()6 1)' *$464 6$ J( 0$>(# 6/1)

    A$#(*146('- =&5/d()' %10;(4 1#( 6/$4( %10;(4 6/16 >$;0' *1;4( ()#$00B()6 1)' *$46 6$ J( B$#( 6/1)

    A$#(*146('-

    C$;# #&4: A1*6$#4 */$4() 6$ J( 1)10EX(' 1#( 6/( 2$%(#6E 5#$>6/ #16(4+ "(# D(BJ(# "(# D$)6/

    \"D"D] *$46 5#$>6/ #16(4+ &)'&%&';104 >&6/ 2#&%16( &)4;#1)*( 0$4&)5 *$%(#15( \2#&%16( '#$2]+ 1)'CD@" #16( */1)5(4- .) 1''&6&$)+ 1 J(46 *14( 4*()1#&$ 1)' 1 >$#46d*14( 4*()1#&$ >(#( #;)+ 144;B&)5

    6/16 6/( 6/#(( $A 6/$4( A$;# #&4: A1*6$#4 >&00 /1%( %10;(4 6/16 A100 $) (&6/(# 6/( 0$>d()' $# /&5/d()'

    $A 6/( #(42(*6&%( #1)5(4-

    R1#&1)*( &) 6/( 2$%(#6E 5#$>6/ #&4: A1*6$# >$;0' *1;4( ()#$00B()6 A$# 6/( 914(0&)( 6$ %1#E A#$B d

    P-Wh 6$ jL-Yh $AA 6/( B&''0( JE ?Cc IUIYdIK+ 1)' &6 >$;0' *1;4( 6/( 4616( *$46 $%(# 6/( 6() E(1#4

    A$# 6/( 914(0&)( 6$ %1#E A#$B dY-Kh 6$ jY-Ph $AA 6/( B&''0(- H$610 ($;0' %1#E

    A#$B GGL+GKK 6$ GYG+YKK &) ?Cc IUIYdIK 14 B(14;#(' A#$B 6/( 914(0&)(- ?616( *$464 $%(# 6() E(1#4

    A$# 6/( ($;0' %1#E A#$B iLLL-I B&00&$) 6$ iWYL B&00&$) #(016&%( 6$ 6/( 914(0&)(-

    R1#&1)*( &) 6/( "D"D *$46 #&4: A1*6$# >$;0' *1;4( 6/( 4616( *$46 $A 6/( 914(0&)( 6$ %1#E A#$B dZ-Ph

    6$ jP-Uh $AA 6/( B&''0( $%(# 6/( 6() E(1#4- H/( 6()dE(1# 4616( *$46 A$# 6/( ($;0' %1#E

    A#$B iLZU-K B&00&$) 6$ iWPL B&00&$) 14 B(14;#(' A#$B 6/( 914(0&)(-

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    14/138

    01"/4(%;" =4>>#5)

    "15([ d()' %10;(4 A$# 6/( A$00$>&)5 #&4: A1*6$#4[ 2$%(#6E 5#$>6/+

    "D"D 5#$>6/+ 1)' 2#&%16( '#$2- H/( >$#46d*14( 4*()1#&$ 144;B(' /&5/d()' %10;(4 A$# "D"D

    5#$>6/+ 2#&%16( '#$2+ 1)' CD@"- R1#&1)*( &) 6/( J(46 *14( _ >$#46d*14( 4*()1#&$4 >$;0' *1;4(

    ()#$00B()6 A$# 6/( 914(0&)( 6$ %1#E A#$B dP-Wh 6$ Uh $AA 6/( B&''0( JE ?Cc IUIYdIK+ 1)' &6 >$;0'

    *1;4( 6/( 6()dE(1# 4616( *$464 A$# 6/( 914(0&)( 6$ %1#E A#$B dW-Sh 6$ jIG-Wh $AA 6/( B&''0(- H$610

    ($;0' %1#E A#$B GUS+ZIP 6$ GKK+GSK &) ?Cc IUIYdIK #(016&%( 6$ 6/( 914(0&)(-

    ?616( *$464 $%(# 6() E(1#4 A$# 6/( ($;0' %1#E A#$B iPWK-L B&00&$) 6$ iY-UZ J&00&$) #(016&%(

    6$ 6/( 914(0&)(-

    )56.07-,56&H/( @N C&)1)*&10 D$'(0 '(B$)46#16(4 6/16 &6 >&00 J( */100()5&)5 A$# D1&)( 6$ 1AA$#' D1&)(81#( &)

    6/( A;6;#( (%() >&6/$;6 (&6/ A0($;0' $AA(# (

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    15/138

    ="/(%+3 B9 B3(5+.4/(%+3

    "15([ G

    +9.4,56&1J&164@5+ 20;4 1 Zh &)*$B( '&4#(51#' (AA(*6&%(0E

    (/&*/ 1#( $A6() 4;BB1#&X(' 14 2#(5)1)6 >$B()+ &)A1)64 1)'

    */&0'#()+ 0$>d&)*$B( A1B&0&(4+ '&41J0(' &)'&%&';104+ 1)' 6/( (0'(#0E- V1*/ B1)'16$#E 2$2;016&$) /14

    &64 $>) 4(6 $A (0&5&J&0&6E #;0(4-

    ?616(4 B1E 104$ #(*(&%( A('(#10 B16*/&)5 A;)'4 A$# 2#$5#1B4 6/16 *$%(# $26&$)10 *16(5$#&(4 $A

    &)'&%&';104+ 1)' 6/(#( &4 *$)4&'(#1J0( %1#&16&$) 1)' *$B20( 6/(4( $26&$)10 *16(5$#&(4 1#(

    '(A&)('- C('(#10 01> A;#6/(# 2#$%&'(4 A$# >1&%(#4 6$ 100$> 4616(4 4$B( A0(1&%(#4 #(T;( 122#$%10 $A 6/( M-?-

    7(21#6B()6 $A =(106/ 1)' =;B1) ?(#%&*(4 \M?7==?] &) $#'(# 6$ #(*(&%( A('(#10 B16*/&)5 A;)'4-

    ?616(4 104$ 1#( 100$>(' 6$ B$'&AE 6/( D('&*1&' ?616( "01) \6/( *$)6#1*6 J(6>(() 6/( 4616( 1)' 6/(

    Federal government that describes the states Medicaid program) through something called the

    G @4 ;4(' &) 6/&4 #(2$#6+ D1&)(81#( &)*0;'(4 100 B(1)4d6(46(' B('&*10 144&461)*( 2#$5#1B4 1'B&)&46(#(' JE 6/( D1&)( 7(21#6B()6

    $A =(106/ 1)' =;B1) ?(#%&*(4+ &)*0;'&)5 8;J81#(-I H/( "16&()6 "#$6(*6&$) 1)' @AA$#'1J0( 81#( @*6+ ";J0&* Q1> O$- GGGdGKW+ >14 1B()'(' JE 6/( =(106/ 81#( 1)' V';*16&$)

    ,(*$)*&0&16&$) @*6 $A IUGU+ ";J0&* Q1> O$- GGGdGZI+ 1)' &4 #(A(##(' 6$ &) 6/&4 46;'E 14 6/( @AA$#'1J0( 81#( @*6 \@8@]-

    Y H/( M-?- 7(21#6B()6 $A =(106/ 1)' =;B1) ?(#%&*(4 1));100E 2;J0&4/(4 2$%(#6E 5;&'(0&)(4 &) 6/( C('(#10 ,(5&46(# A$#

    1'B&)&46#16&%( 2;#2$4(4 $A '(6(#B&)&)5 (0&5&J&0&6E A$# %1#&$;4 A('(#10 2#$5#1B4- H/(4( 5;&'(0&)(4 1#( $A6() #(A(##(' 6$ 14 6/(

    C('(#10 "$%(#6E Q(%(0 \C"Q]-

    K V)1*6(' &) GSPZ+ D('&*1&' &4 A$;)' &) H&60( a.a $A 6/( ?$*&10 ?(*;#&6E @*6- H/( 9101)*(' 9;'5(6 @*6 $A GSSL+ ";J0&* Q1> GUZdYY+

    established the State Childrens Health Insurance Program (SCHIP), which became known as the Childrens Health Insurance

    "#$5#1B \8=."] 1A6(# D1#*/ IUUS- C$;)' &) H&60( aa. $A 6/( ?$*&10 ?(*;#&6E @*6+ &6 &4 *$BB$) 6$ ;4( 8=." 1)' ?8=."

    &)6(#*/1)5(1J0E- FA6()+ 1)' &) B$46 *$)6(

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    16/138

    ="/(%+3 B9 B3(5+.4/(%+3

    "15([ I

    ?616( "01) @B()'B()6 \?"@] 2#$*(44- ?"@4 100$> 4616(4 6$ #(T;(46 J14&* 2#$5#1B */1)5(4+ B1:(

    *$##(*6&$)4+ $# 4()' 6/( A('(#10 5$%(#)B()6 ;2'16(4 $) 6/( 2#$5#1B4- @06/$;5/ >1&%(#4 100$> A$#

    B$#( A0( 1)' &))$%16&%( B$'(04 $A *1#( $# )(> >1E4 6$ '(0&%(# *1#(+ J$6/ 6/(

    >1&%(# 1)' 6/( ?"@ 1#( #(A(##(' 6$ 14 6/( 0(510 1;6/$#&6E 4616(4 2$44(44 6$ */1)5( 6/( D('&*1&'

    2#$5#1B4-Z

    ?616( 21#6&*&216&$) &) D('&*1&' &4 $26&$)10+ J;6 100 4616(4 '$ 21#6&*&216(- PH/( A('(#10 5$%(#)B()6

    2#$%&'(4 B16*/&)5 A;)'4 %&1 1 A$#B;01 ;4&)5 1 6/#(( E(1# 1%(#15( $A 4616( 2(# *12&61 &)*$B(L+ :)$>)

    14 6/( C('(#10 D('&*10 @44&461)*( "(#*()615( \CD@"]- ?616(4 >&6/ 0$>(# 2(# *12&61 &)*$B(4 #(016&%(

    6$ 6/( )16&$)10 1%(#15( #(*(&%( /&5/(# CD@"4 >/&0( 4616(4 >&6/ /&5/(# 2(# *12&61 &)*$B( #(*(&%(

    0$>(# CD@"4- =$>(%(#+ )$ 4616( #(*(&%(4 0(44 6/1) A&A6E 2(#*()6- N()(#100E+ CD@"4 %1#E A#$B E(1#d

    6$dE(1# J14(' )$6 $)0E $) 1));10 A0;*6;16&$)4 $A 2(# *12&61 &)*$B( J;6 104$ ';( 6$ */1)5(4 &)

    C('(#10 01>-W

    I9& ) &/6&6/

    6/( C('(#10 5$%(#)B()6- H/(4( 2#$*(44(4 1#( $A6() 6&B(4 6('&$;4+ 01J$#&$;4+ 1)' $;6B$'('-P @#&X$)1 >14 6/( 0146 4616( &) 6/( M)&$) 6$ &B20(B()6 D('&*1&'+ '$&)5 4$ &) GSWI+ GL E(1#4 1A6(# "#(4&'()6 QE)'$) `$/)4$) 4&5)('

    6/( 2#$5#1B &)6$ 01>-

    L "(# *12&61 &)*$B( &4 B16/(B16&*100E '(6(#B&)(' JE '&%&'&)5 6$610 &)*$B( JE 6$610 2$2;016&$)-

    W @ A(> (14 (14 6$ J( A;)'(' 2#&B1#&0E A#$B #(%();(4 *$00(*6('

    A#$B 21E#$00 '(';*6&$)4+ *;##()60E 16 I-Sh $A (1#)&)54+ 6/&4 &4 )$ 0$)5(# 6/( *14(- @**$#'&)5 6$ 6/( CG-H @$$F", I%*+3( +5 (;%

    J+"3D7 +5 K3F7(%%7 +5 (;% L%D%3", M+7*#(", E$7F3"$N% "$D L%D%3", 'F**,%O%$("34 !%D#N", E$7F3"$N% K3F7( LF$D8 6$610 ((#( KI-G B&00&$) 15(' 2(#4$)4 1)' W-K B&00&$) '&41J0('

    2(#4$)4 $) D('&*1#( A$# 6/( *10()'1# E(1#-

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    17/138

    ="/(%+3 B9 B3(5+.4/(%+3

    "15([ Y

    >&'(42#(1' &B21*6 $) 6/( /(106/d*1#( &)';46#E 1)' 6/( B1)E */1)5(4 6$ 6/( .)6(#)10 ,(%();( 8$'(

