AUGUSTA — A bill that would help low-income Mainers cut through the red tape that can block access to MaineCare health insurance benefits won support at a legislative hearing Wednesday.

Insurance agents, lawmakers and health care organizations urged the Legislature’s Health and Human Services Committee to endorse a measure to reinstate a $300,000 federally funded ombudsman service.

The bill is a response to a state Department of Health and Human Services’ decision last year not to contract out the ombudsman service and instead handle consumer inquiries through its own MaineCare eligibility hotline. The decision has drawn strong opposition.

The former ombudsman contractor, Consumers for Affordable Health Care, a advocacy group that also helps Mainers find insurance coverage through the Affordable Care Act, is suing the LePage administration for not continuing the service.

The advocacy group handled 7,000 consumer requests for help in 2014 before its contract was terminated at the end of the fiscal year in June 2015, said Executive Director Emily Brostek. That’s a four-fold jump from 2006, when it fielded 1,600 inquiries. The jump in inquiries coincides with the implementation of the Affordable Care Act.

On Wednesday, Brostek’s group joined other health care organizations and several Republican legislators in supporting the bill, which compels DHHS to use the federal grant to help Mainers navigate the state bureaucracy and settle eligibility disputes.



DHHS has argued that federal law doesn’t require the state to contract with an outside vendor for ombudsman services, and that it can fulfill its outreach and education obligations in-house.

Advocates of the bill disagree. During the public hearing, lawmakers and health organizations told stories of individuals unable to reach DHHS because of long wait times on the agency’s hotline and conflicting written responses about eligibility. The result, proponents of the bill said, was delayed access to coverage, accumulating medical bills and frustration.

Rep. Karen Vachon, a Scarborough Republican and insurance agent, said that she had seen firsthand how badly consumers need an advocate to help them navigate “the complex relationship between private and public health care coverage” and “how to defend themselves when an injustice has occurred.”

“I can tell you that navigating these systems is a nightmare for many people,” she said. “Consumers, and even professionals like myself, need to be able to rely on an ombudsman for help, whose role is clear and whose advocacy is delivered impartially.”

The proposal, L.D. 1498, has more than a dozen Republican co-sponsors, many representing rural districts where constituents face either long drives or long hold times on the DHHS hotline. In written testimony, Sen. Paul Davis, R-Sangerville, said many of his constituents don’t have Internet access and cannot use DHHS’ Maine Connection portal.


“This means that people who are eligible for MaineCare – kids, parents, people with disabilities, the elderly – are having trouble applying to DHHS and getting the coverage they need to take care of their health,” Davis wrote.


Holdups in processing MaineCare has another effect, advocates of the bill argued. Doug Strout, an insurance agent in Scarborough, said in written testimony that Mainers sometimes have difficulty getting coverage through the Affordable Care Act.

“One problem I come across is the inability for some of my customers to qualify for (ACA) marketplace coverage until they have first been turned down for coverage through (MaineCare),” Strout wrote. He said it’s not uncommon to have children denied coverage through the ACA until they can provide a letter from DHHS showing they’ve been denied MaineCare coverage.

The DHHS is required to process MaineCare applications within 45 days. Brostek, at Consumers for Affordable Health Care, said some of her customers have had to wait 19 months.

William Logan, an attorney representing DHHS, told the committee that the department hasn’t spent federal funds allocated for the ombudsman. Logan, while testifying against the bill, reiterated the department’s position that the ombudsman isn’t required under federal law.


Logan also argued that the bill would exempt the ombudsman from Maine’s records retention law, requiring neither reports about its services nor oversight by the Health and Human Services Committee.

Brostek said her agency continues to provide guidance for MaineCare recipients and is using other funding sources to do so. Two open positions at the organization went unfilled when DHHS ended the ombudsman contract.

Lawmakers will hold a work session on the bill before taking a vote on sending it to the full Legislature for consideration.

Steve Mistler can be contacted at 620-7016 or at:

[email protected]

Twitter: stevemistler

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