MaineCare: As expansion debate rages, already ‘eligible’ remain in limbo

Much of the focus on the new Affordable Care Act enrollment numbers released Monday has centered around private insurance. In Maine, that’s the 13,704 residents who have chosen a health plan through either Anthem or nonprofit insurer Maine Community Health Options.
But another 3,236 Mainers who signed onto since October have learned they’re possibly eligible for Medicaid, known as MaineCare here. Maine’s not expanding the health insurance program for the poor under the ACA, so these are residents who theoretically qualify for the program now, but for whatever reason haven’t already signed up. has categorized them as eligible for either Medicaid or CHIP, the Medicaid program for children.

In fact, many of those more than 3,000 Mainers likely are children, judging from a new analysis by the Kaiser Family Foundation. The report found that in states like Maine not expanding Medicaid, children account for the majority of uninsured people who are eligible for the program. Of the 11,000 uninsured Mainers who could sign up for MaineCare, 7,000, or nearly 63 percent, are children, the analysis found.

These aren’t children who would qualify if Maine were to expand Medicaid, they’re kids who lack health insurance and already qualify for MaineCare but aren’t enrolled. Why is another question. Perhaps their parents aren’t aware that their kids are eligible, or they have other reasons for not enrolling them. thinks this group of Mainers is eligible for MaineCare. The federal government sends their information — names, addresses, income levels, etc. — to the state, which would make the final determination and actually sign them up for MaineCare.

But according to Maine Department of Health and Human Services spokesman John Martins, the state isn’t getting that information and can’t sign people up.

“We are still receiving files that are woefully inadequate in terms of making an eligibility determination,” he wrote in an email.

Maine DHHS hasn’t received complete information for any enrollee, he said. With the exception of basic information such as names, birth dates, Social Security numbers, and addresses, the state has received few details about income levels or household makeup, Martins said. More than half of the individuals funneled through aren’t even eligible for MaineCare, he said, based on their reported income, or they won’t qualify in 2014 because the program is dropping coverage for childless adults.

“We have also had data sent to us for consumers from other states, which clearly we should not have received,” he wrote.

Maine isn’t the only state encountering this problem. Medicaid officials in other states say the files they’re receiving “are riddled with errors and incomplete information,” according to the Washington Post.

I ran Martins’ comments by the Centers for Medicare and Medicaid Services, but haven’t received comment from them.

Monday’s enrollment report from U.S. HHS touches on the troubles in a footnote. “Quality assurance continues on Medicaid assessments and determinations in advance of transfers to states and these figures might alter further based on that review,” it reads.

The feds are sending the enrollment information to the states in something called a “flat file,” which lists people believes are eligible for Medicaid. As the Washington Post explains, the flat file was intended to give states a heads up on enrollment volumes, not to serve as a formal enrollment document.

“Applicants are notified that we are waiting for their application information to be sent to us from the feds in order to determine if they are eligible for MaineCare,” Martins wrote. “We have written to people whose names and flat files we have received, explained that the letter they’ve received from the feds could be confusing and have pointed them to our web site as a way for them to potentially apply for Medicaid.”

The feds will also call potential MaineCare enrollees and direct them to the web site,, where people can be pre-screened for Medicaid, Martins said.

Other health care advocates I’ve spoken to also encourage potential MaineCare enrollees to contact the state directly, rather than through




Jackie Farwell

About Jackie Farwell

I'm the health editor for the Bangor Daily News, a Bangor native, a UMaine grad, and a weekend crossword warrior. I never get sick of writing about Maine people, geeking out over health care data, and finding new ways to help you stay well. I live in Gorham with my husband Nick and our hound dog Riley.