ME – Section 1115 Medicaid Waiver Application Calls for Work Requirements, Premiums, Asset Testing

August 2017 ~

Maine has submitted an 1115 Medicaid waiver application requesting core changes to its Medicaid program, MaineCare, asking federal regulators to approve work requirements, mandatory premiums, and asset testing.

According to the waiver application submitted to CMS by the Maine Department of Health and Human Services (DHHS), the work requirements would apply to able-bodied, low-income adult Medicaid beneficiaries. If approved, MaineCare beneficiaries would be required to work 20 hours per week, pay monthly premiums and be responsible for a co-pay of $10.00 for visits to an emergency department for a nonemergency issue.

If Maine waiver is approved, Maine would be the first state to impose premiums to traditional Medicaid adults: adults who make up to 100% of federal poverty level (FPL), former foster care youth, adults receiving transitional medical assistance, and people with breast/cervical cancer or HIV up to 250% of FPL.

The over-all goal, according to the application, is to “preserve limited financial resources” and encourage individual responsibility for healthcare costs. It also says the plan will “promote financial independence and transitions to employer-sponsored or other commercial health insurance.”

More than 30 states have section 1115 waivers. Six of which – Arizona, Arkansas, Indiana, Iowa, Michigan, and Montana – have received approval for Medicaid premiums to adults when they expanded Medicaid eligibility to 133% of the FPL. However, CMS has yet to approve work requirements for any state.


Source(s): Maine Department of Health and Human Services; HMA Roundup; Think ProgressHealthcareDIVE; Kaiser Family Foundation; Bangor Daily News;