Maine Health Exchange Profile
Establishing the Exchange
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. 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). 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. Soon thereafter, the Advisory Committee released final recommendations and suggested legislation which mirrored the Governor’s memorandum.
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.
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). 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.
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. 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. However, the Governor indicated in April 2012 the state would not spend the grant money.
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.
For more information on Maine’s exchange planning efforts, visit: http://www.dirigohealth.maine.gov/Pages/exchange_planning.html