MaineCare to undergo overhaul Lawmakers denied review

AUGUSTA – The state’s Medicaid program, which spends more state and federal dollars than any other program in state government, is about to be reorganized, members of the Legislature’s Health and Human Services Committee were told Monday. But lawmakers were surprised by how quickly the changes are to be implemented and concerned about not having an opportunity to review them first.

“I met with … all of the staff from the Office of MaineCare services at the Civic Center,” Deputy Health and Human Services Commissioner Mike Hall told the panel Monday. “I proposed, and shared with them, my proposal for doing a significant and substantial restructuring of the Office of MaineCare Services.”

MaineCare is the state’s name for Medicaid, the federal-state program that spends about $1.3 billion a year on health care services for more than 300,000 low-income Mainers. Hall said the proposed changes include “taking apart” the existing administrative system and creating all new divisions with new leadership.

“I want to move it in the direction so that it has the look and feel and the capacity to function more like a modern insurance company,” he told lawmakers Monday.

Asked for details, Hall declined to elaborate. He said he is asking for staff comments on the plan before putting it into effect. He added that he expected to implement the changes beginning next month and before the committee is scheduled to meet again.

“Some of us have had e-mails about this” from concerned DHHS employees, said Sen. Art Mayo, D-Bath, co-chairman of the committee, “but you are not prepared today to give us any specifics?”

Hall said he did not want to discuss his specific plan, because it may change. That did not sit well with some of the lawmakers on the panel charged with oversight of the agency.

“Our oversight role has been diminished in how this is being approached,” Mayo said.

Rep. Hannah Pingree, D-North Haven, the House co-chairman of the committee, was equally concerned. She does not believe anyone on the committee was aware of the proposal until Hall mentioned it, even though there have been discussions about the need to overhaul the agency.

Much of that discussion has dealt with DHHS’ new computer system, which went online last January and has been fraught with software and hardware problems, causing numerous delays and inaccuracies in payments to many of the department’s 7,000 service providers. While some corrections have been made, problems continue to plague the department.

“The MaineCare division of the Department of Health and Human Services has real management problems,” Pingree said. “They have real staff morale issues; they have real problems with training. But we were not aware they had plans to do this now, or by next month sometime.”

Pingree believes there needs to be an overhaul, and that it is a good idea for staff to be involved in the process. And while the changes legally could be made by the department without legislative approval, she said the Legislature needs to be kept informed and given an opportunity to exercise its oversight responsibilities.

“It’s a fundamental change in the way this department will work,” she said. “But I think we need the facts and a comfort level before this is implemented. I don’t see any reason this can’t wait to be implemented until late January so the Legislature has the time to look at this and think about it.”

Sen. Richard Rosen, R-Bucksport, said he is frustrated by the lack of information about the details and the intention of the department to proceed with changes without lawmakers having the ability to review the proposal.

“The only information I have is what we all just heard, so I can’t make any assumptions about what it will do, how it will change the agency,” he said. “This was just a verbal presentation with no paper backup.”

Rosen said the need for overhauling the agency is clear. He said Medicaid affects such a wide range of programs, from nursing home care to medical care for the poor, that lawmakers need to keep close track of changes.

Citing the state’s public records law, Capitol News Service filed a request with DHHS on Monday afternoon for documents outlining the proposed changes in the MaineCare program. Under the law, the department has five days to respond to the request.