More than 200,000 Mainers will now be eligible for dental care under the Medicaid program. Patients can get an emergency supply of insulin that will be capped at $35 per month. Direct care workers will be paid a higher wage for the in-home services they provide to disabled people and the elderly.

But flavored tobacco products will still be legal. And bills that attempted to control the cost of prescription drugs were vetoed by Gov. Janet Mills..

These are some of the key outcomes of action on health care issues in the current session of the Maine Legislature.

One long hoped-for priority for health care advocates – the expansion of Medicaid benefits to include dental coverage for adults – was signed into law.

But despite having Democratic majorities in the House and Senate, Mills used her veto pen on two measures championed by progressives, bills that aimed to control the cost of prescription drugs.

“I am frustrated that even though we have a Democratic legislature and governor, that we are not addressing the root cause of many problems, and that is how expensive health care is,” said Mitchell Stein, a Maine-based independent health policy analyst. “They did accomplish some things. Importantly, the adult Medicaid dental benefit is huge and will actually help improve many people’s lives.”

Another measure, a potential ban on flavored tobacco products, failed when it didn’t receive funding.

DENTAL BENEFIT FOR MEDICAID

Maine was one of only 14 states that didn’t extend Medicaid coverage for dental services to adults. Children who have Medicaid also have dental coverage, but dental insurance for adults is a voluntary benefit under the Medicaid program, which is a federal program funded with a blend of federal and state dollars, but operated by the states.

The expansion will open up access to more than 200,000 Mainers, but based on usage in other states, about 70,000 Maine people will use the new benefit.

The law will cost the state $4 million per year, with the federal government chipping in an additional $12 million annually. In 2012, a study concluded that Maine spent $17 million on emergency room visits for dental care. Emergency room spending for dental services should decline sharply after the new benefit goes into effect on July 1, 2022, following a three-year effort by health care services advocates.

“It’s kind of overwhelming to think how this is going to change so many people’s lives for the better,” said Kathy Kilrain del Rio, director of campaigns and health care advocacy for Maine Equal Justice, a progressive policy group. “People will have access to things normally associated with dental care, cleanings and cavities, and if necessary root canals and other restorative work.”

Del Rio said untreated dental infections can cause worse medical problems for patients. The long runway to implementation – one year – will give the Mills administration time to set up a reimbursement system and work out other logistical issues before people with Medicaid can begin signing up for benefits.

PRESCRIPTION MEDICATION

Democratic lawmakers, including Senate President Troy Jackson – pushed for a suite of bills that attempted to rein in the cost of prescription drugs.

But Mills vetoed two of the more ambitious bills: one by Jackson that outlawed price gouging and another that tried to rein in prices by requiring drug manufacturers to justify price increases.

In her veto message, Mills said she shared the concern with lawmakers about the cost of prescription drugs, but didn’t believe the two bills were constitutional.

The bills “would not survive constitutional scrutiny, would invite costly and protracted litigation and even if unexpectedly upheld in court, would not have the intended effect of significantly lowering the price of medications for Maine citizens,” Mills wrote.

Mills did sign other prescription drug bills into law, including a measure by Sen. Cathy Breen, D-Falmouth, that mandates that those without insurance or who can demonstrate that they have trouble paying for insulin be able to purchase an emergency 30-day supply for $35.

FLAVORED TOBACCO PRODUCTS

A proposed ban on flavored tobacco products that would have cost an estimated $32 million was not funded during a meeting last week of the Joint Standing Committee on Appropriations and Financial Affairs, drawing a rebuke from Rebecca Boulos, executive director of the Maine Public Health Association.

Boulos said lawmakers “played politics with people’s lives.”

“At a time when millions of dollars were added to the rainy day fund, there was no investment in tobacco prevention and control. None. Not one additional dollar to prevent youth tobacco use,” Boulos wrote in a June 30 news release.

While public health advocates decried the failure of the flavored tobacco ban, those supporting services for adults with intellectual and developmental disabilities cheered a bill that improved reimbursement rates.

For the first time, reimbursement rates for direct care workers – such as those who work in group homes or provide home-based health care services – are slated to be higher than the minimum wage and remain higher, even if the minimum wage is increased in future years. The law, which goes into effect in January, states that the reimbursement rate must be at least 125 percent of the minimum wage for services.

Ray Nagel, executive director of the Independence Association in Brunswick, which operates 10 group homes that serve 38 people, said the rate increases “will help tremendously” although there are many reasons for the workforce shortage, so nonprofits that operate group homes will likely still struggle to attract workers.

“People can still get jobs that pay much more elsewhere, but this still really helps with our staffing,” Nagel said. “We will take our victory.”

Another bill that passed extended Medicaid coverage for pregnant women for 12 months after birth. Currently, services are cut off 60 days after the child is born, but postpartum coverage will increase to six months starting in January, nine months starting July 1 and move to 12 months starting in 2023.

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