Maine

HIFA Waiver – In 2002, Maine received approval from the Centers for Medicare and Medicaid Services (CMS) for a Health Insurance Flexibility and Accountability (HIFA) waiver to expand health insurance coverage to childless adults with incomes at or below 125 percent of the federal poverty level (FPL). To fund the coverage initiative, Maine redirects a portion of its disproportionate share hospital allocation to cover this population. Coverage was to be expanded in 2 phases, with the first covering childless adults with incomes at or below 100 percent of the FPL and the second covering childless adults up to 125 percent of the FPL as part of the Dirigo Health Reform initiative. The second phase was never implemented as the program had reached its budget neutrality cap. The expansion was later repealed by the Maine legislature, and CMS removed the state’s authority to cover childless adults with incomes between 101 and 125 percent of the FPL. This waiver was renewed for an additional three years in 2007.

The Deficit Reduction Act of 2005 (DRA) - In January 2008, Maine received approval from CMS to implement a DRA cost-sharing state plan amendment, allowing the state to charge premiums for the Katie Beckett population. (The Katie Beckett population are children who can qualify for Medicaid even though their family has an income above the allowable limit. This eligibility is based on the fact that their medical condition would make them eligible for hospital or skilled nursing facility care.) Premiums, ranging from .005 to 2.5 percent of gross income, will be imposed on families with incomes exceeding 150 percent of the FPL. The state will determine monthly premiums with a sliding fee schedule based on income.