Maine to pursue a state-based Health Insurance Marketplace with Affordable Care Act

 As of August 26, more than 36,016 people have gained health care under MaineCare expansion

Aug, 28.2019

By Ramona du Houx

Late in August, Governor Janet Mills announced that Maine will pursue a State-based Health Insurance Marketplace that improves the state’s ability to fund education and outreach while using the federal HealthCare.gov website to enroll consumers in private health insurance under the Affordable Care Act.

“Over the past eight months, my Administration has expanded health care to more than 36,000 people across the state. These are folks who can now see doctors, receive preventive care, treat illnesses, and afford their medications. While I am pleased with the progress we have made, there is more we can – and must do – to make affordable health care available to more people,” said Governor Janet Mills. “By pursuing a state-based marketplace, we will be putting ourselves – not the federal government – in the driver’s seat when it comes to helping consumers and small employers understand their options for affordable coverage, and we will better insulate ourselves from the attacks on health care that are coming out of Washington.”

Governor Mills submitted a letter of intent to the U.S. Centers for Medicare and Medicaid Services (CMS) indicating that Maine will pursue this option for the 2021 health insurance plan year. She expects to introduce legislation to establish the details of the new state-based marketplace when the Legislature reconvenes in January and will be assessing additional options to make health insurance for small businesses more affordable.

“Other states that have pursued this model have performed better on both enrollment and the cost of monthly premiums,” said Health and Human Services Commissioner Jeanne Lambrew. “This move will allow us to customize our outreach to the communities and small businesses we know need access to health care, but who are hard to reach.” 

With the Affordable Care Act, states can choose one of three options for their Health Insurance Marketplaces, which consumers and small businesses use to shop for plans and apply for financial assistance for coverage. Maine currently relies on the federal government to fully run its Health Insurance Marketplace. 

“A State Based Marketplace would give Maine the ability to better coordinate with health insurance carriers, Marketplace Navigators, and Assisters,” stated Maine Insurance Superintendent Eric Cioppa.  “It would also provide the State with direct access to important data about how the system is working, which will in turn enable the State to make data-driven modifications that specifically benefit Maine consumers.” 

 Under the model announced today, Maine will have greater control over outreach, marketing, and consumer assistance initiatives, while the federal government will continue to provide its call center and HealthCare.gov where consumers can apply for and enroll in coverage. The Mills Administration is also exploring the possibility of transitioning from this model to the third option, a fully State-run Marketplace in the future.

The Maine Bureau of Insurance would still oversee the individual and fully-insured group markets. It would also continue “plan management,” or engagement with insurance carriers on the HealthCare.gov plan offerings. 

If legislation passes to create a State-based Marketplace using the Federal Platform, then Maine will submit a plan to CMS for approval. DHHS can manage the cost of this activity with some of the additional federal funding that will result from Maine assuming control over its Marketplace’s outreach and education. 

This will not affect the upcoming open enrollment period in November 2019, which will proceed in the same way as previous open enrollment periods. 

This move is among the significant steps the Mills Administration has taken over the last eight months to expand access to health care. In the last legislative session, the Mills Administration worked with the Legislature to pass language to enable Maine to examine new ways to make private health insurance more affordable through a State Innovation (1332) Waiver from the federal government. Under this waiver, states may change the application of federal laws governing private health insurance - including the design of federal tax credits – as long as the resulting coverage is affordable, comprehensive, covers as many people, and does not raise federal costs compared to current law. 

Since the launch of State Innovation Waivers in 2017, 13 states, including Maine, have successfully applied for and received approval for these waivers. Maine’s current waiver enables the State’s reinsurance program, the Maine Guaranteed Access Reinsurance Association, to receive roughly $62 million in Federal funding in 2019 to lower premiums for consumers in the individual health insurance market. The language included in the budget does not change this existing waiver, but provides more flexibility to further improve affordability. Before submitting a waiver request to the federal government, the Mills Administration will gather public input. 

Governor Mills expanded MaineCare on her first day in office and, as of August 26, more than 36,016 people have gained health care under MaineCare expansion. Governor Mills also signed into law L.D. 1 which adds State guaranteed protections for health care coverage for people with pre-existing conditions as established under the Affordable Care Act in the State’s regulated markets. She expanded reproductive health care coverage under MaineCare, and signed a comprehensive prescription drug reform package into law to reduce the cost of prescription drugs. She also restored the Maine Low-Cost Drugs for the Elderly and Disabled program to cover an additional 1,800 Maine seniors, supported treatment and prevention programs to help combat the opioid epidemic, and bolstered public health, which can improve affordability of coverage by reducing health problems due to tobacco use and low immunization levels, among other initiatives.