In November 2017, Maine voters approved a referendum to implement expansion of MaineCare under the Affordable Care Act (ACA) to adults with incomes up to 138 percent of the federal poverty level (FPL). As Maine’s legislature begins implementation planning, the Maine Health Access Foundation (MeHAF) asked Manatt to update and refine an analysis prepared by Manatt for MeHAF in April 2015 that examined the estimated budget impacts of a MaineCare expansion. This update is intended to contribute objective and nonpartisan information to policymakers and other stakeholders on the budget impacts of expansion. It reflects more recent data, the experiences of other states, and the applicable federal matching rates for the years under review. In this memorandum, we describe the data and assumptions used by Manatt to produce estimates of MaineCare expansion costs and savings for state fiscal years (SFYs) 2019 through 2021, which are summarized below (Exhibit 1).

Other than estimating hospital tax revenues that could result from expansion, the analysis does not address the potential economic impacts—via jobs, income, and tax revenues—of new and largely federal spending in Maine; nor does it address impacts on healthcare providers (e.g., reductions in uncompensated care costs for the uninsured). In addition, the analysis does not reflect the potential impact of provisions proposed in a Section 1115 waiver for the State’s current MaineCare program (e.g., premium and cost-sharing requirements for certain enrollees), which could affect both enrollment and costs if they were applied to the expansion population.