    6/16 *#(16( )(> 61 D$'&A&(' @'f;46(' N#$44 .)*$B( \D@N.] B(6/$'$0$5E+ 6$

    B1:( );B(#$;4 4E46(B */1)5(4 6$ 6/( D('&*1&' D1)15(B()6 .)A$#B16&$) ?E46(B \DD.?] A$#

    J$6/ *01&B4 1)' 2#$%&'(#4+ 1)' 6$ 1'$26 1 )(> )16&$)10 *$'&)5 4E46(B+ 6$ )1B( 1 A(>-GU

    H&60( ..+ $A 6/( @8@+ *100ed the Role of Public Programs, is a section of the law that makes significant

    */1)5(4 6$ D('&*1&'- D$46 &B2$#61)6 A$# 6/&4 46;'E &4 6/( 2#(d?;2#(B( 8$;#6 #;0&)5 B1)'16( 6/16

    4616(4 B;46 ( 14 21#6 $A 1 201)

    6$ 2#$%&'( /(106/ *1#( A$# 100 @B(#&*1)4- H/( @8@ &)6#$';*(4 )(> 461)'1#'4 A$# (B20$E(#dJ14('&)4;#1)*( 201)4+ 1)' &6 B1)'16(' 6/( *#(16&$) $A /(106/ *1#( &)4;#1)*( (&00 J( 2()10&X(' &A 6/(E '$ )$6 2#$%&'( /(106/ *1#( J()(A&64- O$6>&6/461)'&)5 4$B(

    (&6/$;6 /(106/ &)4;#1)*( 14 '(A&)(' JE 6/( 01> >$;0' J( 4;Jf(*6 6$ 1 61 2$2;016&$)4 ()#$00&)5 &) D('&*1&'+ 1)' &6 2()10&X(4 4616(4 >/$ '$ )$6 ($ 142(*64 $A 6/( 01>[ 6/(

    &)'&%&';10 B1)'16( 1)' 6/( #(T;(B()6 6/16 4616(4 B;46 ((#( 4(21#16(0E 1''#(44('- .) 1 ZdK '(*&4&$)+ 6/(

    8$;#6 #;0(' 6/16 6/( &)'&%&';10 B1)'16( 2()106E >14 )$6 1 2()106E+ 14 '(A&)(' JE 6/( 01>+ J;6 #16/(#

    1 61< A$# *$)46&6;6&$)10 2;#2$4(4 1)' 6/;4 >14 *$)46&6;6&$)10 ;)'(# 6/( 5()(#10 61(# $A

    GU H/( @B(#&*1) @*6&$) C$#;B 2#$%&'(4 $)( *10*;016&$) $) Maines regulatory impact to be upwards of $119 million dollars through

    F*6$J(# IUGI #(T;&)5 6/( (T;&%10()6 $A SL >$#:(#4 6$ '(10 >&6/ 6/( )(> >$#: B1)'16(' JE 6/( @8@- ?(( ?1B 916:&)4+ ?616(

    JE ?616( .B21*6 $A @8@ ,(5;016&$)4, @B(#&*1) @*6&$) C$#;B+ F*6$J(# IUGI+ 1**(44(' 16[

    /662[__1B(#&*1)1*6&$)A$#;B-$#5_4&6(4_'(A1;06_A&0(4_@8@k#(54-2'A-

    GG P"(#+$", L%D%3"(#+$ +5 E$D%*%$D%$( JF7#$%77 =S '%2%,#F7 + ZPL M-?-GGdYSY+ `;)( IUGI-

    http://americanactionforum.org/sites/default/files/ACA_regs.pdfhttp://americanactionforum.org/sites/default/files/ACA_regs.pdfhttp://americanactionforum.org/sites/default/files/ACA_regs.pdf
  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    18/138

    ="/(%+3 B9 B3(5+.4/(%+3

    "15([ K

    8$)5#(44- .) 1 LdI '(*&4&$)+ /$>(%(#+ 6/( 8$;#6 #;0(' &) A1%$# $A 6/( *01&B1)64 41E&)5 6/16 6/(

    #(T;(B()6 6/16 4616(4 () 6/( B1)'16$#E D('&*1&' (14 (461J0&4/(' 6$ 144&46 %;0)(#1J0( *&6&X()4+ '(A&)(' 14

    2#(5)1)6 >$B()+ */&0'#()+ )(('E A1B&0&(4+ 6/( J0&)'+ 6/(

    elderly, and the disabled, in obtainingB('&*10 *1#(-3/&0( &6 &4

    *$BB$) A$# 8$)5#(44 6$ 201*( 0&B&616&$)4 $) A('(#10 A;)'&)5+

    6/( 8$;#6 /14 #;0(' $%(# 6/( E(1#4 6/16 6/( )16;#( $A 6/(

    0&B&616&$)4 B;46 B1&)61&) 1 %$0;)61#E 1*6&$) $) 6/( 21#6 $A 6/(

    4616(4 $# (04( &6 #&4:4 %&$016&)5 6/( 4616(dA('(#10 #(016&$)4/&2

    5;1#1)6((' JE 6/( 8$)46&6;6&$)- H/( A$00$>&)5 T;$6( A#$B 6/(

    '(*&4&$) 4;BB1#&X(4 6/( 0(510 0$5&*-

    Therefore, if States really have no choice other than to accept the package, the offer is

    N+%3N#=%8 "$D (;% N+$D#(#+$7 N"$$+( 2% 7F7("#$%D F$D%3 (;% 7*%$D#$6 *+T%3S S S SE$ 7FO8 #( #7

    *%35%N(,4 N,%"3 53+O (;% 6+", "$D 7(3FN(F3% +5 (;% @)@ (;"( (;% +55%3 +5 (;% !%D#N"#D

    >U*"$7#+$ T"7 +$% (;"( )+$63%77 F$D%37(++D $+ '("(% N+F,D 3%5F7%S K;% !%D#N"#D

    >U*"$7#+$ (;%3%5+3% %UN%%D7 )+$63%77V 7*%$D#$6 *+T%3 "$D Nannot be implemented.GI

    H/( (AA(*6 $A 6/( *$;#6 '(*&4&$) &) PLEJ %-'%2%,#F7&4 6/16 4616(4 /1%( 1 */$&*( $) >/(6/(# $# )$6 6$

    6#1)4A$#B 6/( D('&*1&' 2#$5#1B A#$B 1 2#$5#1B 6$ 144&46 B1)'16$#E 1)' $26&$)10 *16(5$#&(4 $A

    &)'&%&';104 &)6$ 1 2#$5#1B 6$ 2#$%&'( /(106/d*1#( *$%(#15( A$# (%(#E$)( ;)'(# 6/( A('(#100E

    (461J0&4/(' &)*$B( 0(%(0+ 1)' 8$)5#(44 &4 2#$/&J&6(' A#$B 2()10&X&)5 4616(4 6/16 '(*0&)( 6/( $AA(#-

    1235@4/6.9&5:&(9/-,K,0,4D&H/( '(*&4&$) 6$ (/$ 2#(A(# 2;#( B1#:(6 A$#*(4 6$ 6/$4( >/$ 1'%$*16( A$# 1 *$BB1)' 4E46(B 6$6100E #;)

    JE 6/( 5$%(#)B()6-GYH/( T;(46&$) /14 J(*$B( /&5/0E 2$0&6&*&X('+ 14 (4 $A 1 A#(( B1#:(6 4E46(B 1)' 1 4&)50( 21E(# 5$%(#)B()6 4E46(B+ ?(( 7- V#&* ?*/1)4J(#5+ V)%&4&$)&)5 1

    C#(( D1#:(6 &) =(106/ 81#(,)"(+ W+F3$",- R$0- YG- O$-G \IUGG] 1)' =$> ?&)50(d"1E(# =(106/ ?E46(B ,(A$#B .B2#$%(4 ^;10&6E-

    7#- N$#'$) ?*/&AA 1)' 6/( "/E4&*&1)4 A$# 1 O16&$)10 =(106/ "#$5#1B \"O="] 3$#:&)5 N#$;2 $) ^;10&6E- @'1 pted from A Better

    ^;10&6E @06(#)16&%([ ?&)50(dPayer Health System Reform,W+F3$", +5 (;% @O%3#N"$ !%D#N", @77+N#"(#+$8?(26(BJ(# GSSK- @**(44('

    16[>>>-2)/2-$#5_A1*64_T;10&6E-2'A-

    @06/$;5/ 6/( ?;2#(B( 8$;#6

    &) PLEJ = '%2%,#F7'(*&'('

    6/16 4616(4 2$44(44 1 */$&*(

    6$ (

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    19/138

    ="/(%+3 B9 B3(5+.4/(%+3

    "15([ Z

    *1) J(*$B( 2#$J0(B16&* &A 2$0&*EB1:(#4 J(5&) 6$ &5)$#( A1*64 1)' (B2&*10 A&)'&)54 &) A1%$# $A

    2/&0$4$2/&*10 )$6&$)4-

    @06/$;5/ 6/( @8@ J(*1B( 2$0&6&*100E '&%&4&%( A#$B &64 &)*(26&$)+ &6 4((B4 6$ 10&5) >(00 >&6/ 6/$4(

    >/$ /1%( 2/&0$4$2/&*10 0(1)&)54 6$>1#' (&00 /1%( 0$)5461)'&)5 (AA(*64 $) 6/( (*$)$B&* A;6;#( $A 6/( ?616(

    $A D1&)( 1)' &64 *&6&X()4-

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    20/138

    ="/(%+3 B9 B3(5+.4/(%+3

    "15([ P

    H/&4 "15( .)6()6&$)100E Q(A6 901):

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    21/138

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    22/138

    ="/(%+3 BB9 -".%/#%. !%3#3/" #3. N4(/+>"$O#(%+3#' S"5$2"/(%;"

    "15([ W

    @**$#'&)5 6$ 6/( 1*6;1#&10 #(2$#6+ 6/( 6$610 2#$5#1B *$46 $A D('&*1&' &4 2#$f(*6(' 6$ &)*#(14( JE WPh

    A#$B iKIL-K J&00&$) &) CCc IUGG 6$ iLSP J&00&$) &) CCc IUIG ;)'(# 6/( 2"7%,#$%4*()1#&$- =$>(%(#+ &6>$;0' 5#$> 6$ iWYU-S J&00&$) &) CCc IUIG+ ;)'(# 6/(5F,, %U*"$7#+$4*()1#&$+ >/&*/ &4 )(1#0E '$;J0(

    1) &)*#(14( $A SK-Kh- H/( A$#(*146(' 5#$>6/ $A 6/( 6/#(( 4*()1#&$4 1#( &00;46#16(' &) 6/( */1#6 &)

    !%U45" F-GL

    @4 &4 $J%&$;4 A#$B 46;'E&)5 6/( 2#(%&$;4 6>$ */1#64+ 6/( %U*"$7#+$

    2$2;016&$) *1))$6 ($;0' J( &A 6/( @AA$#'1J0( 81#( @*6 &B21*64 >(#(

    (6/].GW

    GL .J&'+ 2- YS-

    GW .J&'+ 2- KI-

    "#$%&' () *&+,'-.'/ 0'/#-1#/ 23&+445'3. 0#44#+36 +7 *'&6+36

    @**$#'&)5 6$ 6/( IUGI

    M?7==? @*6;1#&10 ,(2$#6

    6/( 6$610 2#$5#1B *$46 $A

    D('&*1&'+ &A 100 4616(4

    (

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    23/138

    ="/(%+3 BB9 -".%/#%. !%3#3/" #3. N4(/+>"$O#(%+3#' S"5$2"/(%;"

    "15([ S

    3/&0( 6/( 2#$f(*6(' 5#$>6/ B1E J( 461#60&)5 6$ 4$B(+ M?7==? 1*6;100E 0$>(#(' &64 A$#(*146significantly from its 2011 report for the following reasons in order of importance: (1) states

    ((# *$464 1)' #(';*( 21EB()64 &) IUGI >(#(

    5#(16(# 6/1) 1)6&*&216('+ 1)' 6/(4( #(';*6&$)4 >(#( &)*$#2$#16('

    &)6$ 6/( A$#(*146g \I] H/( 1*6;1#&10 #(2$#6 #(';*(' &64 (46&B16(4 $)

    6/( );BJ(# $A 4616(4 6/16 >$;0' (

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    24/138

    ="/(%+3 BB9 -".%/#%. !%3#3/" #3. N4(/+>"$O#(%+3#' S"5$2"/(%;"

