PUBLIC NOTICE: State Plan Amendment regarding an Alternative Benefit Plan for an Expanded Adult Population

PUBLIC NOTICE

Maine Department of Health and Human Services

Office of MaineCare Services

State Plan Amendment regarding an Alternative Benefit Plan for an Expanded Adult Population

 

The Maine Department of Health and Human Services provides notice of its intent to submit a State Plan Amendment (SPA) to define the Alternative Benefit Plan (ABP) that will be used to allow for expansion of Medicaid eligibility to individuals aged 19‐64 with incomes at or below 133% of the Federal Poverty Level (FPL) who are not enrolled in or eligible for Medicare, consistent with the expanded eligibility criteria as defined by the Affordable Care Act (referred to here as the “Adult Expansion Group”). This ABP will be applicable to individuals in the Adult Expansion Group who are eligible for MaineCare (Maine’s Medicaid program). The Maine Department of Health and Human Services expects to submit this SPA to the Centers for Medicare and Medicaid Services no later than December 31, 2018.

Once approved, the ABP will provide eligible individuals in the Adult Expansion Group with access to the federally mandated Essential Health Benefits. These Essential Health Benefits include the following services:

• Ambulatory patient services
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health and substance use disorder services, including behavioral health treatment
• Prescription drugs
• Rehabilitative and habilitative services and devices
• Laboratory services
• Preventive and wellness services and chronic disease management
• Pediatric services, including oral and vision care

Early and Periodic Screening, Diagnostic and Treatment (“EPSDT”) services will be provided to those eligible individuals in the Adult Expansion Group who are under age 21 as required by law and regulation, and consistent with current state policy regarding the delivery of these services. Other covered services will include medically necessary services as prior authorized, as well as other services required to be covered pursuant to state or federal law, regulation, or policy.

The “section 1937 coverage option” for the ABP will be “Secretary-Approved Coverage” that is based on, and consistent with, the benefits provided in Maine’s approved state Medicaid plan. The “base benchmark plan” will be the largest plan by enrollment of the three largest small group insurance products in Maine’s small-group market. Consistent with federal law and the Maine Medicaid State Plan (the State Plan), the State Medicaid Director will provide written notice regarding this proposed State Plan Amendment to the appropriate tribal contacts on November 19, 2018. In accordance with the State Plan, additional information regarding the proposed changes will be provided to the tribal contacts upon request, and consultation will occur as requested or as otherwise appropriate.

Any comments regarding the proposed State Plan Amendment covered by this public notice, or requests for a written copy, may be submitted in writing to: Office of MaineCare Services, Division of MaineCare Policy, State House Station #11, 242 Water St., Augusta, ME 04333 or via email at Policy.DHHS@maine.gov. Written comments may be reviewed by the public at 242 State St, Augusta, ME 04330. Comments will be accepted until December