Medicaid, SCHIP, and Federal Authority³

HIFA Waiver - In 2002, Maine received approval from CMS for a HIFA waiver to expand health insurance coverage to childless adults with incomes at or below 125 percent FPL by redirecting a portion of its disproportionate share hospital allocation to cover this population. Coverage was expanded in 2 phases, covering childless adults to 100 percent FPL in the first phase, and a plannedexpanding to 125 percent FPL enacted as part of the Dirigo Health Reform was never implemented as the DHHS had reached its budget neutrality cap. The expansion was later repealed by the Maine legislature.

Other

Dirigo Health Reform Act - This comprehensive state-wide health system reform, enacted in 2003, addresses costs, quality, and access to health care with the goal of establishing universal coverage within six years. The Act includes a number of cost-containment initiatives, including system-wide health planning, public price disclosure, simplification of administrative functions and reductions in paperwork, and voluntary limits on the growth of health insurance premiums and health care costs.

The Act creates the Maine Quality Forum, which promotes quality of care initiatives and educate providers and consumers about medical practices and other quality of care indicators. The Act created DirigoChoice, which is an affordable health insurance option to small businesses, the self-employed, and eligible individuals without access to employer-sponsored insurance that offers discounts on monthly payments and reductions in deductible and out-of-pocket costs on a sliding scale to enrollees with incomes below 300 percent FPL.

Funding for the DirigoChoice combines a variety of funding streams: employer contributions, individual contributions, a one time appropriation of state general funds, federal Medicaid matching funds for those individuals who are eligible and through the "savings offset payment" which is generated through the recovery of bad debt and charity care and other voluntary savings targets set by the state. Various funding alternatives are under consideration by the Governor and the Legislature beginning in 2007.

Enrollment in DirigoChoice was approximately 13,300 on December 1, 2006; an additional 5,000 parents on MaineCare are also funded from Dirigo

To learn more about the Maine 's Dirigo program, read SCI's Profile in Coverage.

	Notes and Sources

Information presented in the profile was summarized in December 2006 from a review of state Web sites and reports, and through contacts with state officials. In most cases the profiles were reviewed by state officials; however, it is possible that states have implemented strategies that are not reflected in this profile.

³ The profile only includes Medicaid and SCHIP waivers intended to make comprehensive expansions to the uninsured. At this time, the profiles do not include Family Planning, Pharmacy Plus waivers, or long-term care waivers.

⁴ Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau's March 2005 and 2006 Current Population Survey.