The Maine Legislature has yet to make a final decision on the proposal requiring the Maine Department of Health and Human Services (DHHS) to reimburse hospitals in a timely manner for services provided to MaineCare patients.
When the Legislature adjourned for the session this past Wednesday, Rep. Gary A. Drinkwater’s (R-Milford) bill was carried over after lawmakers failed to come to a consensus on whether or not to fund the proposal.
Although the bill got off to a rocky start in the House, it ultimately passed both chambers by substantial margins in strongly bipartisan votes. The proposal was stalled, however, when it came time for lawmakers to decide whether or not to approve the funding for it.
After failing to decide one way or another before the Legislature adjourned sine die, the bill was carried over to the next special or regular session.
Under LD 331, DHHS would be required to reimburse at least 75 percent of the as-filed settlement from cost reports within 90 days of receipt.
If approved, this would bring the timeline for hospital reimbursements into alignment with the standard set for nursing homes in 2023.
Maine hospitals often face delays in receiving payments for already-provided services, making it difficult for these facilities to cover expenses and meet the needs of their patients.
Rural hospitals in particular have been feeling the squeeze in recent months as entire practice areas, such as obstetrics and gynecology, are getting shut down, and in some cases, hospitals are closing their doors altogether.
Maine’s major hospital networks have advocated in support of LD 331, citing the many challenges they face as a result of waiting years to be reimbursed for services that have already been provided.
“We incur the cost to provide care in real time — our doctors, nurses, medical procedures, clinical imaging — all of it,” said Northern Light Health. “And we are challenged when we wait years to receive the MaineCare settlement payments that we are due. This bill resolves the problem of delayed settlement payments.”
According to Northern Light, services provided to patients in 2024 under MaineCare are not paid for by the State until early 2026, a delay that they refer to as being part of the “predictable timeline” of MaineCare reimbursements.
Northern Light in particular expects to be paid $34 million in 2026 for services provided in 2024 and are due a total of $50 million for “acute hospital and provider services” from prior years.
MaineHealth also reported facing similar difficulties, as they are still awaiting $40 million worth of reimbursements for services provided between October 2022 and September 2023.
When combined with the payments they are owed for the 2024 fiscal year, the state has an outstanding balance of more than $100 million with MaineHealth.
“These are exceptionally challenging times in health care with many hospitals throughout the state having less than 30 days cash on hand,” MaineHealth said in March. “LD 331 would help to address cash flow issues by providing timely payment of care that again, and very importantly, has already been provided.”
Bill sponsor Rep. Drinkwater explained in testimony before the Legislature’s Health and Human Services Committee that Maine has carried a significant balance of MaineCare debt to hospitals in the past, expressing concern that the state may be “starting down that slippery slope again.”
In 2013, then Gov. Paul LePage (R) signed a bill into law setting the stage for the state to redirect $183.5 million from a then yet-to-be-negotiated wholesale liquor contract to help pay off the debt owed to 39 hospitals located throughout Maine.
When combined with about $300 million in federal funding unlocked by the plan, former Gov. LePage was able to pay off the State’s $483 million worth of debt owed to Maine hospitals for services provided under MaineCare.
Maine DHHS has pushed back on the Republicans’ recent effort to ensure that the state’s hospitals are reimbursed for their services in a timely manner, arguing that operationalizing its requirements would not be feasible given the agency’s current resources.
They went on to argue that in order to get ahead of their typical payment schedule, a one-time additional allocation would be necessary in order to avoid borrowing money from future fiscal years.
DHHS did clarify, however, that they are not opposed to the “concept of the bill,” only that it would not be practical without receiving additional monetary support.
Several Committee lawmakers appeared to respond to these concerns, proposing an amendment to give the agency more than $135 million to help clean up their outstanding MaineCare debt with hospitals.
Despite this, Committee members remained divided along partisan lines over this legislation, with all Republicans supporting it and all Democrats opposing it.
This same partisan divided persisted in the House, where the majority Ought Not to Pass report was accepted by a roll call vote of 70-66.
The Legislature soon began to reverse course, however, with the Senate waiting several days before weighing in on the proposal.
Senators then overwhelmingly advanced LD 331 in a bipartisan roll call vote of 29-5. Just five Democrats expressed opposition to the bill.
Interestingly, just one of the two Democratic senators on the Health and Human Services Committee that recommended against the bill’s passage ultimately voted against its passage on the chamber floor.
When the bill was sent back to the House, lawmakers unanimously voted to recede and concur, allowing the bill continue down the path toward passage.
Because LD 331 was introduced as an emergency bill, it required support from at least two-thirds of the lawmakers in both chambers, a threshold that it met with success.
As is standard procedure for any bills requiring funding that make it through the rest of the legislative process, LD 331 was then sent to the Special Appropriations Table for final approval.
Before a decision could be made on whether or not to fund this initiative, however, the Legislature adjourned for the session. Consequently, LD 331 was carried over to the next special or regular session — continuing the delay in hospital reimbursements.