    "15([ GU

    D('&*1&' 2$2;016&$) '(*&'( 6$ ($;0' *$B2#&4( Y-Ih $A N7"+ ;2 A#$B I-Wh &) IUGG- H/( #(2$#6 104$ )$6(' 6/16 >/&0(

    D('&*1&' ()

    1));100E JE Zh 4&)*( 2#&$# 6$ 6/( IUUL #(*(44&$)- H/( */1#6 4/$>) &) !%U45" W &00;46#16(4 /$>

    D('&*1&' ((# 5#$>6/ A$# D('&*1#( 1)' D('&*1&'

    42()'&)5- ?61#6&)5 &) IUGK+ /$>(%(#+ 5#$>6/ &) )16&$)10 /(106/ 42()'&)5 >&00 1**(0(#16( 6$ P-Gh+ #(A0(*6&)5 ((# *$46 4/1#&)5 A$# 6/$4( >&6/ &B2#$%(' *$%(#15(- C. Fleming. M? =(106/ ?2()'&)5

    N#$>6/ "#$f(*6(' 6$ @%(#15( Z-W "(#*()6 @));100E H/#$;5/ IUII+M%",(; @55"#37 J,+6 +$,#$%+ ?(26(BJ(# GW+ IUGY-

    "#$%&' =) 0'/#-1#/ 29:'3/#.%&'6 16 >?1&' +7 @

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    25/138

    ="/(%+3 BB9 -".%/#%. !%3#3/" #3. N4(/+>"$O#(%+3#' S"5$2"/(%;"

    "15([ GG

    (9$

    >&6/$;6 4;*/ 2#$%&4&$)4 /1%( J101)*(' 6/( J;'5(64 &)

    2#1*6&*(-IG H/( A('(#10 5$%(#)B()6+ /$>(%(#+ /14 )$ 4;*/

    *$)46&6;6&$)10 #(46#&*6&$)+ 1)' &) 2#1*6&*( &6 /14 )$6 (/() 6/(#( &4 *$)4&46()6 '(A&*&6 42()'&)5 $) 1) 1));10 J14&4 ';#&)5

    5$$' (*$)$B&* 6&B(4 1)' J1'- H/(E 1#( )$6 101#B(' &A 6/( A('(#10 5$%(#)B()6 *1##&(4 '(J6+ J;6

    6/(E J(*$B( *$)*(#)(' >/() 6/16 '(J6 J(*$B(4 4$ 01#5( #(016&%( 6$ 6/( (*$)$BE 6/16 &6 J(5&)4 6$

    #(46#&*6 A&4*10 A0($ &B2$#61)6 #(14$)4- C.+ &6 /14 )$ ((%(#+ *1) 46&00 $%(#($ /1%( )(&6/(#- FA 6/( 6>$ 6/16 /1%( )(&6/(#[ .)'&1)1 B1E *1##E $%(# 1));10 '(A&*&64 J;6 *1))$6 144;B(

    '(J6+ >/&*/ /14 6/( (AA(*6 $A A$#*&)5 J;'5(61#E '&4*&20&)(g 1)' R(#B$)6+ &) 2#1*6&*(+ /14 )$6 *1##&(' '(A&*&64 A#$B $)( J;'5(6 E(1#

    6$ 6/( )(/() /( &)6#$';*(4 6/( J;'5(6 \KK 4616(4]+ $) 6/(

    Q(5&4016;#( 6$ 2144 1 J101)*(' J;'5(6 \KG 4616(4]+ $# $) 6/( N$%(#)$# >/() /( 4&5)4 6/( J;'5(6 \YL 4616(4]- O16&$)10 @44$*&16&$)

    of State Budget Officers, JFD6%( 93+N%77%7 #$ (;% '("(%7, Summer 2008.

    V*$)$B&464+ &) 5()(#10+ 1#( )$6

    151&)46 A('(#10 '(A&*&64 2#$%&'('

    \G] 6/$4( '(A&*&64 '$ )$6 J(*$B(6/( )$#B 1)' \I] 6/( B15)&6;'(

    $A 6/( '(J6 #(B1&)4

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    26/138

    ="/(%+3 BB9 -".%/#%. !%3#3/" #3. N4(/+>"$O#(%+3#' S"5$2"/(%;"

    "15([ GI

    F%(# 6/( 0146 A&A6E E(1#4+ 6/( A('(#10 5$%(#)B()6 #1) '(A&*&64 )&)(6E 2(#*()6 $A 6/( 6&B(+ ';#&)5 5$$'

    (*$)$B&* 6&B(4 1)' J1'- .) &)A016&$) 1'f;46(' '$001#4+ 6/( 4&< $A 6/( 6() 01#5(46 A('(#10 '(A&*&64 4&)*(

    GSKU &)*0;'( CCc4 IUUW 6/#$;5/ IUGY+ 1)' A&%( $A 6/$4( E(1#4 /$0' 6/( 6$2 A&%( 42$64- @4 4/$>) $)

    6/( 0(A6 /10A $A 6/( 61J0( &) !%U45" IC6/( 01#5(46 A('(#10 J;'5(6 (%(# >14 CCc IUUS+ >/&*/ >14 diG-Z

    6#&00&$) >/() 1'f;46(' A$# &)A016&$) &) IUGY '$001#4-IIV*$)$B&464 5()(#100E J(0&(%(+ /$>(%(#+ 6/16

    *$B21#&)5 B15)&6;'(4 $A &)A016&$)d1'f;46(' '(A&*&64 $%(# 6&B( B1E J( B&40(1'&)5 J(*1;4( &6 '$(4

    )$6 1**$;)6 A$# 6/( 5#$>6/ $A 6/( (*$)$BE- H/(#(A$#(+ 6/(E 0&:( 6$ *$B21#( '(A&*&64 6$ 6/( N#$44

    7$B(46&* "#$';*6 \N7"]- @4 4/$>) $) 6/( #&5/6 /10A $A 6/( 61J0( &) !%U45" I+ #(*()6 '(A&*&64 1#( 46&00

    ()$#B$;40E 01#5(- H/( 6$2 A$;# E(1#4 >&6/ 6/( 01#5(46 '(A&*&64 >(#( ';#&)5 6#E&)5 6&B(4 $A 3$#0' 31#

    ..[ GSKI 6/#$;5/ GSKZ- H/( )((%(#+ 1#( IUUS+ IUGU+ 1)' IUGG-

    F) 6/( 4(*$)' 2$&)6+ #(016&)5 6$ /1%&)5 1 )16&$)10 '(J6 6/16 &4

    B1)15(1J0(+ (*$)$B&464 0&:( 6$ *$B21#( 6$610 )16&$)10 '(J6 6$

    N7"- @51&)46 6/&4 B(6#&*+ 6/( M)&6(' ?616(4 '$(4 )$6 '$ >(00 16

    100- C$# 6/( 4(*$)' T;1#6(# $A IUGY+ 6/( '(J6d6$dN7" #16&$ >14

    GUU-Ph- C&%( E(1#4 15$+ 6/( '(J6d6$dN7" #16&$ >14 $)0E PK-Wh-

    H/&4 *10*;016&$) ;4(4 J$6/ '(J6 /(0' JE 6/( 2;J0&* 1)' JE 6/(

    5$%(#)B()6 &64(0A+ >/&*/ &4 :)$>) 14 &)6#1d5$%(#)B()610 '(J6-

    H/( 0166(# '(J6 *$)4&464 $A 6#;( $J0&516&$)4 /(0' JE %1#&$;4 5$%(#)B()6 15()*&(4+ &)*0;'&)5 6/( 6#;46A;)'4 $A ?$*&10 ?(*;#&6E 1)' D('&*1#(-

    II 7161 /(#( 1)' &) 6/( */1#6 *$B( A#$B 6/#(( 4$;#*(4[ M-?- FAA&*( $A D1)15(B()6 1)' 9;'5(6+ L#7N", Z%"3 CG-[ M#7(+3#N", K"2,%78

    JFD6%( +5 (;% AS'S B+=%3$O%$(+ H1J0( G-Yg 8$)5#(44&$)10 9;'5(6 FAA&*(+ !+$(;,4 JFD6%( I%=#%T'FOO"34 5+3 L#7N", Z%"3 CG-H+

    O$%(BJ(# L+ IUGYg 1)' N#$44 7$B(46&* "#$';*6 '161 A#$B 6/( M-?- 9;#(1; $A V*$)$B&* @)10E4&4- @00 %10;(4 >(#( *$)%(#6(' 6$

    J14( CCc IUGY ;4&)5 N7" 2#&*( '(A016$#4-

    .6 &4 *$BB$)0E 1**(26(' 6/16

    6/( A('(#10 5$%(#)B()6 /14 1

    46#;*6;#10 '(A&*&6 2#$J0(B- F%(#

    6/( 0146 A&A6E E(1#4+ 6/( A('(#10

    5$%(#)B()6 #1) '(A&*&64 )&)(6E

    2(#*()6 $A 6/( 6&B(-

    :#3Y !!R

    B3,'#(%+3 7.^4$(".

    M%''%+3 ?+''#5$

    M#$" R"#5 FGHW

    :#3Y !!R S"5/"3( +,

    K?S

    G IUUS dG+ZGL G G SKY dYU-Y

    I IUGU dG+YLY I G SKK dII-L

    Y IUGG dG+YZG Y G SKZ dIG-Z

    K IUGI dG+GUK K G SKI dGK-I

    Z IUGY dPWU Z IUUS dGU-G

    P GSKY dPYI P IUGU dS-U

    L GSKZ dPIZ L IUGG dW-L

    W GSKK dZSP W GSKP dL-I

    S IUUK dZUS S IUGI dL-U

    GU IUUW dKSK GU GSWY dP-U

    J+2 HG L#5U"$( !"."5#' ?",%/%($ =%3/" !!R HZIG

    "#$%&' A) B+: (C D1&$'6. "'/'&14

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    27/138

    ="/(%+3 BB9 -".%/#%. !%3#3/" #3. N4(/+>"$O#(%+3#' S"5$2"/(%;"

    "15([ GY

    @ *$B21#&4$) $A 6/( M)&6(' ?616(4 6$ $6/(# *$;)6#&(4 104$

    &00;46#16(4 6/( 2$&)6- .A 6/( M)&6(' ?616(4 >(#( 1 B(BJ(# $A 6/(

    V;#$2(1) M)&$)+ &6 >$;0' /1%( 6/( 4&$#46 '(J6d6$dN7" #16&$

    1A6(# N#((*(+ .610E+ "$#6;510+

    .#(01)'+ 1)' 9(05&;B+ 14&)'&*16(' &) 6/( 61J0( &)

    !%U45" X >/&*/ *$B21#(4

    6/( 4(*$)' T;1#6(# $A IUGY+

    6/( B$46 #(*()6 '161

    1%1&01J0(-IYO$6( $) 6/( 0&46

    6/16 6/( *$;)6#&(4 *0$4(46 6$ 6/( M-?- 1#( *$;)6#&(4 46#;550&)5 >&6/

    4(#&$;4 (*$)$B&* 2#$J0(B4-

    H/( /&46$#E $A 8$)5#(44&$)10 1*6&$)4 6$ 4$0%( 6/( *$)6&);10 '(A&*&6

    */100()5(4+ >/&*/ /1%( J(() B$460E ;)4;**(44A;0+ &4 0$)5 1)' >&00 )$6 J( *$%(#(' /(#(- =$>(%(#+ &6

    &4 &B2$#61)6 6$ :)$> 1J$;6 #(*()6 166(B264 6/16 B1E /1%( 1) &B21*6 $) A;6;#( 42()'&)5 $)

    D('&*1&'-

    C. 2#$2$4(' JE "#(4&'()6 9&00 80&)6$)IK14 21#6 $A /&4 GSSL J;'5(6 2#$2$410+*%3 N"*#("*124 >$;0'

    transform Medicaids financing mechanism by limiting each state to fixed d$001# #(&BJ;#4(B()64 A$#

    (1*/ #(*&2&()6 14 $22$4(' 6$ 6/( *;##()6 B(6/$' $A 21E&)5 A$# 1 2(#*()615( 4/1#( $A 6/( *$464- .)

