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126th MAINE LEGISLATURE |
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LD 1487 |
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LR 1044(03) |
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An Act To
Implement Managed Care in the MaineCare Program |
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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 |
Legislative Cost/Study |
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FY 2013-14 |
FY 2014-15 |
Projections FY 2015-16 |
Projections FY 2016-17 |
Net Cost
(Savings) |
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General Fund |
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$0 |
($3,434,799) |
($1,418,768) |
$3,542,400 |
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Appropriations/Allocations |
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General Fund |
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$0 |
($3,434,799) |
($1,418,768) |
$3,542,400 |
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Federal Expenditures Fund |
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$0 |
$329,109,036 |
$357,091,833 |
$279,926,385 |
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Other Special Revenue Funds |
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$0 |
$4,706,952 |
$4,836,712 |
$4,970,364 |
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Revenue |
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Other Special Revenue Funds |
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$0 |
$4,706,952 |
$4,836,712 |
$4,970,364 |
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Legislative
Cost/Study |
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The general
operating expenses of the task force in Part F are projected to be $5,250 in
fiscal year 2014-15 and $750 in fiscal year 2015-16. The Legislature's proposed budget includes
$10,000 in fiscal year 2014-15 for legislative studies. Whether this amount is sufficient to fund
all studies will depend on the number of studies authorized by the
Legislative Council and the Legislature.
The additional costs of providing staffing assistance to the study
during the interim can be absorbed utilizing existing budgeted staff
resources. |
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Fiscal Detail
and Notes |
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This bill
implements and adjusts funding related to the expansion of MaineCare
eligibility and makes other changes to the MaineCare program. |
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Part A
establishes a managed care program for all covered MaineCare services and
provides an appropriation of $250,000 in fiscal year 2014-15 for the Office
of MaineCare Services in the Department of Health and Human Services for the
initial implementation including: convening and supporting the stakeholder
group; preparing and issuing a request for information; preparing a report to
the Legislature on the status of implementation and for required rulemaking. |
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Part C requires
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, the implementation of the MaineCare childless
adults waiver effective October 2002 enrolled approximately 15,000 persons by
the end of the first year and resulted in savings of $1,800,000 that was
subsequently deappropriated from the Mental Health Services - Community
program in fiscal year 2002-03 (PL 2001 c.714). Part C includes a deappropriation of
$5,900,000 in 2014-15 in the Executive Branch Departments and Independent
Agencies -Statewide program in the Department of Administrative and Financial
Services for the initial savings to be identified in existing programs as a
result of the expansion of MaineCare eligibility. |
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Part C includes
an appropriation of $100,000 in fiscal year 2014-15 for the Office of Fiscal
and Program Review to contract with a nonpartisan research organization to
evaluate the impact of the MaineCare expansion on state programs and to
examine the financial feasibility of providing coverage through a Health
Insurance Marketplace model. This
level of contract funding will likely be insufficient to fund any detailed
analysis of both the impact of
MaineCare expansion and the financial feasibility of a Health Insurance
Marketplace model. This level would
not be sufficient to fund any actuarial analysis. |
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Part D of the
bill includes General Fund appropriations of $2,004,662 in 2014-15 for the
Office of Family Independence - District program in the Department of Health
and Human Services for the State share of the costs of 83 new positions to
administer the MaineCare eligibility expansion. Funding for the new positions included in
Part D reflect a 75% federal match for the 64 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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Part D also
includes Federal Expenditures Fund allocations totaling $327,657,166 in
2014-15 as shown below. The estimated federal allocations assume 100 percent
federal matching funds through December 31, 2016 for childless adult waiver
population with incomes less than 134% of the federal poverty line. The
fiscal note also assumes funding for the payment of three months of claims
for this population after December 31, 2016 at the 95% enhanced federal match
rate. |
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FY 2013-14 |
FY 2014-15 |
FY 2015-16 |
FY 2016-17 |
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Childless Adults
@ or below 133% of FPL
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Estimated Population |
55,965 |
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Est. Annual Cost Per Person |
$5,855 |
$0 |
$327,657,166 |
$343,712,367 |
$180,277,137 |
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Assumed Federal
Match |
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100.0% |
100.0% |
100.0% |
100.0% |
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State Share of Costs |
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$0 |
$0 |
$0 |
$0 |
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Childless Adults
- CY 2017 Costs |
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Estimated Cost |
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$0 |
$0 |
$0 |
$90,138,568 |
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Assumed Federal
Match |
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100.0% |
100.0% |
100.0% |
95.0% |
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State Share of Costs |
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$0 |
$0 |
$0 |
$4,506,928 |
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The bill does not
include appropriations for the MaineCare costs of coverage for the parents
population from 101% to 133% of the federal poverty line. Funding for coverage for this population
through December 31, 2013 and for continued transitional MaineCare coverage
was included in PL 2013, c. 368, the 2014-2015 Biennial Budget bill (LD 1509)
at a General Fund funding level estimated at the time to be $8,825,036 for
fiscal year 2013-14 and $9,319,223 for fiscal year 2014-15. PL 2011 c. 657 had originally eliminated
coverage for this population effective September 30, 2012 contingent on
federal approval of a waiver of federal Patient Protection and Affordable
Care Act maintenance of effort requirements.
