After one year, Medicaid expansion is delivering for Mainers

One year ago, newly inaugurated Governor Janet Mills used her first act in office to implement the voter-approved Medicaid expansion law. With the stroke of her pen, tens of thousands of Mainers with low incomes were made eligible for health insurance through MaineCare, the state’s Medicaid program. 

Now, one year later, the benefits of that action are clear. Medicaid expansion is improving Mainers’ health and bringing federal funds into our state.  

Over the course of the past year, more than 56,000 Mainers gained coverage under the law. And today, as of the most recent figures released by the Department of Health and Human Services, more than 43,000 Mainers are currently enrolled in MaineCare as a direct result of the law’s implementation. And initial data reveals that for every dollar Maine spends on coverage, nearly $10 is flowing into the state from the federal government.   

The long road to health care 

Medicaid expansion is a key provision of the 2010 Affordable Care Act, often referred to as Obamacare. The policy expands eligibility for Medicaid to adults without children who earn up to 138 percent of the federal poverty level, or about $23,000 for a family of two. The law also made eligible parents or caregivers of children with earnings between 100 and 138 percent of the federal poverty level, or about $21,000 to $29,000 for a family of three.  

Before the Affordable Care Act, these low-income Mainers were squeezed hard by health care costs. Ineligible for Medicaid but too cash-strapped for private insurance, many of the population often went without. The ACA provided access to affordable coverage for the first time. 

Bipartisan coalitions in the Maine Legislature enacted Medicaid expansion half a dozen times under former Gov. Paul LePage, only to see the laws vetoed at each turn. In 2017, Mainers took to the polls and voted for health care, enacting the law by citizen initiative. Gov. LePage illegally blocked implementation of the law until his last day in office. Gov. Mills implemented the law — and the voters’ will — with her first executive order in office.  

Medicaid expansion is improving Mainers’ health 

The latest figures from the Maine Department of Health and Human services show that more than 43,000 Mainers are currently enrolled in the MaineCare as a result of the expansion law. Over the course of the first 12 months, “more than 56,000” Mainers gained coverage at some point. These figures represent individuals who were ineligible before the law took effect.  

In October, DHHS published an analysis of the expansion’s impact, which revealed the kind of care that had been provided to Mainers as a result of expansion. These included: 

  • mental health treatment for more than 16,000 Mainers; 
  • substance use disorder treatment for more than 6,500 Mainers and opioid use disorder treatment for nearly 4,800 Mainers; 
  • diabetes treatment for nearly 3,000 Mainers. 

Many of the above conditions are especially prevalent among lowincome Mainers, and can be exacerbated, or even caused, by the stress of living in poverty.  

Medicaid expansion brings federal dollars to Maine 

While the state has not released comprehensive information on Medicaid expansion’s fiscal impact in the first year, an estimate for the first three months of state fiscal year 2020 (July through September 2019) shows total expenditures for the Medicaid expansion group were just over $65 million, paid for with just over $6 million in state funds, and just under $59 million in federal funds.  

In other words, Maine received almost $10 in federal funds for every dollar spent on Medicaid expansion in this period. That’s in line with expectations before expansion took place. Those federal dollars will help support jobs in Maine’s health care industry and in the communities that host them. 

Enrollment projected to grow in second year of implementation 

 The tens of thousands of Mainers who now have access to care represent a real success of the expansion program. There are likely thousands more who are eligible but who have not signed up, and greater public outreach will ensure that those numbers grow in the years to come. Based on the experiences of other states, enrollment is not expected to reach its final level until 18 months after implementation. It may take even longer.  

As Maine enters the second year of expanded Medicaid coverage, we should expect enrollment to continue to increase. We should also expect to see signs of additional benefits from expansion, such as improvements to the financial positions of rural hospitals. And most importantly, tens of thousands of Mainers will continue to gain access to affordable health care. 

Mainers interested in applying for coverage should visit to find out if they are eligible.