Bill > LD1878

This bill establishes a comprehensive managed care program for MaineCare services in Maine, which will fundamentally change how Medicaid services are delivered in the state. The bill requires the Department of Health and Human Services to contract with three managed care organizations (MCOs) to provide healthcare services through a capitation payment model, where organizations receive a fixed monthly rate per enrollee instead of being paid for each individual service. The program will initially cover specific categories of Medicaid recipients, including those in the TANF program, children's health insurance program, Medicaid expansion enrollees, and individuals dually eligible for Medicaid and Medicare. The department will select MCOs through a detailed request for proposals process that considers factors like accreditation, quality of care, fraud prevention, provider networks, and ability to address social determinants of health. The contracts will be for five years with potential three-year extensions, and will include specific requirements around administrative services, quality measures, grievance procedures, and data reporting. The bill sets a phased implementation timeline, with most enrollees to be transitioned by February 1, 2029, and dually eligible individuals by July 1, 2030. The department must submit a report to the Legislature by December 3, 2025, detailing the implementation plan and submit necessary federal waivers by April 1, 2026. The legislation authorizes the department to adopt major substantive rules to guide the program's implementation.

Health and Social Services

https://legislature.maine.gov/legis/bills/display_ps.asp?LD=1878&snum=132