DHHS Commissioner Speaks About Welfare Reform at Portland Chamber Event

Portland, Maine - Maine Department of Health and Human Services Commissioner shared the Administration's vision of a Department that is accountable, effective and focuses on moving people to improved health, employment and self-sufficiency on Wednesday at the Portland Chamber's Eggs and Issues forum at the Holiday Inn by the Bay in Portland.

Mayhew spoke primarily about the challenges within the MaineCare program, but also touched on the welfare reforms under way in Temporary Assistance for Needy Families (TANF) to aggressively assist those who receive benefits to get back to work.

"Welfare programs shouldn't be the goal or finish line for those who need assistance,'' Mayhew said. "Prior to this Administration, the TANF benefit could go on for years and years on end, leading to generational poverty and had a limited focus on the value of employment. Today, we have put in place time limits, which incentivize individuals to move toward long-term employment. To work towards this goal, each and every recipient of TANF will receive a job-readiness assessment and be put on a pathway that fits their individual situation."

Regarding MaineCare, the State's Medicaid program, Mayhew spoke of a program that grew more than $1.2 billion over a decade and provides taxpayer-funded health insurance for one of every four Maine people. She said the program has consistently faced annually shortfalls for the last decade. MaineCare has been built on a crumbling financial foundation which has included time-limited federal funds. As a result, she said, other State priorities have suffered.

"The Medicaid budget is eating the rest of State government alive,'' she said. "Medicaid now accounts for 25 percent of all General Fund spending. Other important priorities, like roads, bridges and education, public safety and natural resources are compromised by this growth."

The Commissioner spoke of efforts to manage the high-cost utilizers in MaineCare, as 5 percent of the individuals account for 54 percent of the program's cost and 20 percent account for 84 percent of cost. Those in the top 5 percent are the elderly, disabled, the intellectual and developmentally disabled and those with persistent and mental illness, she said.

All of the Department's efforts within MaineCare are designed to move the system that pays for quality as defined by measurable outcomes, rather than services. Mayhew called the current payment system one with "perverse incentives, where the longer someone is sick, the more money the provider makes."

She spoke of several projects under way to manage and reduce these costs, which focus on decreasing Emergency Department utilization, case management of high cost utilizers, the investment in primary care, the reduction of hospital re-admissions and the elimination of duplicated services.

The Commissioner said one of the most important ways to make Medicaid sustainable is to focus on priority populations. She shared that one of the Governor's passions is caring for the frail elderly and the disabled in our state. MaineCare has been realigned to serve those priority populations.

Mayhew closed her remarks by sharing why Medicaid expansion is a bad deal for Maine and one that would lead to tens of thousands of non-disabled adults being included in the program. She said the reality of sequestration, the federal shutdown and the debt ceiling makes it difficult to believe that federal funding will be available down the road. "While many advocates of expansion say federal money is ‘free,' we know it is borrowed and will have to be paid back by the Maine taxpayers. Given all we have witnessed with the federal government, it is short-sighted to think there is a guarantee that federal funds will be there in the long-term,'' she said. Even if the federal funds were available, she added, the state will incur millions of dollars in cost to hire new staff and pay for thousands of new members. And as soon as 2018, costs will be over $100 million.

"Maine can't afford this type of cost,'' she said. "It will break an already fragile system."

While these costs are concerning, Mayhew said she is more alarmed by the 3,100 individuals who are elderly and disabled who are languishing on wait lists for services in the community. These services will keep them in their respective homes and out of more costly services.

"This Administration, in good conscience, cannot expand Medicaid to able-bodied adults while these individuals go without services," she said. "These are the individuals our program is designed to serve and we are committed to building a sustainable program they can rely on."

The event drew more than 500 people. Mayhew's speech will be broadcast on Time Warner Cable on-demand in the Greater Portland area, beginning this week.