How MaineCare is helping more Mainers afford health care and strengthening the economy

At a glance:

MaineCare helps nearly 476,000 Mainers pay for health care, including doctor visits, medicine, and long-term care. It helps children, older adults, people with disabilities, and working families get the care they need. MaineCare is also a financial lifeline for hospitals, nursing facilities, pharmacies, and health providers.
More people use MaineCare today because Maine expanded coverage for adults with low income, children, pregnant people, and some immigrants. Enrollment grew from about 330,000 people in 2018 to 476,000 in 2026.
Although MaineCare costs more as more people enroll, much of the added cost comes from caring for older adults and people with disabilities.
Most Mainers support keeping or expanding MaineCare because it keeps people healthy, lowers medical debt, strengthens hospitals, and helps Maine’s economy.

MaineCare — Maine’s Medicaid program — helps hundreds of thousands of Mainers afford things like doctor’s visits, prescription drugs, and long-term care every year. Legislators and Governor Mills have recognized everyone deserves access to affordable health care, and expanding access to MaineCare has helped meet that promise for more Mainers. With health care costs rising everywhere, it’s more important than ever to preserve this safety net that keeps costs down and boosts the state’s economy as well as providing care.

Today, roughly 476,000 Mainers rely on MaineCare for some part of their health coverage. They are children, older adults, people with disabilities, working parents, pregnant Mainers, and low-income workers whose jobs often do not provide affordable insurance. In many rural communities, MaineCare is also a financial lifeline for hospitals, nursing facilities, pharmacies, and health providers.

Much of the recent debate around MaineCare has focused narrowly on the size of the program’s budget, overlooking that MaineCare is one of the most effective tools to improve health, reduce medical debt, support working families, and bring billions of federal dollars into Maine’s economy.

Why MaineCare enrollment has increased

MaineCare’s expansion since 2018 is partly due to deliberate policy choices to ensure more people have access to affordable care, and partly because demographic changes would have increased program use even without changes to eligibility criteria.

In December 2018, there were 222,000 Mainers receiving full benefits, plus another 107,000 in limited-benefit programs such as those that provide prescription drug discounts for older Mainers.
By March 2026, those numbers had increased to 326,000 people receiving full benefits and another 151,000 receiving partial benefits.
Total enrollment across both groups increased from 330,000 at the end of 2018 to 476,000 in March 2026. (Current numbers are down slightly since enrollment peaked in the aftermath of the COVID pandemic at 495,000 in September 2024.)
State costs in the program have grown from $800 million in the 2017-18 state fiscal year to an estimated $1.5 billion in the 2025-26 state fiscal year.

MaineCare enrollment timeline since 2019

Since 2019, most of the growth has been due to the expansion of MaineCare eligibility under the Affordable Care Act (ACA) for adults under age 64 earning up to 138% of the federal poverty level (FPL). As of March, just under 84,000 Mainers were enrolled under this category.
In July 2022, Maine began providing coverage to children and young adults under age 21 and pregnant people who aren’t eligible for federal coverage due to their immigration status. This includes some individuals who are undocumented, but also some lawful permanent residents who can’t receive federally funded Medicaid until they’ve held their green cards for at least five years. Enrollment in this program was just over 1,400 in March.
Also in July 2022, like most states, Maine adopted a new federal option to cover unborn children and their mothers, regardless of immigration status. As of March 2026, 156 parents and 19 newborns were enrolled through this pathway.
Since October 2023, copays have been eliminated for children, and eligibility has been increased to just over three times the FPL. In 2024, Maine and many other states adopted a “continuous coverage” provision for children that allowed them to remain in the program for up to 12 months even if their family’s income level had increased enough to disqualify them. Expanding the eligibility limit for children has increased enrollment by approximately 8,000 people each month, while the 3,000 children are enrolled in continuous coverage.
In October 2024, eligibility was expanded in two prescription drug assistance programs paid for through Medicaid — Drugs for Maine’s Elderly and Disabled and the Medicare Savings Program — and the number of enrollees has increased from 107,000 in December 2018 to 129,000 in March 2026.
The remaining enrollment is largely through increases in existing eligibility categories. For example, parents with incomes below the poverty level (approximately 17,000) or older adults (5,000). By contrast, the number of people qualifying because of a disability declined over this period by 17,000. While current data isn’t available on the number of Mainers living below the poverty level or with a disability, it’s likely these enrollment changes are due to changing circumstances among those populations.

