Thanks to the Trump Administration’s unprecedented release of Medicaid claims data, taxpayers may now get insight into how one of America’s most expensive welfare programs has been spending their money.
(Note: The map is based on federal data released by the Department of Health and Human Services. The data show monthly claims-level payments to Medicaid providers from 2018 to 2024. That data was layered with the National Provider Index to form a complete picture of the business connected to each set of billing records. The index used here is a measure of fraud risk based on indicators commonly used by fraud investigators.)
Maine’s Spending Trajectory (2018–2024)
| Year | Total Spending | Claims | Providers (Based in Maine) | Avg Cost/Claim |
|---|---|---|---|---|
| 2018 | $1.077B | 11.9M | 1,570 | $90.78 |
| 2019 | $1.200B | 12.9M | 1,567 | $92.85 |
| 2020 | $1.186B | 11.8M | 1,616 | $100.45 |
| 2021 | $1.299B | 13.8M | 1,657 | $94.45 |
| 2022 | $1.388B | 13.8M | 1,601 | $100.20 |
| 2023 | $1.658B | 14.4M | 1,641 | $115.33 |
| 2024 | $1.679B | 13.1M | 1,605 | $128.21 |
In the seven years from 2018 to 2024, Maine spent a total of $9.49 billion on Medicaid at providers located in Maine. The cost per claim increased 41 percent ($90.78 → $128.21) — far beyond the rate of inflation. Total claims volume grew only 10 percent. This means the cost increase is overwhelmingly driven by unit price inflation, not increased utilization. That’s a red flag — it suggests providers are billing higher per service, not that more people are getting care.
Maine vs. National: Cost Per Claim Outliers
This is where the data gets alarming. Maine is spending 5.4x as much per claim on substance abuse treatment drugs like Methadone and Suboxone. That means that the same treatment covered by the same program is more than five times cheaper in most other states. The same story goes for Maine’s residential care program, which provides group homes for disabled Mainers to live in. The average claim in Maine under that program is $1,671 versus $482.04 nationwide. Here are the numbers for Maine’s cost per claim compared to the national average (with Maine excluded from the benchmark):
| Service Code | Description | Maine Cost/Claim | National (excl ME) | Ratio | Maine Spending |
|---|---|---|---|---|---|
| H0020 | Methadone/Substance Abuse | $106.80 | $19.68 | 5.4x | $129M |
| S5140 | Adult Foster Care | $527.15 | $149.01 | 3.5x | $421M |
| T2016 | Residential Habilitation | $1,671.26 | $482.04 | 3.5x | $2.31B |
| G0299 | Home Health Skilled Nursing | $151.85 | $53.33 | 2.8x | $143M |
| H2036 | Psych Rehab – Intensive | $735.77 | $256.97 | 2.9x | $33M |
| S5125 | Attendant Care | $160.76 | $78.54 | 2.0x | $149M |
| H0019 | Behavioral Health Residential | $564.68 | $277.07 | 2.0x | $670M |
| T1019 | Personal Care Services | $223.01 | $111.29 | 2.0x | $513M |
| H2012 | Day Treatment – Behavioral | $232.06 | $122.73 | 1.9x | $212M |
| H2021 | Community Support | $294.49 | $170.23 | 1.7x | $534M |
Here’s a look at the growth in spending per claim and total spending for services flagged in the Medicaid data as Suboxone or Methadone.
| Year | ME Spending | ME Cost/Claim | National (excl ME) |
|---|---|---|---|
| 2018 | $7.6M | $62.33 | ~$20 |
| 2021 | $16.5M | $105.12 | ~$20 |
| 2024 | $28.7M | $154.70 | ~$20 |
REALTED…
- Five Star Fraud: Records Show Home Health Agency Over-billed MaineCare by Nearly $400k, Disappeared…
- In Case You Missed It: Dr. Oz Puts Mills on 30-Day Notice Over MaineCare Autism Billing…
- Portland Office Becomes a Hub for Medicaid “Home Health” and Somali Money Transfers…
- Are Maine’s “Group Homes” the Next Medicaid Scandal to Unravel?
- Bipartisan Group of 100+ Lawmakers Urge Gov. Janet Mills to Reconsider Contract with ModivCare
- Better Late Than Never: Gov. Mills Finally Backs Gateway Probe After Months of Silence
