Photo / Courtesy of Maine DHHS
Jeanne Lambrew
July 26, 2023
How Maine businesses can prepare for the largest health coverage transition since the ACA
By Jeanne Lambrew, Maine Department of Health and Human Services
Now that the pandemic is over, changes are coming to MaineCare, Maine’s Medicaid program, and we want to help employers prepare.
For the past few years, the federal government directed Maine and other states to temporarily suspend Medicaid eligibility reviews to keep people covered during the pandemic, even if their circumstances changed during that period. Enrollment in MaineCare swelled to over 400,000.
Congress has now directed all states to resume reviewing the eligibility of Medicaid members to determine if they are still eligible. MaineCare is conducting these reviews over the next year.
Tens of thousands of Maine people covered by MaineCare are no longer eligible and will be seeking other health coverage. This represents the largest transition in health coverage since the implementation of the Affordable Care Act.
Some of your employees (or their family members) who currently have MaineCare may remain in the program if they take action to renew it. Others may turn to you for coverage. National estimates suggest that 90% of people found to be no longer eligible for Medicaid have or will be able to receive other coverage through employer-based insurance or CoverME.gov, Maine’s health insurance marketplace.
That’s why it is so important that employers know about this change and take action to educate their employees about how they can keep their MaineCare coverage or transition to other affordable coverage options.
Here are some steps you can take to help your employees and their families stay covered:
Make sure employees know the Department of Health and Human Services will contact them about their MaineCare coverage. Employees should make sure their contact information (such as address, phone number, and email address) is up to date by visiting MyMaineConnection.gov or calling 1-855-797-4357. They should check their mail for a renewal form in an envelope with a blue block, or an e-notice if they signed up for electronic communication. If they get a renewal form, they should complete and submit it right away.
Tell employees about any health care options your company offers. Losing MaineCare is a “Qualifying Life Event,” which means your employees can enroll in a health plan outside of Open Enrollment. Human resources staff should share information about available health coverage options, including premium amounts and plan benefits.
Extend the special enrollment period for your health care plan. Your company may also consider extending the sign-up opportunity for people losing MaineCare to support successful transitions. Many employees may not know that they have a 60-day special enrollment period for employer health plans required by law. Employers should consider extending the special enrollment period for people losing MaineCare through July 2024, when MaineCare will finish processing all redeterminations.
Encourage employees to explore health coverage options on CoverME.gov, Maine’s health insurance marketplace. If your company doesn’t offer health coverage, people losing MaineCare are eligible for a Special Enrollment Period to apply for affordable coverage at CoverME.gov between now and July 2024. All plans on CoverME.gov cover doctor visits, prescription drugs, emergency care, and more. Many people can find a plan for $10 or less per month, with financial help. Maine people can apply at for coverage at CoverME.gov or by calling 1-866-636-0355.
Having the security of health insurance is vital to employees’ health, wellbeing, and productivity. By ensuring your employees are prepared to navigate this transition with the information they need, you can support them and their families in staying covered.
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