Because the federal waiver was not granted, restoring the PL 2011, c.
657 deappropriation of $5,866,833 ($7,822,444 annualized ) for this
initiative was included in the adjustments to the MaineCare baseline in the
2014-2015 Biennial Budget. |
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The Department of
Health and Human Services now estimates this population has a General Fund
cost of approximately $17 million per year, even though there have been no
substantive program changes that would definitively explain a change in
estimate of this magnitude. This fiscal note reflects the difference between
the baseline adjustment used to
prepare the 2014-2015 Biennial Budget and the Department's latest estimate -
see table below. If there are no
subsequent MaineCare appropriations or deappropriations affecting this
population during the 126th Legislature, continued funding for this
population will be included in the 2016-2017 MaineCare biennial budget
baseline. Any biennial 2016-2017
MaineCare budget savings to that baseline will be based on enacted
adjustments made by the 127th Legislature. |
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FY 2013-14 |
FY 2014-15 |
FY 2015-16 |
FY 2016-17 |
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Parents (Between
101 and 133% of the Federal Poverty Line) |
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Estimated Population |
15,000 |
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2014-2015 Budget Baseline Adjustment |
$0 |
$0 |
$25,424,935 |
$26,670,757 |
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Assumed Federal
Match |
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61.8% |
61.6% |
61.6% |
61.6% |
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State Share of Costs |
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$0 |
$0 |
$9,775,887 |
$10,254,906 |
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Updated DHHS Estimates |
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$0 |
$0 |
$46,411,365 |
$48,685,105 |
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Assumed Federal
Match |
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61.8% |
61.6% |
61.6% |
61.6% |
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State Share of Costs |
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$0 |
$0 |
$17,845,170 |
$18,719,423 |
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2016-2017 GF Baseline Adjustment |
$0 |
$0 |
$8,069,283 |
$8,464,517 |
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The fiscal note
assumes any secondary impact on the numbers of persons participating in
MaineCare as a result of this bill's expansion of MaineCare eligibility would
be minimal based on the fact that most of the populations affected by the
bill have been covered by MaineCare or on a MaineCare waitlist within the
last year. The secondary impact on
MaineCare participation as a result of implementation of the federal Patient
Protection and Affordable Care Act (ACA) on MaineCare eligibility groups not
addressed by the bill is not a result of this bill and therefore not included
in this fiscal note. Any secondary ACA
impact on the childless adult expansion population is assumed to have a
minimal impact on General Fund costs given the 100% federal match. The
secondary ACA impact on the parents expansion population could be significant
and if it exceeds the growth assumptions for this population may result in
additional General Fund costs beginning in fiscal year 2014-15. While the
bill in aggregate assumes savings that could offset these General Fund costs,
it does not include a mechanism to return savings to the MaineCare program
until savings exceed the assumed statewide deappropriation included in this
bill. |
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Additional costs
and/or savings resulting from Part G requirements related to programs for
adults with intellectual disabilities and autism are assumed to be absorbed
within existing resources for existing programs. |
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Part H provides a
Federal Expenditures Fund allocation of $207,018 in fiscal year 2014-15 for
the Department of the Attorney General for 2 Attorney General Detective
positions in the Healthcare Crimes Unit. |
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