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127th MAINE LEGISLATURE |
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LD 854 |
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LR 44(02) |
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An Act To
Increase Access to Health Security by Expanding Federally Funded Health Care
for Maine People |
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Fiscal Note for
Bill as Amended by Committee Amendment " " |
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Committee: Health and Human Services |
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Fiscal Note Required: Yes |
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| Fiscal Note |
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FY 2015-16 |
FY 2016-17 |
Projections FY 2017-18 |
Projections FY 2018-19 |
| Net Cost
(Savings) |
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General Fund |
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($6,001,462) |
$3,120,730 |
$16,538,046 |
$22,933,736 |
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| Appropriations/Allocations |
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General Fund |
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($6,001,462) |
$3,120,730 |
$16,538,046 |
$22,933,736 |
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Federal Expenditures Fund |
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$205,254,579 |
$420,496,553 |
$428,546,225 |
$444,669,939 |
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Other Special Revenue Funds |
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$4,563,610 |
$6,084,810 |
$6,084,810 |
$6,084,810 |
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| Revenue |
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Federal Expenditures Fund |
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$205,254,579 |
$420,496,553 |
$428,546,225 |
$444,669,939 |
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Other Special Revenue Funds |
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$4,563,608 |
$6,084,810 |
$6,084,810 |
$6,084,810 |
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| Fiscal Detail
and Notes |
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Part A of this
bill expands medical coverage under the MaineCare program to adults who
qualify under federal law with incomes up to 133% of the nonfarm income
official poverty line, with the 5% federal income adjustment for family size,
and the Medicaid services provided under this paragraph must be provided
within the limits of the state and federal funds appropriated and allocated
for the program budget. Part A also requires that, on a quarterly basis, the
commissioner shall determine the fiscal status of program expenditures as a
result of expansion under this paragraph and report the fiscal status of the
program. Finally, Part A allows for the termination of the program under two
scenarios: 1) after reporting that expenses for services provided under this
subsection are anticipated to exceed the appropriated funds or 2) If the
federal share for individuals eligible under this paragraph is reduced below
the amounts specified in 42 United States Code, Section 1396d(y)(1). |
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Part B of the
bill as amended, includes a General Fund deappropriation of $13,000,000 in
fiscal year 2015-16 and $27,000,000 in fiscal year 2016-17 in the Executive
Branch Departments and Independent Agencies -Statewide program in the
Department of Administrative and Financial Services for savings to be
identified in existing programs as a result of the expansion of MaineCare
eligibility. Part B of the amended bill also requires the Office of Fiscal
and Program to do an evaluation of current state programs to identify savings
that would result from the MaineCare expansion, identifies programs and
populations that may realize savings and deappropriates funds statewide. The specific programs and amount of savings
that will be realized and distributed to each program cannot by determined at
this time. As a benchmark, a review was done of a report on potential savings
created by an outside consulting group, familiar with Medicaid expansions.
The review noted that, though the overall saving expected were high, it lead
to a reasonable expectation of greater than $20,000,000 million in savings
annually, with the full implementation of the expansion, as identified in
this bill. |
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The bill as
amended includes General Fund appropriations of $1,933,957 in fiscal year
2015-16 and $2,578,609 in fiscal year 2016-2017 for the Office of Family
Independence - District program in the Department of Health and Human
Services for the State share of the costs of 103 new positions to administer
the MaineCare eligibility expansion.
