Revised MaineCare plan unveiled Co-chairman of panel reviewing program unaware of reorganization

AUGUSTA – An overhaul of the state program that provides health care to Maine’s poor is scheduled to begin next month, but lawmakers who were unaware the reorganization was taking place want a hand in the process, even though Gov. John Baldacci has indicated the changes can’t wait for the Legislature.

“This wasn’t just moving the chairs about, ” John Nicholas, Commissioner of the Department of Health and Human Services, told the state Commission on the Future of MaineCare. “This is about major changes and a refocus and better use of the resources we have.”

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 about 300,000 low-income Mainers. The program provides an array of services from nursing home care for seniors to hospital care for injured children.

The MaineCare Commission, established by the Legislature to study the Medicaid program and make recommendations to the January session, was not aware of the administrative overhaul DHHS has planned.

“I was not aware of it until it was mentioned at the Health and Human Services Committee,” Sen. Michael Brennan, D-Portland, co-chairman of the Commission and Senate Majority Leader, said Tuesday. “That’s why we asked Jack [Nicholas] and Mike [Hall] to come before us and explain what is happening.”

Under the plan authored by Deputy DHHS Commissioner Mike Hall, four divisions with unrelated responsibilities would be reorganized into six divisions reporting to the director. Hall said there have been serious problems in the 700-worker organization that need to be fixed.

“There has never been an in-house training capability,” he said. “We hire people and put them in what may be one of the most sophisticated and complicated agencies in state government, and we just give them a computer and a desk and say see you later.”

Hall said his plan would add a training coordinator to assure workers get training before they are on the job and expected to answer questions about the complex Medicaid system by providers and others.

“This is being done within existing resources,” Nicholas said. “Without this, I would have had to come before the Legislature and ask for an additional appropriation. This will save money by being more effective and efficient.”

The new administrative plan creates a communications director and a medical director who report to the office director. Documents obtained under the state public records law indicate the target date for the new organizational structure is January 30, 2006, and that the planning has been under way for months.

“From what has been presented, this looks like a good plan,” Sen. Richard Nass, R-Acton, a member of the Commission and of the Appropriations Committee, said. “I am still concerned they do not have all of the bill paying issues under control, and that’s been a problem since last February.”

Hall has been acting director of the MaineCare office since he took on the task of fixing the computerized bill paying system. He said progress has been made in repairing the system, but he acknowledged the system has not been fully fixed.

Rep. Hannah Pingree, D-North Haven, co-chair of the Legislature’s Health and Human Services Committee, said the changes being discussed are so significant to the operation of MaineCare that the Department should delay its implementation until lawmakers can be fully informed.

“Politically, I think it is a very good idea to involve the Legislature,” Brennan said. “This is something that will have a wide ranging impact on the people of Maine.”

But Gov. John Baldacci said the “transformation” of the agency cannot wait for the Legislature to return to Augusta. He said the administrative reorganization will start next month.

“This is a plan that needs to move forward, “he said. “The Legislature will have the opportunity to review it, comment on it and make any adjustments, but this needs to move forward.”

Nicholas will not be around to oversee the change. He resigned Wednesday afternoon for personal reasons and was replaced by Deputy DHHS Commissioner Brenda Harvey, who will serve as acting commissioner until lawmakers approve a replacement. Baldacci said he hopes to nominate a new commissioner before lawmakers conclude the January session sometime in the spring.