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Coffee CAHC policy round-up: January 17, 2018

Coffee CAHC is a twice-weekly newsletter where we round up and comment on the latest health coverage policy developments both nationally and here in Maine. We hope you find these updates helpful!

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Coffee CAHC

115th Congress, 2nd session

128th Maine Legislature, 2nd regular session


Wednesday, January 17th, 2018

It’s snowy! It’s warm! It’s snowy! It’s warm! It’s snowy AND it’s warm!


National level

2017 Steve spent a ton of time in this section of Coffee CAHC writing about all the gyrations in the ACA debate. I really, really, really hope that 2018 Steve doesn’t do the same thing, but focused on CHIP/health center funding.

…but that being said…

Has Congress funded CHIP yet? No. What about health centers? That’s a big fat “nope”, too.

Everything is caught up in the question of a long-term funding package. Right now, Congress is keeping the government open through a series of short-term “continuing resolutions”, which extend all federal funding for a matter of weeks. They keep doing this to try and buy themselves time to come up with a more comprehensive, long-term deal.

The deal remains elusive because the deliberations on a long-term package present an opportunity for Democrats to exercise significant leverage and advance their own policy priorities: any big measure will require 60 Senate votes, meaning Democratic support is vital. Their key priorities right now? CHIP and health center funding, and an extension for the program called Deferred Action for Childhood Arrivals, or DACA – the nearly 700,000 immigrants known as “dreamers”.

At the moment, what House Republicans have put on the table is another short-term extender for the overall spending package that includes a 6-year reauthorization for CHIP. It doesn’t include anything for health centers, it kicks some ACA taxes out to 2019, and it doesn’t do a thing for the dreamers. Democrats are likely to oppose it. Something has to pass by midnight this Friday, or else the federal government shuts down.

And the wheels on the bus go ‘round and ‘round…


State level

There was a hearing yesterday on a bill that we are particularly interested in: LD 1712, “An Act Regarding Health Care Ombudsman Services”, sponsored by Representative Karen Vachon.

Right now, the state Department of Health and Human Services is required to provide “ombudsman” services in the Medicaid program, which they are supposed to contract out to a neutral third party. They certainly aren’t contracting those services out, and we suspect that they aren’t really providing them in-house, either, as they have claimed in the past.

Basically, what an ombudsman program does in this context is provide some consumer-facing oversight and advocacy. A Medicaid (or MaineCare) ombudsman, for instance, would help folks through the process of applying for MaineCare; make sure that DHHS eligibility determinations are correct; help consumers overcome incorrect denials or terminations; etc etc.

If that sounds familiar to some of you who know the work that we do on our HelpLine at CAHC, well, that’s because it’s exactly what we do on our HelpLine. And in fact, we used to provide services to Maine DHHS on a contract to serve as the ombudsman. That contract was sort of abruptly terminated a few years ago, for reasons that we’re still not entirely clear on.

The bill in question would add what we feel is a really important duty to the ombudsman services: when somebody qualifies for a Marketplace special enrollment period (SEP), the ombudsman would help them apply.

That matters because of something called “churn”. While it’s easy and convenient to think about our coverage system as separate and distinct islands – that’s MaineCare island, this is the Marketplace archipelago, that promised land in the distance is called Medicare – the reality is that the lines between them blur all the time. And every time folks are forced to switch coverage because of changes in what they’re eligible for, some get lost at sea. Making sure that the ombudsman is ready to help folks transition between MaineCare and other coverage will go a long way toward ensuring that as few people as possible fall between the cracks.


Would you like to know more?

Oooo, exciting wonk day today: the new federal poverty guidelines are out! These are the foundation for how eligibility is calculated across any number of crucial programs, including Medicaid and the Marketplace.


Until next time, friends, I remain,


Comments are closed.

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