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The Maine Department of Health and Human Services this week notified health care providers about its plans to withhold certain payments starting Wednesday if an emergency budget is not passed this Tuesday with the support of two-thirds of the Legislature. The reductions are needed to ensure the program does not run out of money before the new fiscal year starts July 1.
While the reduced payments will add financial strain to health care providers, MaineCare patients are unlikely to see an immediate impact. That’s because health care providers are required to give the state 30 days notice before they stop serving patients covered by the public insurance program, according to Ann Woloson, executive director of Maine Consumers for Affordable Health Care, a nonprofit health care advocacy group.
That policy, however, contains an exception for “reasonably unforeseen circumstances.”
“We have gotten calls (from people) saying they’re worried about it,” Woloson said, “but we haven’t heard anybody saying the provider is closing their door and no longer taking MaineCare beneficiaries.”
Beginning Wednesday, the state will only pay 70% of prospective interim payments to critical access hospitals, while withholding payments for all hospital claims greater than $50,000 and payments to large retail pharmacies, large durable medical equipment providers, and out-of-state providers of hospital, ambulance, pharmacy and durable medical equipment services.
Health insurance is complicated and can be particularly so for people who don’t have access to it through employment, Linda Sanborn, board member of Consumers for Affordable Health Care, told the committees during a joint hearing of the budget and Health Coverage, Insurance and Financial Services committees on Feb. 26.
As the state’s Health Insurance Consumer Assistance Program, the organization provides that guidance to Mainers. For example, Sanborn said the program recently helped a York County resident who was inappropriately denied coverage file an appeal.
But Sanborn is concerned about several factors that could soon make the program’s services even more vital.
Those who wish to continue with their current health care should look into the federal government's Temporary Continuation of Coverage, experts say. Under this option, you're able to extend your federal workplace plan for up to 18 months after termination. (It's similar to COBRA, or the Consolidated Omnibus Budget Reconciliation Act, for private-sector workers.)
Keep in mind that, with TCC, you'll be responsible for the full cost of your premiums, plus any administrative fees.
"It's going to be [a] pretty big hike," said Brennan Rhule, a Reston, Virginia-based certified financial planner who specializes in federal workers.
If the new premium cost is too high to shoulder under TCC, you may qualify for a special enrollment period of the Affordable Care Act marketplace, according to Kate Ende, leader of the policy team at the Consumers for Affordable Health Care, a nonprofit. The special enrollment period typically gives you 60 days to sign up for a marketplace plan after you lost your coverage.
Medicaid might also be an option, Ende said, and if you qualify you can enroll at any time for it.
