Childless, able-bodied adults are driving cost and enrollment under Medicaid expansion

Stethoscope wrapped around hundred dollar bills

Governor Mills’ first move in office was to sign an executive order expanding Medicaid to more than 70,000 Mainers. Maine voters approved Medicaid expansion at the ballot box with nearly 59 percent of the vote in 2017. With concerns about how expansion would be funded and whether it would be financially solvent, Governor LePage delayed implementation until the end of his term in January 2019. 

Since Governor Mills signed the executive order when she took office in January, more than 37,000 individuals have enrolled under expansion. According to the Maine Department of Health and Human Services (DHHS), adults without children represent 81 percent of those who have enrolled thus far. Of those individuals, 10,500 of them, or nearly one-third of all enrollees, are between the ages of 19 and 29.

These trends are much different than what was projected in a study conducted this year by the Muskie School of Public Service. Their research indicated that adults between the ages of 19 and 24 were least likely to enroll under expansion. This age group represented just 6.6 percent of eligible low-income, childless adults whereas individuals between the ages of 55 and 64 were expected to make up approximately 45 percent of the expansion population. 

In an August update, the Maine DHHS indicated that the number of enrollees was trending younger than anticipated and indicated that older individuals might enroll under expansion at a later date. The research conducted at the Muskie School of Public Service certainly supports that potential outcome, since it estimates that almost 73 percent of individuals eligible to enroll are over the age of 45. 

Erika Ziller, one of the authors of the report, said this population could be waiting to re-enroll under expansion because they may have already obtained insurance through the Affordable Care Act Marketplace.

According to the Maine DHHS, approximately 10,000 letters were sent to individuals who had enrolled through the marketplace and invited them to sign up for Medicaid if they were eligible. In 2020, most of these people will likely transition to Medicaid because they will no longer be eligible for subsidies that make insurance through the marketplace affordable for these populations.

Nonetheless, this doesn’t change the fact that Maine taxpayers are subsidizing healthcare for childless, able-bodied adults. The state budget dedicated $125 million to cover the cost of Medicaid expansion over the 2020-21 biennium while forgetting Maine’s most vulnerable citizens.

There are approximately 1,600 individuals on Section 21 waitlists in the state. These are people who have intellectual disabilities and truly need assistance from state government — they’re not healthy, childless, 19- to 29-year-olds who are presently driving enrollment and the costs of expansion.   

Put simply, it is irresponsible for state government to neglect its most vulnerable citizens while spending hundred of millions to subsidize health care for childless, able-bodied adults.


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