    (44()*(+ 2#$5#1B 42()'&)5 5#$>6/ >$;0' J( 0&):(' 6$ ()#$00B()6+ )$6 6/( $%(#100 *$46 $A 42()'&)5-

    @06/$;5/ *%3 N"*#("*124 /1%( J(() ;6&0&X(' &) 4(0(*6 D('&*1&' '(B$)46#16&$) 2#$f(*64 6$ ()4;#(

    A('(#10 ($;0' B$46 0&:(0E /1%( 6$ B1:( ;2 6/( '&AA(#()*(-IZ

    7&AA(#()6 B(6/$'$0$5&(4 *1) J( ;6&0&X(' &) '(6(#B&)&)5*%3 N"*#("*124- F)( B(6/$' >$;0' (461J0&4/

    1 A('(#10 #(&BJ;#4(B()6 0&B&6 2(# (1*/ #(*&2&()6+ 1)' 4616(4 >$;0' J( #(42$)4&J0( A$# 1)E 1B$;)6

    42()6 $%(# 6/16 0&B&6- ?$B( B(6/$'4 >$;0' 61:( &)6$ 1**$;)6 6/( /&46$#&* 2(#d#(*&2&()6 D('&*1&'

    42()'&)5 $A 6/( 4616(4+ (461J0&4/&)5 0&B&64 $) 1 4616( 42(*&A&* J14&4- F6/(# B(6/$'4 >$;0' 4(6 ;2

    4(21#16( *124 J14(' $) 42(*&A&* 2$2;016&$) 5#$;24-

    IY EuroStat, European Union, Luxembourg, Euro area and EU28 government debt up to 93.4%and 86.8% of GDP, >F3+'("( P%T7

    I%,%"7%+ GZY_IUGY+ F*6$J(# IY+ IUGY- M-?- 7(J6 *10*;016(' ;4&)5/662[__>>>-6#(14;#E'(*6-5$%_>(J4&6( $A 6/( M-?- 7(21#6B()6

    $A H#(14;#E- @**(44(' 7(*(BJ(# GU+ IUGY- N7" '161 A#$B M-?- 9;#(1; $A V*$)$B&* @)10E4&4-

    IK 3/() 6/( NF"d*$)6#$00(' 8$)5#(44 2144(' 1 D('&*1&' J0$*: 5#1)6 J&00 &) 6/( 016( GSSU4+ "#(4&'()6 80&)6$) %(6$(' &6 1)' &)

    #(42$)4( 2#$2$4(' /&4*%3 N"*#("cap method as a compromise. Under the Presidents proposal, the*124 >$;0' J( *10*;016(' A$#

    42()'&)5 $) 42(*&A&* (0&5&J&0&6E 5#$;24+ 4;*/ 14 &)'&%&';104 >&6/ '&41J&0&6&(4+ )$)d'&41J0(' 1';064+ */&0'#()+ 1)' 6/( (0'(#0E-

    IZ V'>&) "1#: 1)' D166 9#$1'';4+ Medicaid Per Capita Cap Would Shift Costs to States and Place Lowd.)*$B( 9()(A&*&1#&(4 16 ,&4:,

    8()6(#5+3 JFD6%( "$D 9+,#N4 93#+3#(#%78F*6$J(# K+ IUGI-

    "#$%&' J) K+5:1&' L>

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    28/138

    ="/(%+3 BB9 -".%/#%. !%3#3/" #3. N4(/+>"$O#(%+3#' S"5$2"/(%;"

    "15([ GK

    @06/$;5/ 6/( &B20(B()616&$) $A*%3 N"*#("*124 >$;0' 2#$%&'( 4616(4 >&6/ 46#&*6(# 42()'&)5 0&B&64+

    6E2&*10 2#$2$4104 /1%( 100$>(' &)*#(14(' A0((%(#+ >$;0' B$46 0&:(0E )$6

    J( 5#1)6('+ 6/;4 144;#&)5 6/( *$)6&);16&$) $A /&46$#&* *14(0$1' 5#$>6/ 1)' 1 4&5)&A&*1)6 0$44 $A

    A('(#10 '$001#4 6$ 4616(4-IP

    8$)5#(44B1) 9&00 8144&'E A#$B Q$;&4&1)1 2#$%&'(4

    1 #(*()6 ( 6/&4 *$46 41%&)5 &)&6&16&%(

    *$)6&);(4 6$ #(4;#A1*( >/() &) IUGI /( 2#$2$4('

    6$ (T;10&X( D('&*1&' 42()'&)5 1*#$44 100 4616(4

    >&6/ 1 *%3 N"*#(" *12 6/16 %1#&(' JE D('&*1&'

    *16(5$#E-IL=&4 2#$2$410 *100(' A$#*%3 N"*#("*124

    6/16 '&AA(#(' A$# (0&5&J&0&6E 5#$;24+ 4;*/ 14 */&0'#()+ 1';064+ 6/( J0&)' 1)' &)'&%&';104 >&6/ '&41J&0&6&(4+

    1)' (0'(#0E &)'&%&';104 #(*(&%&)5 0$)5d6(#B *1#( 4(#%&*(4+ J14(' $) 6/( B('&1) *$46 $A *1#(-IW

    "1EB()64 ;)'(# /&4 2#$2$410 >$;0' J( #&4: 1'f;46(' A$# 6/( 2$2;016&$) 14 >(00 14 '$>) 6$ 6/(

    #(*&2&()6-ISD$#( #(*()60E+ $) D1E G+ IUGY+ ?()16$# F##&) =16*/ \,dM61/] 1)' ,(2#(4()616&%( C#('

    M26$) \,dD&*/-] B1'( 2;J0&* 1 2lan for Making Medicaid Work. One of their blueprints key

    2#$2$4104 >14 6$ &B20(B()6 2(# *12&61 *124-YU

    =&46$#&*100E+ 6&B(4 $A A('(#10 A&)1)*&10 *#&4(4 /1%( J(() 6/( B1&) #16&$)10( A$# &B2$4&)5 *%3 N"*#("

    *124- 8(#61&) 2$0&*EB1:(#4+ /$>(%(#+ J(0&(%( 6/16 &) 1''&6&$) 6$ 41%&)5 B$)(E+ 6/(E >$;0' &B2#$%(

    *1#(- @06/$;5/ )$*%3 N"*#("*12 2#$2$410 /14 J(() &B20(B()6(' 1*#$44 6/( ()6( 2#$5#1B 6$ '16(+

    6/( 5#$>&)5 A('(#10 J;'5(6 '(A&*&614 >(00 14 1 A;)'1B()610 J(0&(A JE *(#61&) 2$0&*EB1:(#4 6/16

    *124 &)*()6&%&X( &B2#$%(' $;6*$B(4B1:(4 *(#61&) 6/16*%3 N"*#("*124 >&00 *$)6&);( 6$ J( $AA(#('

    14 1 4$0;6&$) 6$ 6/( *;##()6 A&4*10 */100()5(4 A1*(' JE 6/( A('(#10 5$%(#)B()6-

    .) IUGG+ '(J16( $%(# #1&4&)5 6/( '(J6 *(&0&)5 $A 6/( A('(#10 5$%(#)B()6 0(' 6$ 1 *$B2#$B&4(- .)

    (&6/

    6/( ()1*6B()6 $A 6/( 9;'5(6 8$)6#$0 @*6 $A IUGG- H/( ?(0(*6 8$BB&66(( >14 */1#5(' >&6/

    IP V%() 6/$;5/ 2(# *12&61 *124 )$#B100E &B2$4( 1 0&B&616&$) $) 4616( A0(

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    29/138

    ="/(%+3 BB9 -".%/#%. !%3#3/" #3. N4(/+>"$O#(%+3#' S"5$2"/(%;"

    "15([ GZ

    '(%(0$2&)5 1)' 2#$2$4&)5 1 J&21#6&41) J;'5(6 6$ #(';*( 6/( J;'5(6 JE iG-Z 6#&00&$) $%(# 6() E(1#4-

    .A 6/( ?(0(*6 8$BB&66(( A1&0(' JE `1);1#E GZ+ IUGI+ 6$ /1%( 0(5&4016&$) ()1*6(' 6/16 >$;0' 1*/&(%(

    1 iG-I 6#&00&$) '(A&*&6 #(';*6&$)+ 6/( @*6 6#&55(#(' 1;6$B16&* #(';*6&$)4 &) '(A()4( 1)' $6/(#

    discretionary spending spread evenly over FFYs 2013 through 2021, also known as 7%\F%7(3"(#+$.

    H/( @*6 (14 (

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    30/138

    ="/(%+3 BB9 -".%/#%. !%3#3/" #3. N4(/+>"$O#(%+3#' S"5$2"/(%;"

    "15([ GP

    '(J6 5#(> 16 Z-Kh A#$B 7(*(BJ(# IUGI 6$ 7(*(BJ(# IUGY >/&0( N7" /14 $)0E 5#$>) Y-Yh \$# G-Wh

    &A E$; 1'f;46 A$# &)A016&$)]+ 6/( )16&$)10 '(J6 *$)6&);(4 6$ 5#$> A146(# 6/1) N7"+ 201*&)5 2#(44;#( $)

    8$)5#(44 6$ 1*6 $) 6/( '(A&*&6 2#$J0(B-

    H/( );BJ(#4 10$)( *100 166()6&$) 6$ 6/( D('&*1&' 2#$5#1B+ 1)' 6/( 4$0;6&$) A#$B 6/( 2$&)6 $A %&(>$A 6/( A('(#10 5$%(#)B()6 &4 $J%&$;4- C('(#10

    '(A&*&64 *$)6&);( 6$ B$;)6+ 1''&)5 6$ 6/( )16&$)10

    '(J6 16 1 A146(# #16( 6/1) N7" 5#$>6/+ 1)'

    D('&*1&' &4 6/( A146(46 5#$>&)5 J;'5(6 *16(5$#E-

    `;46 #(*()60E+ 6/( 8$)5#(44&$)10 9;'5(6 FAA&*(

    4;55(46(' 1) $26&$) 6$ &B2$4( 1 *12 $) A('(#10

    D('&*1&' 42()'&)5 6$ /(02 J#&)5 6/( A('(#10

    '(A&*&6 2#$J0(B ;)'(# *$)6#$0-

    .) O$%(BJ(# IUGY+ 6/( 8$)5#(44&$)10 9;'5(6 FAA&*( 2;J0&4/(' 6/( #(2$#6 X*(#+$7 5+3 I%DFN#$6 (;%1E4 6$

    *;6 J1*: $) D('&*1&' 42()'&)5- F)( $J%&$;4 >1E >$;0' J( 6$ #(';*( CD@"4- 80(1#0E+ 6/(#( &4 #&4:

    6/16 8$)5#(44 B1E 4/&A6 B$#( *$464 $A D('&*1&' 6$ 6/( 4616(4+ 1)' ="/(%+3 VB$A 6/&4 #(2$#6 >&00

    1''#(44 6/16 #&4: B$#( A;00E-YK

    [email protected],C9&:@52&4I9&+4/49-&Health care and its ancillary support services are the largest items in states budgets, and it is

    YY 8$)5#(44&$)10 9;'5(6 FAA&*(+ X*(#+$7 5+3 I%DFN#$6 (;% $;0' J( /1#' 2#(44(' A$# 1)E

    8$)5#(44 $# "#(4&'()6 6$ &)*#(14( A;)'&)5- H/( $)0E >1E 6$ B$%( 16 6/&4 2$&)6 >$;0' J( 6$ #(';*( A;)'&)5-

    .) O$%(BJ(# IUGY+ 6/( 8$)5#(44&$)10 9;'5(6

    FAA&*( ,(2$#6 4616(4 6/16 D('&*1&' &4 (

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    31/138

    ="/(%+3 BB9 -".%/#%. !%3#3/" #3. N4(/+>"$O#(%+3#' S"5$2"/(%;"

    "15([ GL

    )$6(>$#6/E 6/16 $)( $A 6/( *$)*0;4&$)4 $A 6/( $AA&*&10 1*6;1#&10 #(2$#6 $) D('&*1&' &)%$0%(4 6/(

    J;'5(64 $A 6/( 4616(4[

    Despite the amount of time that has passed since the end of the recession, some of

    #(7 %55%N(7 +$ !%D#N"#D 7(#,, 3%O"#$S >$3+,,O%$( #7 *3+^%N(%D (+ ;"=% 63+T$ O+3%

    \F#NY,4 (;"$ (;% AS'S *+*F,"(#+$ #$ CG-C8 ",2%#( "( 7,+T%3 3"(%7 (;"$ #$ 3%N%$( 4%"37S

    K;% %U*#3"(#+$ +5 (;% (%O*+3"34 L%D%3", O"(N;#$6 3"(% #$N3%"7%7 ,%D (+ 7F27("$(#",

    increases in State Medicaid expenditures, but States budget revenues have not kept

