Cutler Institute for Health and Social Policy

Population Health and Health Policy

Examining MaineCare’s Coverage Options Under the Affordable Care Act


This Brief was prepared by Erika Ziller and Trish Riley of the Muskie School of Public Service to inform an April 8, 2013 colloquium convened to explore options and implications of the Affordable Care Act (ACA) for Maine.

Highlights: In addition to increased Medicaid funding, in January 2014, the ACA will provide federally subsidized health care coverage for individuals with incomes up to 400% for Medicaid in a state, coverage will be subsidized by federally funded tax credits through health insurance exchanges, now known as the “Marketplace.” Those under 100% FPL are not eligible for Marketplace subsidies but could be eligible for Medicaid, depending upon state decisions.

Even if Maine does not choose to cover all those newly eligible under the ACA, beginning in 2014, MaineCare must extend eligibility for children aging out of foster care until they are 26, regardless of income. An estimated 46,000 uninsured individuals, nearly all of whom will be adults without children, would be newly eligible for Medicaid should Maine decide to participate in the ACA optional Medicaid coverage.

If Maine chooses not to participate in the ACA optional Medicaid program, the 14,000 uninsured childless adults with incomes between 100% and 138% FPL referenced above would be eligible to participate in subsidized coverage through the federal Marketplace, although there is disagreement over the affordability of these plans for this group. The 32,000 uninsured childless adults with incomes below 100% FPL would be ineligible for any subsidy through the Marketplace.

Continued coverage for currently eligible populations in Maine is uncertain. Maine must comply with a significant number of ACA provisions related MaineCare. These new requirements must be in place in all states, whether or not states extend eligibility in the Medicaid program or operate a health insurance Marketplace.

Publication Type: 
Research and Policy Brief
Publish Date: 
March 20, 2013

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Dr. Ziller to speak on Rural Implementation and Impact of Medicaid Expansions

The impact of the ACA Medicaid expansion on health care coverage and access in rural areas is largely unknown and will depend on the different state policy contexts in which the expansions are implemented and on existing system capacity. Understanding how many rural residents are likely to become newly eligible for Medicaid under the ACA, as well as their characteristics and health status, will provide important information to aid policymakers in structuring outreach and enrollment strategies and ensuring that the healthcare infrastructure and delivery systems in rural areas can address the needs of these individuals.

On March 18th, Dr. Ziller, Deputy Director of the Maine Rural Health Research Center at the University of Southern Maine, will present via a SHARE webinar, nationally representative information identifying rural-urban differences among low-income non-elderly adults (18 to 65) in the following areas:

  • Medicaid eligibility, pre-ACA
  • Medicaid participation, pre-ACA
  • New Medicaid eligibility in 2014

Dr. Ziller will also analyze the characteristics associated with any rural-urban differences in the above areas. Characteristics to be considered include age, gender, employment, education, income, Census region, health status, current relationship to primary care provider, primary care supply, and FQHC availability.

This webinar is based on Dr. Ziller's research under a State Health Access Reform Evaluation (SHARE) grant to inform federal and state implementation of the ACA Medicaid expansion by estimating the size and characteristics of the rural population likely to be newly eligible.
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