Various factors have contributed to increased MaineCare enrollment. While the expansion of MaineCare coverage for adults without children and immigrants spurs a lot of criticism of the program, expanded coverage for particularly vulnerable populations, especially children, pregnant Mainers, and older Mainers, has accounted for nearly half the additional caseload during the Mills administration.

What’s driving the cost

While the number of people using MaineCare has increased substantially due to expanded eligibility, the additional cost in the program comes disproportionately from older Mainers and Mainers with disabilities. These individuals typically have more acute medical needs and cost more to cover — and that cost has increased as Maine’s population has continued to age.

Between January 2019 and October 2024 (the last month for which detailed cost information is available), opening MaineCare to 84,000 non-disabled adults under the Affordable Care Act’s Medicaid expansion cost the state an additional $75 million a year, while simply maintaining the existing eligibility criteria for older Mainers resulted in an extra 5,000 people enrolling and additional costs of more than $60 million per year. Continuing the existing eligibility rules for Mainers with disabilities resulted in $111 million in additional annual state costs, even as the number of people enrolled declined by 10,000.

The costs for expanding MaineCare to immigrants who meet the income requirement is even smaller. The 1,400 children in the state-funded immigrant program cost the state approximately $8.5 million per year — around 0.6% of all anticipated state spending on MaineCare in this fiscal year.

In addition to increased usage among acute care populations, MaineCare’s costs also reflect the increasing expense of medical care in general. Like other Medicaid programs, while MaineCare attempts to limit costs by negotiating with hospitals and other providers, it is not immune from inflationary pressures.

Between January 2019 and October 2024, the monthly per person cost of MaineCare coverage increased by 10% for parents with incomes below the poverty level under age 65 and 12% for children. For adults in the expansion group, costs increased just 3%. By contrast, costs for all medical care in the private sector during this period increased by 16%.

MaineCare is good value for money and helps the economy

Data shows MaineCare remains good value for money. The cost of covering an adult below the age of 65 averaged around $8,000 per year in 2024 for comprehensive coverage without copays or deductibles. By contrast, the average plan in Maine’s private individual market cost $9,000 in premiums alone. And if people go uninsured altogether, the cost of treatment falls on Maine’s hospitals, some of which are already struggling.

In addition to keeping costs down by negotiating prices with hospitals and other providers, Medicaid helps Maine’s economy by bringing federal dollars into the state:

For most enrollees, the federal government pays approximately two thirds the cost of care.
For the 134,000 children in the program, the federal government pays around three quarters of the cost.
For the 85,000 adults in the expansion group, the federal government pays $9 for every $1 the state incurs.

This results in the MaineCare program pulling down almost $3.5 billion in federal funds every year.

Mainers want to see more MaineCare coverage, not less

While some politicians are calling for cuts to MaineCare, public opinion is clearly in favor of maintaining or even expanding the program further. In a recent poll, half of surveyed Maine voters wanted to expand the program while only 17% supported cutting it.

There are several proposals which could expand MaineCare coverage as voters want:

Making all Maine children eligible for the program regardless of income, as proposed by Senator Ann Carney in a bill that passed the legislature but wasn’t funded.
Increasing the eligibility level for adults to a higher ratio of the FPL. The District of Columbia, for example, provides Medicaid to adults earning 215% percent of the FPL (just under $3,000 a month for an individual or just over $34,000 per year).
Creating a public option that allows Mainers to buy into the Medicaid program, leveraging federal matching funds to reduce premiums and deductibles for Mainers.
Making home care more available for older Mainers and Mainers with disabilities and investing more care worker wages to ensure there’s enough availability to meet demand for services. The state has implemented limited cost-of-living increases for workers in this sector but declined to ensure they were paid at least 140% of the state’s minimum wage this year.

Legislators and the next governor can also work to undo the harmful cuts Republicans in Washington, including President Trump, have made to MaineCare. As many as 31,000 Mainers could lose their MaineCare coverage next year because they are either unable to find steady work or can’t provide the right paperwork to prove their employment status. To further make Medicaid work for Mainers, the State could fund navigators to help people understand the new changes and keep their coverage, as Maine did with the Unemployment Insurance program. The State could choose to cover these individuals without federal funding or invest in educational or employment opportunities that help people qualify for and maintain their health coverage.

MaineCare is a proven way to keep people healthy, contain costs, and boost Maine’s economy — and Mainers support it. Lawmakers should be building on the program’s success in future years.