    *"N%_ (;%7% N+$5,#N(#$6 (3%$D7 "**%"3 (+ ;"=% 2%%$ " 7#6$#5#N"$( 3%"7+$ 5+3 (;%

    3%,"(#=%,4 7,+T 3"(% +5 !%D#N"#D %U*%$D#(F3% 63+T(; #$ CG-C.YZ

    @4 *1) J( (6/ $A 6/( D('&*1&' 2#$5#1B 1)' &64 *#$>'&)5 $;6 $A $6/(# &B2$#61)6 2#&$#&6&(4 /14 J(() 1 B1f$# *$)*(#) A$# B$46

    5$%(#)$#4+ '(B$*#16 1)' #(2;J0&*1)- @4 #(*()60E 14 IUGI+ D$)61)1 N$%(#)$# 9#&1) ?*/>(&6X(#+ 1 7(B$*#16+ 6$0' 6/( 314/&)56$)

    "$46 6/16+ m;)0&:( 6/( A('(#10 5$%(#)B()6+ D$)61)1 *1)e6 f;46 2#&)6 B$)(E- 3( /1%( 1 J;'5(6 4;#20;4+ 1)' >(e#( 5$&)5 6$ :((2 &6

    6/16 >1E-m ?(( O-8- @&X()B1) 1)' b1#() H;B;06E+ 7(B$*#164 ?/1#( 8$)*(#)4 $%(# D('&*1&' V

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    32/138

    ="/(%+3 BB9 -".%/#%. !%3#3/" #3. N4(/+>"$O#(%+3#' S"5$2"/(%;"

    "15([ GW

    M4&)5 (46&B16(' O@?9F '161 4/$>&)5 100 A;)'4 A$# ?Cc IUGY+ D1&)(

    #1):4 0$> &) J14&* (';*16&$) (4 6/( 6$2 A&%( 4616(4 A$# (1*/ $A

    6/(4( *16(5$#&(4 1)' 2#$%&'(4 6/( #1):&)54 A$#

    D1&)(+ O(> =1B24/(+ 1)' 6/( 4616( 1%(#15(-

    R(#B$)6 42()'4 6/( B$46 $A 1)E 4616( $) J14&*

    (';*16&$) 16 YI-Zh+ A$00$>(' JE .)'&1)1 16 YG-Yh-

    O(> =1B24/( #1):4 GY6/16 IY-Yh- H/( 4616( 1%(#15( &4 GS-Kh- D1&)( #1):4 YG4616 GP-Ph- C$#

    D('&*1&'+ D1&)( /14 6/( 6/' /&5/(46 (U*%$D#(F3% I%*+3(] >U"O#$#$6 L#7N", CG--CG-H '("(% '*%$D#$6S IUGYS

    "#$%&' S) >.1.' E13F6 7+& >:'3/#3$ +3 ;16#- 2/%-1.#+3 N0'/#-1#/

    =(#(" #3. :#3Y _ =(#(" #3. :#3Y _

    G- R(#B$)6 YY G- D&44$;#& YP

    I- .)'&1)1 YG I- "())4E0%1)&1 YK

    Y- N($#5&1 YG WP -#%3" WF

    K- D&))(4$61 IL K- @#&X$)1 YIZ- H(.1.' 1Q'&1$' 8=

    WHP -#%3" HT

    0.4/#(%+3

    =!R FGHW S"5/"3(#U" +, J+(#' =(#(" M4.U"(

    -".%/#%.

    D1&)( #1):4 0$> &) J14&*

    (';*16&$) (

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    33/138

    ="/(%+3 BB9 -".%/#%. !%3#3/" #3. N4(/+>"$O#(%+3#' S"5$2"/(%;"

    "15([ GS

    H/( *#$>'&)5 $;6 $A 4616( 42()'&)5 A$# bdGI (';*16&$)+ J$6/ )16&$)100E 1)' 4616(dJEd4616(+ B1E /(02

    (/E 6/(#( /1%( J(() $)0E B1#5&)10 51&)4 &) (';*16&$)10 $;6*$B(4 4&)*( 6/( GSLU4+ >/()

    6/( ;2>1#' 6#()' &) /&5/d4*/$$0 5#1';16&$) #16(4 $A 6/( IU6/ *()6;#E 1 2166(#) 6/16 /1' /(02('

    6$ A;(0 >$#:(# 2#$';*6&%&6E 1)' (*$)$B&* 5#$>6/ *1B( 6$ 1 /106- @06/$;5/ D1&)(+ 0&:( $6/(#

    4616(4+ /14 (

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    34/138

    ="/(%+3 BB9 -".%/#%. !%3#3/" #3. N4(/+>"$O#(%+3#' S"5$2"/(%;"

    "15([ IU

    #(T;( B$#( &)6()4( 4(#%&*(4 1)' 4;22$#64+ 4;*/ 14 &)'&%&';104 >&6/ &)6(00(*6;10 '&41J&0&6&(4 $# 6/(

    (0'(#0E+ 6$ 1%$&' &)46&6;6&$)10 *1#(-KG @ IUGG b1&4(# C$;)'16&$) #(2$#6 4/$>(' 6/( >1&6 0&46 A$#

    D1&)(sGSGZ\*] >1&%(# 2#$5#1B4 6$ J( 10B$46 6>$ 6/$;41)' >/&0( $6/(# O(> V)501)' ?616(4 /1' 1

    0$>(# );BJ(# $A *&6&X()4 1>1&6&)5 4(#%&*(4- ?$B( $6/(# 4616(4 /1' )$ >1&6 0&464 16 6/( 6&B( $A 6/(

    46;'E-KI"())4E0%1)&1 >14 6/( *0$4(46 4616( 5($5#12/&*100E >&6/ 1 >1&6 0&46 6/16 ((#( 6>()6Ed6>$ 4616(4 &) 6/( #(2$#6 >&6/ >1&6 0&46 2$2;016&$)4 0(44

    6/1) 6/16 $A D1&)(-KY 9E (0(*6&)5 6$ */1)5( 6/( 2;#2$4( $A D('&*1&' A#$B 1 2#$5#1B 6$ 4(#%(

    vulnerable populations to one that serves everyone below a fixed income level, expanding stat(4

    4((B 6$ J( 5&%&)5 0&660( *$)4&'(#16&$) $A /$> 6$ /1)'0( 6/( 2$2;016&$)4 6/16 /1%( /1' 6$ ()';#(

    >1&6&)5 0&464- H/(4( 2$2;016&$)4 #(2#(4()6+ &) B$46 *14(4+ &)'&%&';104 >/$ *1))$6 J( (14&0E 4(#%('

    6/#$;5/ *$BB(#*&10 /(106/ 201)4+ ;)0&:( 6/( ( V)501)'- \?(( !%U45" Z-bKK

    .) 1) 166(B26 6$ 1''#(44 4$B( $A 6/(4( &44;(4+ 6/( @8@ #(T;('

    *(#61&) */1)5(4 6$ 2#$%&'(# #16( 46#;*6;#(4- H/( @8@ B1)'16(' 6/16

    D('&*1&' #(&BJ;#4(B()6 #16(4 6$ 2/E4&*&1)4 &) A1B&0E D('&*1&'+

    5()(#10 &)6(#)10 B('&*&)(+ 2('&16#&* B('&*&)(+ 1)' 4;J42(*&106&(4 >/$

    2#$%&'( 2#&B1#E *1#( 4(#%&*(4 J( #1&4(' 6$ GUUh $A D('&*1#( #16(4 J;6$)0E 6/#$;5/ *10()'1# E(1# IUGK- F6/(# 21#64 $A 6/( @8@ 2#$%&'(

    &)*#(14(' A;)'&)5 6$ 41A(6Ed)(6 2#$%&'(#4 6/16 4(#%( 0$>d&)*$B(

    &)'&%&';104 1)' A1B&0&(4- H/&4 $**;##(' 16 1 6&B( >/() B$46 4616(4

    6/16 B1E 144&46 &) '&%(#6&)5 1)'_$# 6#1)4&6&$)&)5 &)'&%&';104 A#$B &)46&6;6&$)10 4(66&)54 &)6$ 6/( /$B(4 1)' *$BB;)&6E- ?((

    >>>-D('&*1&'-5$%-

    KG D('&*1&' &4 1 0&A(0&)( A$# B$46 2($20( >&6/ 4&5)&A&*1)6 '&41J&0&6&(4 >/$ /1%( 5#(16(# B('&*10 )(('4 1)' $A6() #(T;( 144&461)*(

    >&6/ 1*6&%&6&(4 $A '1&0E 0&%&)5 6/#$;5/$;6 6/( 0&A(6&B(4+ 4;*/ 14 5(66&)5 '#(44('+ 61:&)5 B('&*16&$)+ 2#(21#&)5 B(104+ 1)' B1)15&)5

    B$)(E- D('&*1&' &4 $%(#>/(0B&)50E 6/( 01#5(46 A;)'&)5 4$;#*( $A J$6/ 1*;6( /(106/ *1#( 1)' 0$)5 6(#B 4(#%&*(4 1)' 4;22$#64

    4&)*( 2($20( >&6/ '&41J&0&6&(4 >/$ 1#( *$%(#(' JE D('&*1&' 5()(#100E '$ )$6 /1%( 1**(44 6$ (B20$E(# J14(' $# $6/(# 2#&%16(*$%(#15(-

    KI @**$#'&)5 6$ 6/( b1&4(# IUGG ?616( =(106/ C1*64 $) 31&6&)5 Q&464+ ';( 6$ 6/( 0&B&6(' );BJ(# $A =89? 40$64 &) 4616(4+ 6/(#( 1#( $%(#

    ZUU+UUU 2($20( $) >1&6&)5 0&464 A$# 4(#%&*(4+ $%(# YUU+UUU $A >/$B 1#( '&41J0('- H/( >1&6 *1) J( 14 0$)5 14 WdGU E(1#4- H/&4 *#&4&4

    #(4;064 &) ;))(*(441#E+ ;)>1)6(' 1)' *$460E &)46&6;6&$)10 *1#(g A1B&0E B(BJ(#4 J(&)5 A$#*(' 6$ T;&6 f$J4 $# 61:( $) 4(*$)' f$J4

    6$ /(02 *1#( A$# 6/( 0$%(' $)(g 1)' A1B&0&(4 /1%&)5 6$ 0(1%( 6/( 0$%(' $)(4 ;)166()'(' $# &) 6/( *1#( $A ;)T;10&A&(' 2(#4$)4-

    KY .) ?Cc IUGY+ 6/( Q("15( @'B&)&46#16&$) *$BB&66(' iGU B&00&$) &) 6$610 A;)'4 6$ #(';*( 6/( >1&6&)5 0&46 A$# 6/( &)6(00(*6;100E

    '&41J0('- V%() >&6/ 6/16 *$BB&6B()6+ D1&)( 46&00 /14 G+YIW &)'&%&';104 >1&6&)5 A$# 4(#%&*(4-

    KK @%&: ,$E+ =$> 7$ 90;( ?616(4 V>>-A$#J(4-*$B_4&6(4_6/(12$6/(*1#E_IUGI_UL_IY_/$>d'$dJ0;(d4616(4d((46 &) O(> V)501)'-

    http://www.medicaid.gov/http://www.medicaid.gov/http://www.forbes.com/sites/theapothecary/2012/07/23/how-do-blue-states-expand-medicaid-by-paying-doctors-less/http://www.forbes.com/sites/theapothecary/2012/07/23/how-do-blue-states-expand-medicaid-by-paying-doctors-less/http://www.medicaid.gov/
  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    35/138

    ="/(%+3 BB9 -".%/#%. !%3#3/" #3. N4(/+>"$O#(%+3#' S"5$2"/(%;"

    "15([ IG

    >(#( 46#;550&)5 >&6/ #(%();( 40;B24 ';( 6$ 6/( #(*(44&$) 1)' J(*1;4( $A J;'5(6 '(A&*&()*&(4 >(#(

    *;66&)5 #(&BJ;#4(B()6 #16(4+ )$6 &)*#(14&)5 6/(B-

    7(42&6( 6/(4( &)*#(14(4 &) #16(4+ B1)E #(2$#64+ &)*0;'&)5 $)( A#$B 6/( )$)21#6&41) (*$)$B&* 1)'

    4$*&10 #(4(1#*/ 5#$;2 M#J1) .)46&6;6(+

    KZ

    )$6(' 6/16 B$46 4616(4 J(0&(%(' 6/16 6/( 6(B2$#1#E #16(&)*#(14( >$;0' /1%( 0&660( (AA(*6 $) 166#1*6&)5 )(> 2/E4&*&1)4 >&00&)5 6$ 1**(26 )(> D('&*1&'

    216&()64 J;6 J(0&(%(' &6 >$;0' /(02 B1&)61&) 2#$%&'(# 21#6&*&216&$) &) 6/( 4/$#6 6(#B-

    H/( 41B( #(2$#6 )$6(' 6/16 6/( #16( &)*#(14(4 1#( (46&B16(' 6$ &)*#(14( 2#$%&'(# 21#6&*&216&$) JE

    GGh+ >/&*/ >$;0' )$6 J( 4;AA&*&()6 ()$;5/ 6$ *$%(# 6/( *;##()6 (>>-/(106/2$*:(6-*$B_/(106/*1#(d#(4(1#*/_&)A$4616_0(44d6/1)d/10Ad$Ad2/E4&*&1)4d1**(26dB('&*1&'+ 1**(44(' 7(*(BJ(#

    GU+ IUGY-

    KL =(106/ @AA1+ @;5;46 IUGI+ %$0- YG+ )$- W+ 22- GPLYdGPLS-

    "#$%&' T) K'3.6 +3 .?'

