How the incoming Trump administration could impact people covered under MaineCare

While more than 400,000 Mainers are currently covered under MaineCare, the state’s Medicaid plan, that could soon change under the incoming Trump administration’s proposed cuts to the federal budget. And because Medicaid provides free or low-cost health care, changes in funding or eligibility could leave the poorest Mainers without health care coverage.

That’s according to three experts who discussed the impact of cuts and the people that would be affected by these changes.

“Medicaid serves the lowest income people. So by its nature, the people most impacted will be the lowest-income Mainers who have the least ability to absorb additional health care costs,” said Kathy Kilrain del Rio, advocacy and programs director at Maine Equal Justice.

“If these types of cuts happen, we’re going to see poor health outcomes for Mainers, and we’re going to see more people struggling with medical debt or trying to figure out, do they pay their rent or do they pay a medical bill?”

Medicaid, the government health program that covers approximately 82 million people, makes up about 10% of the federal budget, which makes it prime for funding cuts, as Republicans have long tried to limit the program. The most recent cuts are proposed through three different avenues: The Heritage Foundation’s Project 2025 report, the fiscal year 2025 Republican Study Committee budget plan and the FY 2025 House of Representatives budget resolution.

All three plans propose varying degrees of cuts to the Medicaid program under a second Donald Trump presidency and a majority Republican Congress. Although the changes are not the same across the three proposals, all three include some version of slashing federal funding to state-run programs, changing eligibility to make it harder to qualify for Medicaid, and reducing the current 90% federal reimbursement rate for Medicaid. While Trump did not address cuts to Medicaid directly on the campaign trail, he tried to reduce access to the program and the Affordable Care Act in his first term. 

“Given their constant attempts and complaints about [it] in the past, I think that’s an area that we will see some effort to perhaps roll things back, and that’s concerning,” said John Gale, a senior research associate at the Maine Rural Health Research Center within the Muskie School of Public Service at the University of Southern Maine.

“I think President-elect Trump and others have the idea that there’s a lot of people on Medicaid that aren’t deserving, so I can see them trying to roll back eligibility requirements, perhaps impose work restrictions and that’ll hurt a lot of people.”

Maine was one of the states to expand Medicaid, allowing more than 100,000 people to access MaineCare because of the higher income limits under expanded eligibility. But with funding cuts and eligibility restrictions, which experts have said would more severely impact rural areas, the most vulnerable people are in danger of losing access to affordable health care, according to Kilrain del Rio.

“Because of the expansion, because of the increased subsidies in the marketplace, health care costs were significantly reduced for Mainers,” she said. “So we’ll be taking steps backwards if we cut any of those things.”

Maine Department of Health and Human Services, which administers MaineCare, said the agency can’t speculate on what the new administration’s health care agenda will look like. But the state will advocate to let Mainers keep their Medicaid enrollment, said spokesperson Lindsay Hammes in a statement. 

“What we know is that the Department will continue to work with policymakers on both sides of the aisle to advocate — that Medicaid continues to provide health care coverage for Maine people,” she wrote. “Research consistently shows that Medicaid enhances life outcomes — helping children succeed in school, supporting working adults in maintaining employment, and enabling older adults and people with disabilities to live independently with dignity in their communities.”

How federal cuts could impact MaineCare

Currently, health care providers who accept MaineCare submit claims to the state that are reimbursed based on rates that are set for different types of services, such as mental or oral health, reproductive health, or primary care. The state, in turn, is reimbursed most of those costs by the federal government.

Lowering reimbursement rates is one way to cut costs around Medicaid. But health care providers are already receiving a smaller amount through MaineCare compared to private insurance for providing the same service. If reimbursement rates were cut, health care providers across the state may stop accepting MaineCare because they would not be able to afford providing those services, Kilrain del Rio said.

“So the state would have to pick up the tab for some services, to keep a lot of people covered that currently is paid by the federal government,” Gale said.

Another potential way of cutting Medicaid would be a move to block grants, which was a model proposed under former Republican presidents, including George W. Bush and Ronald Reagan.

Instead of reimbursing states for their actual costs, the federal government would issue each Medicaid program a lump sum that they have to figure out how to use, Gale said.

“The cost of health care is always fluctuating, so a block grant really doesn’t do a good job of anticipating what health care costs may look like,” Kilrain del Rio said.

“And that’s one of the reasons why states would likely be forced to cut access to either services or eligibility or both, in order to make sure they stay within that block grant.”

Eligibility changes could leave some Mainers without coverage 

Another proposal would be to impose work requirements in order to qualify for Medicaid federally. 

In 2017, former Republican Gov. Paul LePage requested a federal waiver to institute work requirements, which the Trump administration approved days before LePage left office. However, when Democratic Gov. Janet Mills took over, she rejected the waiver.

“We believe that the likely result of this … would leave more Maine people uninsured without improving their participation in the workforce,” she said in a public statement at the time. 

This year, legislative Republicans asked the Mills administration to reconsider work requirements, arguing that they would incentivize people on Medicaid to seek out work. 

“Requiring able-bodied adults to be engaged in their communities or working in order to receive taxpayer-funded insurance will incentivize people to work,” Republican Rep. Shelley Rudnicki from Fairfield said in February.

If work requirements were imposed on the federal level by the incoming administration, people on Medicaid would have to prove they have been looking for work, and if they don’t find employment, they risk being kicked off, Gale said. When Arkansas became the first state to require adults ages 30 to 49 to work 20 hours a week, participate in “community engagement” activities, or qualify for an exemption to maintain coverage, 18,000 adults lost coverage within a few months, before a federal judge put the rule on hold.

However, Republican U.S. Rep. Jodey Arrington of Texas, who leads the House Budget Committee, has already said he favors a “responsible and reasonable work requirement” for Medicaid, according to the New York Times.

“People are more likely to be able to work if they have access to the full range of health care needs, and also, people need health care whether or not they’re able to work,” Kilrain del Rio said. 

“Putting a work requirement into a health care program is a really short sighted option, which will ultimately result in people losing health care, and it will result in fewer people in our workforce.”

Work requirements for Medicaid also negatively impact people with disabilities, people who have caregiving responsibilities, and people who live in more rural areas with limited access to transportation.