Medicaid expansion enrollment is on track to surpass projections

Stethoscope wrapped around hundred dollar bills

Medicaid expansion enrollment under Governor Janet Mills is taking off – almost 16,800 individuals have enrolled to receive Medicaid benefits under the new eligibility requirements. The Manatt report cited by Governor Mills in her State of the Budget Address expects just over 70,000 people to enroll by fiscal year 2021 and a cost to the state of $159 million over the biennium.

Despite this, Governor Mills in her biennial budget proposed to dedicate approximately $147 million to expansion over the biennium, and to stash away $29 million in a Medicaid reserve account to pay for potential cost overruns.

When Medicaid expansion was on the ballot in 2017, proponents claimed that just over 70,000 people would enroll in the program. At the current rate of 1,292 new enrollees per week, the state is on track to exceed enrollment projections by January 2020. Higher-than-expected enrollment is not far-fetched and could result in the program costing more to taxpayers. In fact, other states that expanded their Medicaid programs experienced an average of 92 percent cost overruns, almost doubling the cost of expansion.

When Illinois expanded Medicaid to able-bodied adults, their health department projected a maximum enrollment of 380,000 new individuals. By March 2017, over 650,000 enrolled under expansion, costing the state more than double what was initially projected.

If Maine experiences a 50 percent cost overrun (less than average) in the 2020-21 biennium, it would cost an additional $44 million after the reserve account is depleted. Taking this risk could result in tax increases for Mainers, especially if the biennial budget spends all projected revenue or revenue projections do not pan out.

Governor Mills also approved a temporary call center to streamline the enrollment process. Job training for this facility began on April 1 and may result in a larger weekly enrollment rate. If this occurs and enrollment is steady throughout the biennium, the state may exceed initial enrollment projections before the end of the calendar year. This would undoubtedly increase the cost of Medicaid expansion, which will require state taxpayers to chip in more of their hard-earned money.

According to the Maine Department of Health and Human Services, almost 14,000 of the people already enrolled under expansion are adults without children (83 percent of new enrollees). These individuals are being prioritized over people with intellectual and developmental disabilities who continue to languish on Medicaid and state-funded wait lists.

Governor Mills’ proposed budget funds just 300 new slots in existing programs for Mainers with intellectual and developmental disabilities, which is the minimum amount required by law. In other words, the budget expands Medicaid to thousands of adults without children but does little to eliminate wait lists for the truly needy. In essence, we’re rolling out the red carpet for a population that should be working while kicking truly vulnerable Mainers to the back of the line.

It’s also worth mentioning that Governor Mills rejected the Section 1115 demonstration waiver requested by former Governor LePage and approved by the federal government. The waiver would have required able-bodied adults who receive Medicaid benefits to work, volunteer, search for jobs, or go to school a minimum of 20 hours per week.

Allowing able-bodied adults to become dependent upon a government program is irresponsible governance – if individuals can work, they should be required to do so in order to receive government benefits. In sum, this administration is ignoring the truly needy by spending hundreds of millions of dollars to allow able-bodied, childless adults to receive Medicaid benefits, without requiring them to work.


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