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    36/138

    ="/(%+3 BB9 -".%/#%. !%3#3/" #3. N4(/+>"$O#(%+3#' S"5$2"/(%;"

    "15([ II

    01#5( 5$%(#)B()6 15()*&(4+ Medicaids continuously growing bureaucratic and regulatory structure

    /14 6E2&*100E J(*$B( '&AA&*;06 6$ B1)15( 1)' &4 $;6B$'('-KW ?616(4 6/16 >1)6 6$ '(A&)( 5$104

    '&AA(#()60E A#$B A('(#10 461)'1#'4 $# 6#E &))$%16&%( 122#$1*/(4 1#( #(T;(' 6$ 4((: A('(#10

    122#$%10 &) 6/( A$#B $A >1&%(#4- H/( 4;J4(T;()6 #(4;06 A$# B1)E 4616(4 /14 J(*$B( 1 *;BJ(#4$B(

    4(6 $A #;0(4 1)' '&AA(#()6 4(#%&*(4 \1)' 4(#%&*( '(A&)&6&$)4] 6/16 '$ )$6 *$B2$#6 $# 6#1)4&6&$) 1*#$446/( B1)E $2(#16&)5 >1&%(#4- H/(E *1) 104$ J( '&AA&*;06 6$ )1%&516(+ B1)15(+ 1)' B$)&6$#+ 1)' B$46

    $A 6/( 6&B( /1%( %(#E 0&660( 6$ '$ >&6/ &B2#$%(' $%(#100 /(106/ $;6*$B(4- M)A$#6;)16(0E+ J(*1;4(

    6/( 1'B&)&46#16&$) 1)' $2(#16&$) $A D('&*1&' /14 J(*$B(

    4$ $%(#0E J;#'()4$B( 1)' *$B20(/$

    6/( 4E46(B &4 4;22$4(' 6$ 4(#%( *1) J(*$B( /1#B(' &) 6/(

    2#$*(44 JE #(*(&%&)5 &)1'(T;16( $# 2$$# T;10&6E *1#(-

    @''&6&$)10 (%&'()*( $A 6/( *;BJ(#4$B( 46#;*6;#( &4

    '(B$)46#16(' JE 6/( E(1#4 4$B( 4616(4 >1&6 6$ $J61&)

    >1&%(#4 1)' 6/( &)1J&0&6E $A 6/( *;##()6 A('(#101'B&)&46#16&$) 6$ &B20(B()6 4(%(#10 B1f$# 2$0&*E

    B(14;#(4 $A 6/( @8@ &) `1);1#E IUGY+ 0&:( &44;&)5 5;&'1)*(

    on how states were to implement a new coverage option called the basic health program aimed

    16 /(02&)5 0$> 1)' B&''0( &)*$B( A1B&0&(4 >/$ '&' )$6 T;10&AE A$# D('&*1&' 51&) *$%(#15(-

    ;5@9& 33@53@,/49& )/@9& +944,6F& *99/() 0(44 ($;0' 4(#%( 6/(4( &)'&%&';104 B$#( 122#$2#&16(0E-

    8;##()60E+ *0$4( 6$ PU% of Medicaids long term care funding

    5$(4 6$ &)46&6;6&$)10 *1#(-KS H/&4 A('(#10 J&14 6$>1#'4

    &)46&6;6&$)10 *1#( &4 ';( 6$ 6/( A1*6 6/16 );#4&)5 /$B( 4(#%&*(4

    1#( B1)'16$#E A$# 4616(4+ >/&0( =89? 1#( $26&$)10- ?616(4

    *;##()60E /1%( 6>$ B1&) $26&$)4 6$ A;)' =89? 6/#$;5/

    D('&*1&' 6/( =89? >1&%(# \?(*6&$) GSGZ\*]] $# 6/( =89?

    4616( 201) $26&$) \?(*6&$) GSGZ\&]]- H/( GSGZ\*] >1&%(# &4 $)0E

    1%1&01J0( 6$ &)'&%&';104 >/$ T;10&AE A$# 1) #$7(#(F(#+$", ,%=%, +5

    N"3%- M)'(# 6/&4 >1&%(#+ 4616(4 *1) *12 6/( );BJ(# $A (0&5&J0( 2($20(+ B1&)61&) >1&6&)5 0&464+ 1)'

    KW President Obama recently stated in an MSNBC interview with Chris Matthews that we have these big agencies, some of which

    1#( $;6'16('+ 4$B( $A >/&*/ 1#( )ot designed properly,1**(44(' 16[/662[__'E)-2$0&6&*$-*$B_2#&)646$#E-*ABn;;&'oUKW7UZIGd

    YC7VdKLSYdSSYSdL9V9@@89G8PL-

    KS ?6#&'(4 /1%( J(() B1'( $%(# 6/( 2146 GZ E(1#4 6$ */1)5( 6/( &)46&6;6&$)10 J&14 &) D('&*1&'+ /$>(%(#+ 6/( 01JE#&)6/ $A J;#'()4$B(

    A('(#10 #;0(4 1)' #(5;016&$)4 1)' 6/( 6('&$;4 >1&%(# 1)' 4616( 201) 1B()'B()6 2#$*(44 /1%( B1'( 6/( ;)'(#61:&)5 $A J101)*&)5

    6/( 4E46(B 1)' &B20(B()6&)5 122#$2#&16( *1#( 4(66&)54 &)*$)%()&()6 1)' 1'B&)&46#16&%(0E J;#'()4$B( A$# 4616(4-

    @4 >&6/ B1)E 01#5( 5$%(#)B()6

    agencies, Medicaids continuously

    5#$>&)5 J;#(1;*#16&* 1)'

    #(5;016$#E 46#;*6;#( /14 6E2&*100E

    J(*$B( *;BJ(#4$B( 1)' 1#*/1&*

    >&6/ 1 BE#&1' $A '&421#16( #;0(4 1)'

    #(5;016&$)4 1*#$44 2$2;016&$)4-

    C('(#10 #(5;016&$)4 A1%$# *$460E

    &)46&6;6&$)10 *1#( >/() 0(44

    ($;0' 4(#%(

    #(*&2&()64 B$#( 122#$2#&16(0E-

    Close to 60% of Medicaids long

    6(#B *1#( A;)'&)5 5$(4 6$

    &)46&6;6&$)10 *1#(-

    http://dyn.politico.com/printstory.cfm?uuid=048D0521-3FDE-4793-9939-7BEBAACB1C67http://dyn.politico.com/printstory.cfm?uuid=048D0521-3FDE-4793-9939-7BEBAACB1C67http://dyn.politico.com/printstory.cfm?uuid=048D0521-3FDE-4793-9939-7BEBAACB1C67http://dyn.politico.com/printstory.cfm?uuid=048D0521-3FDE-4793-9939-7BEBAACB1C67http://dyn.politico.com/printstory.cfm?uuid=048D0521-3FDE-4793-9939-7BEBAACB1C67
  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    37/138

    ="/(%+3 BB9 -".%/#%. !%3#3/" #3. N4(/+>"$O#(%+3#' S"5$2"/(%;"

    "15([ IY

    0&B&6 4(#%&*(4 6$ *(#61&) 5($5#12/&* 1#(14- @''&6&$)100E+

    4616(4 B;46 1220E A$# #()(>10 $A 6/( >1&%(# A#$B D('&*1&'+

    >/&*/ &4 1 J;#'()4$B( 1)' 0()56/E 2#$*(44- H/( GSGZ\&]

    4616( 201) $26&$)+ $) 6/( $6/(# /1)'+ 100$>4 4616(4 6$ /1%(

    (0&5&J&0&6E 6/16 &4 J(0$> 6/( &)46&6;6&$)10 0(%(0 $A *1#( J(A$#(2($20( )((' );#4&)5 /$B( *1#(-ZU

    D1&)( $AA(#4 1 );BJ(# $A '&AA(#()6 D('&*1&' 4(#%&*(4 A$#

    =89?- .) 1''&6&$) 6$ B1)'16$#E 1)' $26&$)10 D('&*1&' ?616( "01) 4(#%&*(4+ 6/(#( 1#( *;##()60E A&%(

    122#$%(' /$B( 1)' *$BB;)&6E J14(' >1&%(#4 6/16 4(#%( (0'(#4+ 1';064 >&6/ 2/E4&*10 1)'

    &)6(00(*6;10 '&41J&0&6&(4+ 1)' */&0'#()+ &)*0;'&)5 $)( #(*()60E #(*(&%(' 122#$%(' 42(*&A&* 6$ 1';064

    >/$ /1%( (&6/ 0(5&4016&%( 4;22$#6 &4 &) 6/( B&'46 $A 166(B26&)5 6$ #(B('&16( 1)' 4&B20&AE 6/( *$B20(&6/ T;10&6E 1)' '&5)&6E-

    =1%&)5 #(*()60E #(*(&%(' 1 5#1)6 *100(' 6/( 9101)*&)5 .)*()6&%(4 "#$5#1B N#1)6 \9."]+ D1&)(

    ;)'(#6$$: 1 B1f$# &)&6&16&%( 6/16 &)*0;'(4 6/( A$00$>&)5[

    3$#:&)5 >&6/ *$BB;)&6E 21#6)(#4 1)' 461:(/$0'(#4 &) 1 *$001J$#16&%( A14/&$) 6$ 1*/&(%( 6/(5$104 $A &)*#(14&)5 /$B( 1)' *$BB;)&6E J14(' 4;22$#64+

    9;&0'&)5 ;2$) 6/( 4;22$#64 6/16 D1&)( *;##()60E /14 &) 201*( 6$ *#(16( 1 O$ 3#$)57$$#_?&)50( V)6#E "$&)64E46(B+

    7(%(0$2&)5 4616(>&'( *$#( 461)'1#'&X(' 144(44B()64+ 1)' 8#(16&)5 1 *$)A0&*6dA#(( *14( B1)15(B()6 4E46(B-

    ZU H/( @AA$#'1J0( 81#( @*6 '$(4 2#$%&'( 1 )(> 4616( 201) $26&$) 6$ 2#$%&'( /$B( 1)' *$BB;)&6EdJ14(' 4(#%&*(4 &) D('&*1&'

    ?(*6&$)+ GSGZ\:]- @04$+ 14 $A @2#&0 IUGU+ 6/( GSGZ\&] 4616( 201) $26&$) )$ 0$)5(# 100$>4 4616(4 6$ *12 6/( );BJ(# $A (0&5&J0( 2($20(+

    :((2 >1&6&)5 0&464+ 1)' 0&B&6 4(#%&*(4 6$ *(#61&) 5($5#12/&* 1#(14- H/(E B1E 61#5(6 4(#%&*(4 6$ *(#61&) 2$2;016&$) 5#$;24-

    ZG ?(( D7==?s9101)*&)5 .)*()6&%( "1EB()6 "#$5#1B @220&*16&$)+ D1E IUGY+ 1**(44(' 16[/662[__>>>-B('&*1&'-5$%_D('&*1&'d

    8=."d"#$5#1Bd.)A$#B16&$)_9EdH$2&*4_Q$)5dH(#Bd?(#%&*(4d1)'d?;22$#6_9101)*&)5_7$>)0$1'4_D1&)(d9."-2'A-

