Obamacare in Maine

Obamacare-enrollment is a site where you can find detailed information on the Affordable Care Act


Health Insurance Marketplace in Maine

If you live in Maine, you’ll use this website, HealthCare.gov, to apply for coverage, compare plans, and enroll. Spanish language speakers can contact cuidadodesalud.gov. Specific plans and prices will be available on October 1, 2013, when Marketplace open enrollment begins. Coverage can start as soon as January 1, 2014.

The Insurance Exchange/Marketplace

What has been done, not been done, or left up to the federal government to do.

Establishing the Exchange in Maine

On November 16, 2012, Governor Paul LePage (R) wrote in a letter to federal officials that Maine would not be pursuing efforts to implement a state-based health insurance exchange.1 Legislation establishing a state-run health insurance exchange failed to pass in 2011 and 2012.

Prior to ending planning efforts, the Governor created an exchange Advisory Committee in July 2011, which included representatives from small businesses, the insurance and hospital industries, and providers, to provide recommendations and suggest exchange legislation to the Governor and the Joint Standing Committee on Insurance and Financial Services (LD 1582).2 A few months later, the Governor’s Office released a memorandum in September 2011, expressing preference for an exchange to be established within the Department of Professional and Financial Regulation, under the authority of the Director of the Department.3 Soon thereafter, the Advisory Committee released final recommendations and suggested legislation which mirrored the Governor’s memorandum.4

Contracting with Plans: On March 18, 2013, Superintendent of Insurance Eric Cioppa sent a letter to the Center for Consumer Information and Insurance Oversight (CCIIO) announcing Maine’s intent to perform plan management functions, despite not having entered into a state-federal partnership exchange. The Bureau of Insurance will license carriers, review rates, and verify carrier compliance with Exchange eligibility requirements, state law mandates, and essential health benefits. The Bureau also intends to resolve consumer complaints, provide technical assistance to carriers, and carry out market conduct and solvency analyses. Superintendent Cioppa attested that Maine has the legal authority and functional capacity to execute plan management activities, as required by the Affordable Care Act.5

Navigator Program: Despite the decision not to pursue a state-based exchange, on April 13, 2012, the Governor signed legislation creating a Navigator program for an exchange operating in the state (LD 1497).6 The program would allow brokers to act as Navigators in the exchange and would require others who want to serve as Navigators to register or obtain a limited license- with the criteria for certification to be determined by the superintendent of insurance.

Essential Health Benefits (EHB): The Affordable Care Act requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. States must decide whether to benchmark their EHB plan to one of ten plans operating in the state or default to the largest small-group plan in the state. Since Maine has not put forward a recommendation, the state’s benchmark EHB plan will default to the largest small-group plan in the state, Anthem (Blue Cross Blue Shield of Maine)- Blue Choice PPO.

Consumer Operated and Oriented Plan Program

Consumer Operated and Oriented Plan (CO-OP) Program are qualified nonprofit health insurance issuers that offer competitive health plans in the individual and small group markets.  CO-OP in Maine:

Maine Community Health Options

Exchange Funding

In September 2010, the Governor’s Office of Health Policy and Finance received the federal Exchange Planning grant of $1 million. In addition, Maine is a member of the consortium of New England states that received a federal Early Innovator Grant of $36 million to develop, share, and leverage insurance exchange technology. The multi-state consortium also includes Connecticut, Rhode Island, Vermont, and Massachusetts with the University of Massachusetts Medical School as the grant holder.7 In November 2011, the Dirigo Health Authority was awarded a $5.8 million federal Level One Establishment grant to design and begin to build business operations and information technology systems for the Exchange and Medicaid.8 However, the Governor indicated in April 2012 the state would not spend the grant money.9

Expansion of Medicaid

From 2014 to 2017, the federal government will pay for 100% of the difference between a state’s current Medicaid eligibility level and the ACA minimum. Federal contributions to the expansion will drop to 95% in 2017 and remain at 90% after 2020, according to the ACA.

As the ACA was originally written, states would lose all Medicaid funding if they refused to expand their program to the ACA minimum.

However, the Supreme Court in June 2012 ruled that the federal government could not withhold Medicaid funding for states that chose not to expand their programs. The decision effectively allowed state officials to opt out of the expansion, and some have said they will do just that.

Maine is not participating in Medicaid expansion.

Next Steps

On March 29, 2013, Maine received approval from CCIIO to perform plan management activities. The federal government will retain control over all other Exchange functions.10

For more information on Maine’s exchange planning efforts, visit: http://www.dirigohealth.maine.gov/Pages/exchange_planning.html

1. Governor LePage. Maine Issues Letter to Federal Health Officials Opting Out of Health Insurance Exchanges. November 16, 2012. http://content.govdelivery.com/bulletins/gd/MEGOV-5cfe96#.UKZvoA8Yogk
2. LD 1582. Resolve, Creating the Advisory Committee on Maine’s Health Insurance Exchange. Signed July 6, 2011. http://www.mainelegislature.org/legis/bills/display_ps.asp?LD=1582&snum=125
3. State of Maine Department of Professional and Financial Regulation. Memorandum. September 13, 2011.http://www.dirigohealth.maine.gov/Documents/Health%20Exchange%20recommendation.pdf
4. Recommendations Regarding the Maine Health Benefit Exchange. Report to the Governor and the Joint Standing Committee on Insurance and Financial Services. September 20, 2011.
5. Letter from Superintendent Cioppa to Gary Cohen. March 18, 2013.
6. H.P. 1098 – L.D. 1497. 2012 Session. An Act Relating to Navigators under Health Benefit Exchanges. http://www.mainelegislature.org/legis/bills/getPDF.asp?paper=HP1098&item=7&snum=125ME
7. Massachusetts Application for the Cooperative Agreement to Support Innovative Exchange Information Technology Systems. New England States Collaborative Insurance Exchange Systems. December 22, 2010.
8. Maine Level One Establishment grant Project Narrative. September 29, 2011.http://www.dirigohealth.maine.gov/Documents/ME_L1_Project_Narrative_09292011_FINAL.pdf 
9. Letter from Governor LePage to Katherine Bryant (CCIIO). April 18, 2012. PoliticoPro.
10. Letter from Gary Cohen to Superintendent Cioppa. March 29, 2013.

Also of interest

Provided by the Henry J. Kaiser Family Foundation

Who can help you (the Navigators)

Get local help

Western Maine Community Action

Western Maine Community Action, Inc. is a private non-profit community agency and is the lead for a state-wide consortium of eight community action agencies, collectively referred to as the WMCA Community Action Navigator Consortium. Funds will be used to create a statewide network of education, outreach and enrollment assistance available and accessible to every uninsured and under-insured individual in Maine.

Fishing Partnership Health Plan

Fishing Partnership Health Plan (FPHP) is a health plan developed that provides subsidized coverage to uninsured commercial fisherman, many of whom operate as small business owners or employees. FPHP, in collaboration with the Maine Lobstermen’s Association, will undertake a series of community health navigation activities, including: outreach; social marketing; distribution of material describing the program, the Affordable Care Act, and the health insurance enrollment process.

Information for:

Individuals and Families

Small businesses

If you need more detailed analysis, identification of issues, solutions, and implementation of your health insurance plan please let us know at obamacare-enrollment.com and we’ll get right back to you.


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