Opinion: Four years later, MaineCare expansion has made us a healthier, stronger state

On January 3, 2019, Governor Janet Mills signed her first executive order, implementing the expansion of MaineCare, Maine’s Medicaid program, which had been approved by voters in 2017. Over the past four years, Medicaid expansion has been transformational for Maine people, hospitals, and the economy. Since the program was implemented in January 2019, more than 130,000 Mainers received access to affordable health care. The program has brought more than $1.4 billion in federal funding to the state, and it has significantly improved hospitals’ balance sheets.

In the era of the COVID-19 pandemic, MaineCare proved to be a vital safety net for tens of thousands of Mainers. And as the pandemic pushed enrollment in the program above prior projections, additional federal funding made MaineCare an even better value for the state than anticipated.

Enrollment

As of October 1, just under 100,000 people were currently enrolled under the Medicaid Expansion program. This is considerably more than the estimated 71,000 in the run-up to expansion. However, the increased enrollment numbers are at least partly driven by the COVID-19 pandemic. Maine’s expanded Medicaid eligibility rules had only been in place for a little over a year when the COVID-19 pandemic hit the state in March 2020. Not only were more people eligible for assistance due to the unprecedented economic fallout caused by the pandemic, but emergency rules adopted by the federal government allowed for anyone enrolled in the program as of March 2020 to maintain their coverage, even if their income increased to a level which would normally make them ineligible. In exchange, the federal government has provided state programs with additional funding. This provision of “continuous coverage”is tied to the federal public health emergency, and one estimate suggests as many as one in five Mainers currently enrolled could lose coverage when the emergency ends.

Medicaid expansion has played a key role in ensuring Mainers have access to affordable health insurance. Between 2019 and 2021, the share of Mainers without any health insurance decreased from 8 percent to 5.7 percent of the general population — the biggest improvement over this period for any state. The data shows that half the improvement in the uninsured rate was due to improvements in coverage among Mainers below 138 percent of the federal poverty level — precisely the people eligible for Medicaid expansion.

Costs and federal funding

Even though enrollment has been higher than anticipated, costs to the state have been lower than expected, partly due to the enhanced federal funding during the pandemic. Over the last four years, the state has spent just over $160 million on expanded MaineCare, and in return has received over $1.4 billion in matching federal funds. By contrast, pre-expansion analysis estimated the state would spend $205 million in the first three fiscal years and receive $1.25 billion in matching funds.

The generous federal match — 9 dollars in federal money for every 1 dollar spent by the state — means a stronger state and local economy. That money not only helps ensure affordable coverage for Mainers but supports Maine hospitals and the local economy more broadly as health care workers spend their paychecks at local businesses.

Impacts on hospitals

Medicaid expansion has also helped improve the bottom lines of hospitals, especially those in rural areas which have a high share of patients with low income. While the magnitude of this improvement is hard to measure with certainty because hospitals were severely impacted by the COVID-19 pandemic, between 2018 and 2020, charity care costs for Maine’s hospitals fell by $106 million while the cost of uncollectable debt fell by $71 million, according to data from the Maine Health Data Organization. Comprehensive MHDO data isn’t available for all hospitals, but some examples suggest this trend continued into 2021. MaineHealth, the state’s largest health care provider, saw its charitable care costs fall from $44 million in 2020 to $29 million in 2021.

As more Mainers with low income were covered by MaineCare, they had less reliance on charity care and took on less debt that they were unable to repay.

Impacts on immigrants

The COVID-19 pandemic has shown clearly that public health relies on the ability of all Mainers to access affordable care. But expanding and guaranteeing access to health care doesn’t only help us during a pandemic. We’re all better off when our neighbors can afford to see a doctor, buy prescription medicines, and get the treatment they need.

Unfortunately, Maine has excluded hundreds of New Mainers from the expansion population. Lawmakers can correct this and continue the path toward ensuring everyone in our state has access to health care and a chance to thrive which will result in an even stronger economy.

Uses and treatment

MaineCare has increased access to important treatments for Mainers with low income. People living in poverty often have less access to adequate healthy food and are more likely to suffer from conditions such as diabetes and hypertension, for which thousands of Mainers have now received treatment under expanded MaineCare. The program has also helped improve access to lifesaving preventative care such as breast and colorectal cancer screenings. Without health insurance, many Mainers with low income don’t have primary care physicians and miss out on these preemptive screenings.

Effects of MaineCare coverage go beyond health outcomes. Medicaid access has also been shown to reduce poverty and provide more economic stability. Access to health care means less hunger, fewer evictions, and better credit scores as individuals’ pocketbooks are no longer squeezed by medical costs. In short, MaineCare expansion has been a success on multiple levels, providing more care to Mainers while improving hospital financials and strengthening the state’s economy.

On this four-year anniversary of the program’s implementation, Maine lawmakers should celebrate its success and continue to find ways to expand access to affordable care.

This post was initially published at the Maine Center for Economic Policy blog.