    D7==? 6$5(6/(# >&6/ 0(5&4016&%(

    4;22$#6 &4 &) 6/( B&'46 $A 166(B26&)5

    6$ #(B('&16( 1)' 4&B20&AE 6/(

    *$B20(< $2(#16&$)10 0$)5 6(#B *1#(

    4E46(B 6/16 /14 J(()&)46&6;6&$)10&X(' &) 6/( '(21#6B()6

    $%(# 6/( 2146 YU E(1#4 $# B$#(-

    http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Support/Balancing/Downloads/Maine-BIP.pdfhttp://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Support/Balancing/Downloads/Maine-BIP.pdfhttp://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Support/Balancing/Downloads/Maine-BIP.pdfhttp://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Support/Balancing/Downloads/Maine-BIP.pdfhttp://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Support/Balancing/Downloads/Maine-BIP.pdf
  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    38/138

    ="/(%+3 BB9 -".%/#%. !%3#3/" #3. N4(/+>"$O#(%+3#' S"5$2"/(%;"

    "15([ IK

    H/&4 5#1)6 >&00 *$B20(B()6 $6/(# $)5$&)5 &)&6&16&%(4 &)

    D1&)( 1&B(' 16 4E46(B #(A$#B 1)' #(J101)*&)5 0$)5d6(#B

    4(#%&*(4 1)' 4;22$#64 \QH??] 6$>1#'4 *$BB;)&6E 0&%&)5-

    7(42&6( 6/( &)*0;4&$) $A 6/(4( 1)' $6/(# &)*#(B()610*/1)5(4 6$ D1&)(81#( $%(# 6/( E(1#4 1)' 6/( *;##()6 >$#:

    $A 6/( Q("15( @'B&)&46#16&$) 6$ J$046(# /$B( 1)'

    *$BB;)&6E J14(' 4(#%&*(4 1)' J101)*( 6/( 4E46(B+ 6/(

    A('(#10 J&14 6$>1#' &)46&6;6&$)10 *1#( #(B1&)4- 9(*1;4(

    DDHHS operational resources are 4(%(#(0E 0&B&6('+ &6 >$;0' 4((B 2#$2(# 6/16 D1&)(81#( *$)6&);(

    6$ A$*;4 $) *#(16&)5 1)' &B20(B()6&)5 46#;*6;#10 #(A$#B4+ >/&*/ 1#( '(4&5)(' 6$ $AA(# B$#(

    122#$2#&16( *1#( 4(66&)54 A$# (0'(#0E 1)' %;0)(#1J0( 2$2;016&$)4 1)' >/&*/ >&00 &B2#$%( 6/( T;10&6E

    $A *1#( A$# 100 #(*&2&()64 6/#$;5/ *;##()6 1)' A;6;#( A('(#10 21#6)(#4/&24 0&:( 9."+ >&6/$;6 /1%&)5 6/(

    1''&6&$)10 J;#'() $A 61:&)5 $) )(> 2$2;016&$)4 %&1 6/( @8@ 16 6/( *;##()6 6&B(-

    L55@&G9/04I&'74.529-&D$#( '&46;#J&)5 1)' 2(#/124 #(016(' 6$ 2#$J0(B4 #(51#'&)5 1**(44 6$ '$*6$#4+ D('&*1&' *$%(#15(

    '$(4 )$6 *$##(016( >&6/ J(66(# /(106/ $;6*$B(4- ?6;'&(4 4/$> 6/16 *$B21#(' 6$ D('&*1#( 216&()64+

    2#&%16(0E &)4;#(' 216&()64+ 1)' 4;#2#&4&)50E (%() ;)&)4;#(' &)'&%&';104+ D('&*1&' #(*&2&()64 /1%(

    2$$#(# /(106/ $;6*$B(4- C$# (&6/$;6 &)4;#1)*(+ $) 1 >&'( #1)5( $A B(14;#(4 #(016(' 6$ 4;#5(#E

    outcomes. Titled, 93#O"34 9"4%3 '("(F7 @55%N(7 !+3(",#(4 5+3 !"^+3 'F36#N", X*%3"(#+$7+ZI

    6/( 46;'E/1' 1 %(#E 01#5( 41B20( 4&X( \WSY+PZW B1f$# 4;#5&*10 $2(#16&$)4 $**;##&)5 J(6>(() IUUY 1)' IUUL]

    1)' *$)6#$00(' A$# 15(+ 4(&6/ )$ &)4;#1)*(-ZY@ 46;'E $A 216&()64 ;)'(#5$&)5 0;)5 6#1)4201)64+ &) 6/( W+F3$", +5

    M%"3( "$D 1F$6 K3"$7*,"$("(#+$+ A$;)' 6/16 D('&*1&' 216&()64 >(#( W-Gh 0(44 0&:(0E 6$ 4;#%&%( 6()

    E(1#4 1A6(# 6/( 4;#5(#E 6/1) 6/( 2#&%16(0E &)4;#(' 1)' ;)&)4;#(' *$;)6(#21#64-

    ZK

    ZI 71B&() `-Q1"1#+D-7-+ 1)'8146&50&1)$ D- 9/1B&'&216&+7-F-+81#0$4 D- D(#E+D-7-+ D-"-=-+N($#5( - ?6;:()J$#5+"/-7-+71%&' ,-

    `$)(4+D-7-+9#;*( 7- ?*/B(#+D-7-+.#%&)5 Q- b#$)+D-7-+ 1)'N$#1% @&01>1'&+D-7., "#&B1#E "1E(# ?616;4 @AA(*64 D$#610&6E A$#

    Major Surgical Operations,@$$",7 +5 'F36%348 ?(26(BJ(# IUGUg IZI\Y][ 22- ZKKZZG-

    ZY ?) D- b$#$;:&1) "/-7-+ and Pual M. Bakaki M.D., M.S., Derek Raghavan M.D., Ph.D., ?;#%&%10 7&421#&6&(4 JE D('&*1&' ?616;4,

    )"$N%3+ ";J0&4/(' $)0&)( 7(*(BJ(# IUGG+ R$0;B( GGW+ .44;( GL+ 22- KILGdYILS-

    ZK `(#(B&1/ N- @00()+D-7-+ 1)'N($#5( `- @#)1$;61:&4+D-7-+`$)16/1) 9- F#()4+D-7-+`$/) D*7E(#+D-7-+`$/) R- 8$)6(+ D-7-+

    @4/&4/ ?- ?/1/+D-7-+8/#&46&1) @- D(#0$+D-7-+ D-"-=-+ Insurance Status is an independent predictor of longd6(#B 4;#%&%10 1A6(#

    @ 46;'E *$)';*6(' 16 6/( M)&%(#4&6E

    $A R&)&1+ 1)' 2;J0&4/(' &) 6/(

    @))104 $A ?;#5(#E+ A$;)' 6/16

    D('&*1&' 216&()64 A1#(' 2$$#0E+

    #(016&%( 6$ 6/$4( >&6/ 2#&%16(&)4;#1)*( 1)' (%() 6/$4( >&6/$;6

    &)4;#1)*(+ $) 1 >&'( #1)5( $A

    B(14;#(4-

    http://www.ncbi.nlm.nih.gov/pubmed/?term=LaPar%20DJ%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Bhamidipati%20CM%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Mery%20CM%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Stukenborg%20GJ%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Jones%20DR%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Jones%20DR%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Schirmer%20BD%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Kron%20IL%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Ailawadi%20G%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20647910http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20647910http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20647910http://www.jhltonline.org/article/S1053-2498(10)00442-0/abstracthttp://www.jhltonline.org/article/S1053-2498(10)00442-0/abstracthttp://www.jhltonline.org/article/S1053-2498(10)00442-0/abstracthttp://www.jhltonline.org/article/S1053-2498(10)00442-0/abstracthttp://www.jhltonline.org/article/S1053-2498(10)00442-0/abstracthttp://www.jhltonline.org/article/S1053-2498(10)00442-0/abstracthttp://www.jhltonline.org/article/S1053-2498(10)00442-0/abstracthttp://www.jhltonline.org/article/S1053-2498(10)00442-0/abstracthttp://www.jhltonline.org/article/S1053-2498(10)00442-0/abstracthttp://www.jhltonline.org/article/S1053-2498(10)00442-0/abstracthttp://www.jhltonline.org/article/S1053-2498(10)00442-0/abstracthttp://www.jhltonline.org/article/S1053-2498(10)00442-0/abstracthttp://www.jhltonline.org/article/S1053-2498(10)00442-0/abstracthttp://www.jhltonline.org/article/S1053-2498(10)00442-0/abstracthttp://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20647910http://www.ncbi.nlm.nih.gov/pubmed/?term=Ailawadi%20G%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Kron%20IL%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Schirmer%20BD%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Jones%20DR%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Jones%20DR%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Stukenborg%20GJ%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Mery%20CM%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Bhamidipati%20CM%5Bauth%5Dhttp://www.ncbi.nlm.nih.gov/pubmed/?term=LaPar%20DJ%5Bauth%5D
  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    39/138

    ="/(%+3 BB9 -".%/#%. !%3#3/" #3. N4(/+>"$O#(%+3#' S"5$2"/(%;"

    "15([ IZ

    8$)4&'(#&)5 6/( 2$$# #(4;064 A#$B 4*&()6&A&* 46;'&(4 $) /(106/ $;6*$B(4 A$# D('&*1&'+ 6/( T;(46&$)

    A$# 2$0&*EB1:(#4 &4 >/(6/(# D('&*1&' $;5/6 6$ J( 6/( 2#$5#1B $A */$&*( 6$ (

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    40/138

    ="/(%+3 BB9 -".%/#%. !%3#3/" #3. N4(/+>"$O#(%+3#' S"5$2"/(%;"

    "15([ IP

    H/&4 "15( .)6()6&$)100E Q(A6 901):

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    41/138

    ="/(%+3 BBB9 @+< =(#("$ 75" ?"/%.%3U

    "15([ IL

    +9.4,56&111J&G5A&+4/49-& @9&H9.,()6EdA&%( 4616(4 1#( ( 10$)5 21#6E 0&)(4+

    6/(#( 122(1#4 6$ J( 1 21#6&41) 2166(#) $) /$> 4616(4 1#( '(*&'&)5 6$ (&6/ 1 7(B$*#16&* 5$%(#)$# 1)' 1 7(B$*#16d*$)6#$00('

    0(5&4016;#( 1#( (1E 6$ (%551&I +7 H?1. .?' >.1.'6 W&'

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    42/138

    ="/(%+3 BBB9 @+< =(#("$ 75" ?"/%.%3U

    "15([ IW

    %0,F,K,0,4D&H949@2,6/4,56&)I/0096F9-&C#$B 1) $2(#16&$)10 2(#42(*6&%(+ 4616(4 6/16 1#( #(0E&)5 $) 1 A('(#100E 1'B&)&46(#(' /(106/ *1#(

    (/&*/ &)*0;'(4 D1&)(+ 1#( (&6/ '(6(#B&)&)5 (0&5&J&0&6E-

    H/( M?@ H$'1E #(*()60E #(2$#6(' 6/16 6/([

    5%D%3", ;%",(; N"3% %UN;"$6% #7 #$N+33%N(,4 D%(%3O#$#$6 (;"( 7+O% *%+*,% "3%

    %,#6#2,% 5+3 !%D#N"#D T;%$ (;%4 N,%"3,4 "3% $+(8 ,%"=#$6 (;%O T#(; ,#((,% N;"$N% (+

    6%( (;% 7F27#D#a%D #$7F3"$N% (;%4 "3% %$(#(,%D (+ "7 (;% 4E46(B4

    >&00 ;4( '161 4/1#&)5+ '#1>&)5 A#$B %1#&$;4 4616( 1)' C('(#10 '161 #(*$#'4+ 6$ 2$2;016( 1)' %(#&AE

    &)A$#B16&$) $) D('&*1&' 1220&*16&$)4 1)' #(d*(#6&A&*16&$)4-

    .A (&6/ 6/( 1J&0&6E

    6$ B1:( #(10d6&B( (0&5&J&0&6E 1)' ()#$00B()6 '(6(#B&)16&$)4+

    1)' B&6&516( 6/( )((' A$# 1220&*1)64 6$ 2#$%&'( &)d2(#4$)

    212(#>$#: 6$ %(#&AE &)A$#B16&$) 2#$%&'(' 6$ 6/( 4616( $)

