Of all the numbers that have tumbled out of Gov. Paul LePage’s proposal to fill a $220 million budget shortfall with cuts to MaineCare, the state’s Medicaid program, one of the most striking is also one of the smallest.

Five percent. That’s the percentage of MaineCare recipients who are responsible for 55 percent of the program’s costs.

The governor’s plan could cut some benefits for all recipients and cut all coverage for thousands of others to make the budget balance, but Maine  still could be left with a small population of very sick people who need more and more costly care.

This part of the MaineCare equation deserves some special attention from the Legislature. If the goal of the budget adjustment is to reduce the cost of the program, then the place to start should be managing services for the most expensive 5 percent.

Many superlatives are being thrown around about the number of Maine people enrolled in Medicaid and the average cost to treat them. The portrayal of Maine as an outlier has been overblown, however, and many states have faced large increases in their Medicaid budgets.

What some of these states have done more aggressively than Maine is use case management, in which providers are paid by the patient instead of by the service, to control costs. Such a program was under way at the time of LePage’s inauguration last year, but the effort was set back by personnel shake-ups in the Department of Health and Human Services when the new administration arrived.

There is no cost-reduction miracle, but intensive case management of the most expensive of the program’s clients could cut costs in a way that does not leave 65,000 currently insured Mainers with no coverage. It is certainly a better place to start than wholesale service denials, as proposed by the governor.

Key legislative Republicans said Tuesday that they were not going to support one of the governor’s most extreme proposals — ending state support for seniors and others in assisted-living facilities.

As the governor’s other proposals receive scrutiny, lawmakers should look closely at the cost drivers in the state’s health care system and find better ways to save money than eliminating coverage for people who need it.

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