Funding for the new positions reflects a 75% federal match for the 79
Eligibility Specialist positions and a 50% federal match for the other new
positions. The funding for the
Eligibility Specialist positions assumes a 700 person caseload for each new
position. This is the target caseload
the Department of Health and Human Services has identified for the
Eligibility Specialist positions. |
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The bill as
amended includes a General Fund appropriation of $9,380,367 in fiscal year
2016-17 to the Department of Health and Human Services for medical costs for
newly eligible childless adult population, as shown below. Federal
Expenditures Fund allocations totaling $178,843,392 in fiscal year 2015-16
and $365,834,327 in fiscal year 2016-17 as shown below. The estimated
appropriations and allocations assume 100 percent enhanced federal matching
funds through December 31, 2016, 95% enhanced federal matching funds through
December 31, 2017, 94% enhanced federal matching funds through December 31,
2018 and 93% enhanced federal matching funds through December 31, 2019, for
childless adult population with incomes less than 138% of the federal poverty
line. |
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FY 2015-16 |
FY 2016-17 |
FY 2017-18 |
FY 2018-19 |
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Childless Adults
@ or below 138% of FPL
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Estimated Population |
58,240 |
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Est. Annual Cost Per Person |
$6,142 |
$178,843,392 |
$375,214,694 |
$393,602,227 |
$412,891,315 |
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Assumed Federal Match |
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100.0% |
97.5% |
94.5% |
93.5% |
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Federal Share of Costs |
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$178,843,392 |
$365,834,327 |
$371,954,105 |
$386,053,380 |
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State Share of Costs |
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$0 |
$9,380,367 |
$21,648,122 |
$26,837,935 |
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The bill as
amended also includes General Fund appropriations of $11,184,976 in fiscal
year 2015-16 and $23,465,879 in fiscal year 2016-17 to the Department of
Health and Human Services for medical costs for the parent's population from
101% to 138% of the federal poverty level, as shown below. The below assumes
15,455 parents who lost coverage and an additional 4,500 parents who have not
had MaineCare in the past, but will opt for MaineCare coverage after
expansion. Since this group was eligible under previous rules, they will not
be considered newly eligible and the state will receive the Regular FMAP. The
bill as amended also includes Federal Expenditures Fund allocations for the
parents identified below totaling $18,777,456 in fiscal year 2015-16 and
$39,394,766 in fiscal year 2016-17, as shown below, for the regular FMAP
matching funds. |
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FY 2015-16 |
FY 2016-17 |
FY 2017-18 |
FY 2018-19 |
| Parents (Between 101 and 133% of the Federal Poverty Line) |
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Estimated Population |
19,955 |
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Est. Annual Cost Per Person |
$3,003 |
$29,962,433 |
$62,860,645 |
$65,940,100 |
$69,170,416 |
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Assumed Federal Match |
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62.67% |
62.67% |
62.67% |
62.67% |
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Federal Share of Costs |
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$18,777,456 |
$39,394,766 |
$41,324,661 |
$43,349,100 |
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State Share of Costs |
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$11,184,976 |
$23,465,879 |
$24,615,439 |
$25,821,316 |
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The bill as
amended also includes General Fund appropriations of $816,270 in fiscal year
2015-16 and $1,632,540 in fiscal year 2016-17 to the Department of Health and
Human Services for medical costs for the children who have not had MaineCare
in the past, but whose family will opt for MaineCare coverage after
expansion. Since these children were eligible under previous rules, they will
not be considered newly eligible and the state will receive the enhanced CHIP
FMAP. The bill as amended also includes Federal Expenditures Fund allocations
for the children identified below totaling $7,633,730 in fiscal year 2015-16
and $15,267,460 in fiscal year 2016-17, as shown below, for the enhanced CHIP
FMAP matching funds. |
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FY 2015-16 |
FY 2016-17 |
FY 2017-18 |
FY 2018-19 |
| Crowd-out Children (Between 101 and 133% of the Federal Poverty
Line) |
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Estimated Population |
4,800 |
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Est. Annual Cost Per Person |
$3,521 |
$8,450,000 |
$16,900,000 |
$16,900,000 |
$16,900,000 |
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Assumed Federal Match |
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90.34% |
90.34% |
90.34% |
90.34% |
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Federal Share of Costs |
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$7,633,730 |
$15,267,460 |
$15,267,460 |
$15,267,460 |
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State Share of Costs |
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$816,270 |
$1,632,540 |
$1,632,540 |
$1,632,540 |
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The bill as
amended also includes deappropriations for the remaining funding in the
baseline for the MaineCare costs of coverage for the parents population from
101% to 138% of the federal poverty line. This group was covered through
December 31, 2013, with the possibility of transitional coverage extending
through December 31, 2014. The department identified a General Fund total in
the baseline for spending on this population, as of May 2014, of $16,936,665.
Of this baseline, $10,000,000 was deappropriated in PL 2013, c. 595 to fund Section 21 and 29
waitlist members and to increase nursing facility reimbursement rates. Since,
there were no subsequent MaineCare appropriations or deappropriations
affecting this population during the 126th Legislature, continued funding for
this population was included in the 2016-2017 MaineCare biennial budget
baseline. This bill deappropriates the remaining $6,936,665 that still
remains in the baseline. |
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Additional costs
for the Legislature's Office of Fiscal and Program Review will be absorbed
within existing budgeted resources. |
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