A bill that would provide free healthcare to income eligible adults in Maine regardless of immigration status moved through the legislature’s Health and Human Services Committee on Tuesday.
The bill — “An Act to Improve the Health of Maine Residents by Removing Exclusions to the MaineCare Program” — is a high priority for Democratic lawmakers. It was introduced by House Speaker Rachel Talbot Ross (D-Portland) and has earned support from a broad array of liberal nonprofits.
If it passes, as appears likely, Maine would expand eligibility for Medicaid, known in Maine as MaineCare, to all individuals over the age of 21.
MaineCare is a welfare program that provides comprehensive health care for low-income individuals and families at little to no cost to the enrollee. It’s paid for through a combination of state and federal tax dollars.
Since July 2022, non-citizen children and pregnant women who live in Maine have been eligible to apply for MaineCare and/or the Children’s Health Insurance Program (CHIP) regardless of immigration status.
LD 199 would mean that every foreign national present in Maine — whether they are an asylum seeker, refugee, or present in the U.S. illegally — would have access to MaineCare if they meet the income qualifications.
The bill would take effect in 2024.
Dozens of progressive activists turned out for the hearing.
Selam Runyon-Baruch, Director of Development and Community Engagement for the New Mainers Public Health Initiative, said Tuesday during the hearing she once refused medical care after a severe car accident because she lacked health insurance.
“I understand what it means to live with the fear of not having health insurance, which is why I’m fighting for LD 199,” Runyon-Baruch told lawmakers.
“How can we say we are ensuring everyone has a quality life without meeting their basic need of adequate health care?” she said.
James Myall, an economic policy analyst for the liberal Maine Center for Economic Policy, said the bill would be a boon for Maine’s economy.
“I also want to emphasize that healthy Mainers are productive Mainers and that by assisting new Mainers with access to health care we’ll be ensuring they are able to contribute to our collective well-being to the fullest extent through the economy,” Myall said.
“We know that these small investments upfront will result in larger dividends for the state later on economically,” he said.
Under MaineCare’s eligibility rules, an able-bodied childless adult must make less than $20,124 in order to qualify for MaineCare. For a family of four, that limit is $41,400, according to the Maine Department of Health and Human Services (DHHS).
During the COVID-19 pandemic, the federal government expanded eligibility to include individuals with higher incomes.
Those changes led to a 40 percent growth in the MaineCare rolls.
With the expiration of the federal public health emergency, increased federal reimbursements have gone away.
As a result, Maine is currently implementing an “unwind” — a 14 month process that will reevaluate whether U.S. citizens added to MaineCare over the past three years will continue to receive the benefit.
DHHS says it will reevaluate 31,000 Mainers each month starting in May, and those who are ineligible for MaineCare will lose their free coverage.
Taken together, LD 199 and the unwind could set up a process by which Maine residents who work and pay taxes are taken off the MaineCare rolls at the same time non-citizens who have not been paying taxes are added.
Then there’s the long term costs of expanding what is already one of the most expensive welfare programs nationally and in Maine.
LD 199 doesn’t have a fiscal note yet, so it’s unclear how much the state is saying it would cost.
But it certainly won’t be free for state taxpayers.
As of Wednesday, lawmakers on the Health and Human Services Committee haven’t said how many non-citizens the expanded program would cover.
Part of the problem is no one really knows how many non-citizen adults are currently living in Maine, but the size of that population will be one half of the equation that determines how large of an expense the legislature is considering.
The Kaiser Family Foundation data shows Maine’s per enrollee Medicaid spending was $8,466 in 2019. Information at Medicaid.gov pegs the per enrollee cost a little higher at $10,692 for the same year.
Assuming a population of 10,000 to 20,000 non-citizens will be added to the Medicaid rolls, the expenditure could be anywhere from $50 million to $200 million in new MaineCare spending every year.
That money will come directly from Maine’s general fund.
Because non-citizens are ineligible for Medicaid under federal law, the expense of expanding the program to include asylum seekers, refugees, and illegal aliens would be shouldered entirely by Maine taxpayers.
Additionally, the proposal could incentivize non-citizens to relocate to Maine, which would drive up costs in ways that are hard to predict.
For example, if asylum seekers or illegal aliens currently living in New Hampshire or Massachusetts decide to relocate to Maine in future years because of the availability of “free” health care, then those costs will increase.
The proposal would add to a slate of existing and proposed benefits that already make Maine an attractive place to relocate for foreign nationals in the U.S. Maine’s municipal governments already provide benefits regardless of immigration status under their General Assistance (GA) programs. Some foreign nationals in Maine will be eligible for two free years of rent in affordable housing complexes under development in southern Maine.
Maine is one of nine states that already provides comprehensive taxpayer-funded coverage to minors regardless of immigration status. If LD 199 passes, Maine could become the first and only state to offer taxpayer-funded healthcare to all adults and minors regardless of immigration status.
Currently, a few states and the District of Columbia offer Medicaid coverage to some adults. For example, Illinois’ Medicaid program covers non-citizen adults 65 years of age or older, while California’s Medicaid program covers adults aged 19-26 and adults older than 50. The state will expand to cover all adults no earlier than Jan. 1, 2024, but the precise details aren’t yet known.
In addition to the potential cost of expanding the program, more Medicaid patients would place a greater strain on Maine’s hospitals.
Maine’s hospitals have frequently said one of their top challenges is operating in an environment where many patients are paying for care with MaineCare, which they argue reimburses at too low of a rate.
Eastern Maine Medical Center, a subsidiary of Northern Light Health and one of Maine’s largest hospitals, estimated in its 2018 Form 990 tax filing that it accepted a $50.6 million shortfall in services billed to Medicaid.
Historically, Maine’s hospitals have agreed to accept this lower rate of reimbursement in exchange for the benefits they are afforded as tax-exempt nonprofits.
Rep. Kathy Javner (R-Chester), a Republican on the Health and Human Services Committee, sat through hours of testimony in support of LD 199 on Tuesday, but she remains opposed to the bill.
“Democrats are not willing to support a much needed tax cut for Maine citizens, but are more than willing to support spending millions more of our money on expanding MaineCare coverage to non-citizens,” said Javner.