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Back to State Legislation on Comprehensive Health Care Coverage
State Legislation on Comprehensive Health Care Coverage: Maine
Background | Coverage | Employer Contribution | Individual Contribution | Benefits Assistance
Background
Maine passed its comprehensive health care law in 2003. “An Act To Provide Affordable Health Insurance to Small Businesses and Individuals and To Control Health Care Costs.” - The Maine Act expanded coverage in two ways.
First, it allowed more state residents to become eligible for the state’s Medicaid program, MaineCare. It also created a new program, Dirigo Health, to cover some of those who still did not qualify for MaineCare, such as the uninsured and employees of small businesses. Joint Select Committee on Health Care Reform. - Under the Maine Act, the program is managed by an independent executive agency, the Dirigo Health Agency. The agency’s mandate is to “arrange for the provision of comprehensive, affordable health care coverage to eligible small employers, including the self-employed, their employees and dependents, and individuals on a voluntary basis.” Me Rev. Stat. Ann. tit. 24-A § 6902.
- The program is funded with additional Medicaid federal matching funds and “savings offsets” that all state insurers are required to pay. 121st Maine Legislature Office of Fiscal and Program Review.
- Dirigo Health also collects payments from participating employers and plan enrollees to cover the following costs:
(a) The Dirigo Health Program for enrolled employees and dependents in contribution amounts determined by the board;
(b) Dirigo Health's quality assurance, disease prevention, disease management and cost-containment programs;
(c) Dirigo Health's administrative services; and
(d) Other health promotion costs. Me Rev. Stat. Ann. tit. 24-A § 6910(4)(B)(2)
Coverage
- Dirigo Health is partnered with a private insurer to create a health coverage plan called DirigoChoice. DirigoChoice
- DirigoChoice offers traditional health coverage with no pre-existing condition restrictions and no deductibles for preventative care or prescription drugs. DirigoChoice
- Limits are set for deductibles and out of pocket costs. Me Rev. Stat. Ann. tit. 24-A § 6908(2)(C)
Employer Contribution
- Employers who have their employees’ health insurance through Dirigo Health have an agency-set "contribution level" which cannot exceed 60% of specified costs. Me Rev. Stat. Ann. tit. 24-A § 6910(4)(B)
Individual Contribution
- Employees contribute to pay certain specified costs and are responsible for deductibles and annual out-of-pocket expenses. Me Rev. Stat. Ann. tit. 24-A § 6910(4)(B) & DirigoChoice
Benefits Assistance
- DirigoChoice participants earning less than 300% of the federal poverty level are eligible for sliding scale subsidies, based on income, to pay for their health care coverage. Me Rev. Stat. Ann. tit. 24-A § 6912 & Discount Estimator worksheet
For more information on Maine see:
Last Updated: 09/23/2011
