Resolve, to Study a Medicaid Forward Plan for Maine

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132nd MAINE LEGISLATURE
FIRST REGULAR SESSION-2025
Legislative Document No. 1070
S.P. 455 In Senate, March 18, 2025
Resolve, to Study a Medicaid Forward Plan for Maine
Received by the Secretary of the Senate on March 14, 2025. Referred to the Committee on
Health and Human Services pursuant to Joint Rule 308.2 and ordered printed.
DAREK M. GRANT
Secretary of the Senate
Presented by Senator TIPPING of Penobscot.
Cosponsored by Representative ARFORD of Brunswick and
Senators: CARNEY of Cumberland, RENY of Lincoln, TALBOT ROSS of Cumberland,
TEPLER of Sagadahoc, Representative: FAIRCLOTH of Bangor.

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1Sec. 1. Office of Affordable Health Care to study state-administered health
2coverage. Resolved: That the Office of Affordable Health Care, in consultation with
3 stakeholders chosen by the office, shall study the impact of implementing a so-called
4 Medicaid Forward plan by amending the MaineCare state plan to provide medical
5 assistance to residents who are under 65 years of age, who have a household income
6 exceeding 138% of the federal poverty level and who are not otherwise eligible for and
7 enrolled in health care coverage. The office shall consider the following in its study:
8 1. The effects on the individual, group and self-insured health insurance markets,
9 including the Maine Health Insurance Marketplace and the health benefits programs
10 provided to state and local public employees and to public school employees, of providing
11 mandatory or optional Medicaid coverage to individuals who would otherwise be eligible
12 for health insurance through these markets;
13 2. The effects on health care providers and health care facilities, including
14 reimbursement rates needed to maximize access to health care services;
15 3. The operational needs for administering an amended state plan, including staffing
16 and technical needs for enrollment and collection of premiums or cost sharing;
17 4. The funding plan, including necessary expenditures and total revenue generated;
18 5. The ability of the plan to require premiums or cost-sharing measures under federal
19 law;
20 6. The fiscal impacts on recurring and nonrecurring spending in the state budget; and
21 7. The financial sustainability of the plan, including steps necessary for the Department
22 of Health and Human Services to apply for federal waivers to maximize federal funding
23 and leverage those waivers to ensure affordability for enrollees in the plan.
24Sec. 2. Medicaid Forward plan. Resolved: That the Office of Affordable Health
25 Care shall propose a plan to implement the Medicaid Forward plan. The office shall include
26 the following in its plan:
27 1. A financing plan, which must include recommended appropriations of state funds,
28 projected federal funds, savings directly or indirectly attributable to the implementation of
29 the program design, a sliding scale for premiums and cost sharing based on household
30 income for individuals eligible to enroll in the Medicaid Forward plan and other potential
31 cost offsets;
32 2. Information about recommended reimbursement rates to maximize access to health
33 care services under the Medicaid Forward plan;
34 3. Details about the office's operational needs for administering the Medicaid Forward
35 plan;
36 4. A timeline for implementing the Medicaid Forward plan in phases by expanding
37 successively to:
38 A. Residents with household incomes below 200% of the federal poverty level;
39 B. Residents with household incomes below 300% of the federal poverty level;
40 C. Residents with household incomes below 400% of the federal poverty level; and
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1 D. Residents with household incomes at or above 400% of the federal poverty level;
2 and
3 5. Information about federal waivers needed to maximize federal funding and ensure
4 affordability and choice for enrollees.
5Sec. 3. Report. Resolved: That, by January 1, 2026, the Office of Affordable
6 Health Care shall submit to the Joint Standing Committee on Health Coverage, Insurance
7 and Financial Services a report detailing the office's study of and program design for the
8 Medicaid Forward plan.
9SUMMARY
10 This resolve requires the Office of Affordable Health Care to study the impact of
11 implementing a Medicaid Forward plan and amending the MaineCare state plan to provide
12 medical assistance to residents who are under 65 years of age, who have a household
13 income exceeding 138% of the federal poverty level and who are not otherwise eligible for
14 and enrolled in health care coverage. The office is required to propose a plan to implement
15 a Medicaid Forward plan. The resolve requires the office to submit a report to the Joint
16 Standing Committee on Health Coverage, Insurance and Financial Services by January 1,
17 2026 detailing the office's study of and program design for the Medicaid Forward plan.
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