    6/( 1220&*16&$)4- H/( */100()5( A$# B1)E 4616(4 &4 6/16 6/(E

    '$ )$6 2$44(44 1 4$2/&46&*16(' ()$;5/ 4E46(B 1J0( 6$

    /1)'0( 6/( 6E2( $A %$0;B(- D1&)( &4 &)*0;'(' 1B$)5 6/$4( 4616(4-ZS

    ZP Jayne ODonnell. C('(#10 ( $;6#(1*/ B(6/$'4g 6/( 2$6()6&10 #($#51)&X16&$) $A 4616( (0&5&J&0&6E (B20$E((4g

    1)' ;)2#(*('()6(' *$$#'&)16&$) J(6>(() $#51)&X16&$)4 1)' ()6&6&(4-

    ZS V0&5&J&0&6E 4E46(B4 1)' 461AA 1#( 10#(1'E ()$#B$;40E J;#'()('- C$# (&6/ 1 4&X(1J0( D('&*1&' 2#$5#1B+ &4

    f;46 $)( 4616( 6/16 &4 ((0A1#( 4E46(B #$004- .) A1*6+ 6/( (1#0E A&)'&)54

    $A 1) $)5$&)5 #(%&(> $A 6/( .00&)$&4 D('&*1&' 2#$5#1B #(%(10(' 6/16 /10A6/( 2($20( ()#$00(' >(#( )$6 (%() (0&5&J0(- @ #(%&(> $A

    6/( .00&)$&4 D('&*1&' 2#$5#1B *$)AB4 B144&%( >146( 1)' A#1;'- @ #(%&(> >14 $#'(#(' B$#( 6/1) 1 E(1# 15$dd J(*1;4( $A

    *$)*(#)4 1J$;6 >146( 1)' 1J;4(- ?$ A1#+ 6/( 4616( 41E4 #(%&(>(#4 /1%( (/() 6/(E *0(1#0E 1#(

    not. A'@ KX

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    43/138

    ="/(%+3 BBB9 @+< =(#("$ 75" ?"/%.%3U

    "15([ IS

    ;9 #(2$#6 #(0(14(' JE 6/( 8()6(#4 A$# D('&*1#(

    1)' D('&*1&' ?(#%&*(4 $) 7(*(BJ(# Y+ IUGY #(%(104 6/16 *0$4( 6$ G-Z B&00&$) 2($20( >(#(

    '(6(#B&)(' (0&5&J0( &) 6/( B$)6/ $A F*6$J(# 6$ ()#$00 &) D('&*1&' $# 6/( 8/&0'#()e4 =(106/ .)4;#1)*("#$5#1B \8=."]-

    @4 $)( ($ B$)6/4 $A ()#$00B()6+ 6/( 4616(e4 /(106/d

    *1#( (0E (0&5&J0( A$# ((#( *;##()60E (0&5&J0( J;6 >(#( )$6

    ()#$00('+ >/&*/ 0(A6 $)0E GW+UUU 20;4 #(4&'()64 >/$ 2;#*/14(' 2#&%16( 2$0&*&(4-PU

    H/( );BJ(# $A 1220&*16&$)4 A$# D('&*1&' /14 &)*#(14(' ;)'(# 6/(

    @AA$#'1J0( 81#( @*6+ >&6/ 5#$>6/ B$#( 4;J461)6&10 &) 4616(4 6/16

    /1%( '(*&'(' 6$ ( B$)6/4+ 1)' 6/( 6$610 );BJ(# $A

    &)'&%&';104 '(6(#B&)(' 6$ J( (0&5&J0( A$# D('&*1&' $# 8=." >14

    PSL+UGS- .) ( (0&5&J&0&6E '(6(#B&)16&$)4 >(#( B1'(- H/( 6$610

    1*#$44 100 4616(4 >14 1) W-Ph &)*#(14( &) 1220&*16&$)4 1)'

    G+KPU+YPL )(> (0&5&J&0&6E '(6(#B&)16&$)4-PG

    H/&4 '161 &)'&*16(4 6/16 (%() >&6/$;6 (&00 4(( 1 4;J461)6&10 &)*#(14( $A )(>0E(0&5&J0( &)'&%&';104 A#$B 2(#4$)4 *;##()60E (0&5&J0( A$# D1&)(81#(-PI

    &

    1)' A$;)' 6/16 YZL+UUU+ $# 1J$;6 /10A $A 6/(B 4/$;0')e6 /1%( #(*(&%(' J()(A&64- @A6(# A;#6/(# #(%&(>+ 6/( 4616( '(*&'(' 6/16 6/(

    2(#*()615( $A 2($20( >/$ '&')e6 T;10&AE >14 1*6;100E 1J$;6 $)( $;6 $A A$;#- m.6 41E4 6/16 >(e%( /1' 1 4E46(B 6/16 &4 'E4A;)*6&$)10-

    Once people got on the rolls, there wasn't the will or the means to get them off, said (state) Senator Bill Haines of Alton.@ 4616(

    42$:(4B1) &)4&464 6/16 6/( 2(#*()615( $A ;)T;10&A&(' #(*&2&()64 >&00 *$)6&);( 6$ '#$2 '#1B16&*100E 14 6/( #(%&(> *$)6&);(4

    J(*1;4( 6/( J(5&))&)5 $A 6/( 2#$*(44 A$*;4(' $) 6/( 2($20( 6/16 >(#( B$46 0&:(0E 6$ J( ;)T;10&A&(' A$# 6/$4( J()(A&64- H('71J#$>4:&+ R&*(d"#(4&'()6 $A H/( .00&)$&4 "$0&*E .)46&6;6( 6/&): 61):+ 42$:( >&6/ O(>4 K %&1 ?bc"V- =( 41&' 6/( D('&*1&' #(%&(>

    found two out of three recipients either got the wrong benefits, or didn't deserve any at all. We added so many people to

    D('&*1&' #$004 4$ T;&*:ly, we've lost control of who belongs there, said Dabrowski. But regardless of how it ends, critics say it is

    2#$$A 6/16 .00&)$&4 /14 '$)( 1 2$$# f$J $A protecting tax payers money, a'126(' A#$B 8/1))(0 K bDFR-*$B+ ?6- Q$;&4+ 1**(44('

    16[/662[__>>>-:B$%-*$B_)(>4_f;46d2$46('_@;'&6d#(%(104d/10Ad$Ad2($20(d()#$00('d&)d.QdD('&*1&'d2#$5#1Bd)$6d(0&5&J0(dIYUZWPYIG-/6B0-

    PU 314/&)56$) ?&5)&)5 M2 D$#( "($20( A$# D('&*1&' 6/1) "#&%16( "01)4S )"(;+,#N X$,#$%- 7(*(BJ(# P+ IUGY-

    PG 8()6(#4 A$# D('&*1#( 1)' D('&*1&' ?(#%&*(4- D('&*1&' 1)' 8=."[ F*6$J(# D$)6/0E @220&*16&$)4 1)' V0&5&J&0&6E 7(6(#B&)16&$)4-

    7(*(BJ(# Y+ IUGY-

    PI .J&'+ H1J0( G+ F*6$J(# @220&*16&$)4 1)' V0&5&J&0&6E 7(6(#B&)16&$)4-

    ?616(4 1#( #(2$#6&)5 /&5/(#

    ()#$00B()6 &) D('&*1&' 6/1)

    &) 2#&%16( &)4;#1)*( 4&)*( 6/(

    @AA$#'1J0( 81#( @*6

    (

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    44/138

    ="/(%+3 BBB9 @+< =(#("$ 75" ?"/%.%3U

    "15([ YU

    +909.49/$ #(*(&%( A$$' 461B24 &) 6/( 4616(-F6/(# 4616(4 /1%( A$00$>(' 4&B&01# 1'%(#6&4(B()6 *1B21&5)4 >&6/ %1#&(' 4;**(44-

    75%d+3#9 H/( );BJ(# $A )(> 1220&*16&$)4 &4 )$6 1%1&01J0( 16 6/&4 6&B(- .) 6$610+ @#&X$)1 (0E (0&5&J0( ()#$00B()6 &) (&6/ ( &)*$B(4- @)$6/(# GU+UUU 2($20( ()#$00(' &) 6/16 2#$5#1B >&00 104$

    J( 6#1)4A(##(' 6$ ( 6/(E 1#( 2$6()6&100E (0&5&J0( A$# D('&*1&' 1)' &)%&6&)5 6/(B 6$ ()#$00 JE #(42$)'&)5 6$ 6/( 0(66(#- H$ ()#$00+ 6/( 2(#4$)

    #(6;#)4 1 4&B20( A$#B 1)' 6/( 4616( *$)';*64 1''&6&$)10 '161 */(*:4+ 14 122#$2#&16(- ?&)*( 6/( 4616( J(51) 4()'&)5 0(66(#4 &)

    early September, Arkansas reports that 63,465 individuals have been fast tracked into Medicaid >&6/ 0&660( >1&6- 7;#&)5 6/(

    41B( 2(#&$' $A 6&B(+ 6/( 4616( 104$ A$;)' Y+UUU ;)()#$00(' */&0'#() >/$ 1#( (0&5&J0 e for ARKids First, the states Medicaid and

    8=." 2#$5#1B4- 8()6(#4 A$# D('&*1#( 1)' D('&*1&' ?(#%&*(4+ D('&*1&' 1)' 8=."[ F*6$J(# D$)6/0E @220&*16&$)4 1)' V0&5&J&0&6E

    7(6(#B&)16&$)4+ 7(*(BJ(# Y+ IUGY+ 2- Y-

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    45/138

    ="/(%+3 BBB9 @+< =(#("$ 75" ?"/%.%3U

    "15([ YG

    8+33"/(%/4(9 8$))(*6&*;6 /14 ()#$00(' Y+ZZU )(> 2($20( &) &64 (

    &)*$B(d/(106/ 2#$5#1B /1%( 10#(1'E J(() B$%(' &)6$ (&6/ &)*$B(4 ;2 6$ 6/( A('(#10 2$%(#6E 0(%(0 \iGG+KSU]- .64 (&%#9 7-8- J(51) (&6/ &)*$B(4 ;2 6$ GIYh $A 6/( A('(#10 2$%(#6E 0(%(0 \iGK+GYY]- @4 $A ?(26(BJ(# YU+

    ()#$00B()6 &) 6/( 201) >14 WI+KIY- D1#E01)' (&00 1;6$B16&*100E *$)%(#6 6$ A;00 D('&*1&' J()(A&64-

    .) 1''&6&$)+ #(4&'()64 &) 1 )1##$> &)*$B( J1)' \GIKh 6$ GYWh $A 2$%(#6E] *1) 4&5) ;2 A$# (

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    46/138

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    47/138

    ="/(%+3 BBB9 @+< =(#("$ 75" ?"/%.%3U

    "15([ YY

    N6%+9 H/( B$46 #(*()6 4616( 6$ ($)

    122#$%10 A$# ( 1220&*16&$)4 >(#( A&0(' $%(# 6/( 2/$)(+ &) 2(#4$)+ 1)'

    6/#$;5/ 6/( B1&0- H/( %146 B1f$#&6E $A ()#$00B()64 *1B( A#$B 1 B1&0&)5 &) 016( ?(26(BJ(# 6/16 >()6

    6$ IPU+UUU #(4&'()64 >/$ (&6/(# #(*(&%( A$$' 461B24 $# /1%( */&0'#() ()#$00(' &) D('&*1&'- H/(

    4616( (

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    48/138

    ="/(%+3 BBB9 @+< =(#("$ 75" ?"/%.%3U

    "15([ YK

    H/&4 "15( .)6()6&$)100E Q(A6 901):

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6 2013 - Draft

    49/138

    ="/(%+3 BV9 -#%3"8#5" N;"5;%"6/ >/() &) A1*6 A$;# $A 6/$4( 4&< 15( *16(5$#&(4 1#( 2#$f(*6('

    6$ /1%( 4&5)&A&*1)6 5#$>6/- H/( *10*;016&$) >$#:4 6/16 >1E J(*1;4( 6/( 15( *16(5$#&(4 $A GZdIK 1)' KZdZK 1#( 2#$f(*6(' 6$ /1%(

    "#$%&' (() *&+,'-.'/ K?13$'6 #3 01#3'Y6 W$' *&+7#4' 7&+5 8C(8 .+ 8C88

    .) 6/( *14( $A D1&)(+ &6 /14

    6/( 6/' B$46 15('

    2$2;016&$) &) 6/( *$;)6#E+ 1)'

    14 $A IUGI+ $)( A&A6/+ $# GLh+

    $A Maines population was

    15( 4&

  • 8/13/2019 Maine Medicaid Expansion Report - Jan 6