The Kennebec Journal

July 14

Dirigo nets $17M from U.S.

State public health plan a vehicle for federal reform

By Rebekah Metzler rmetzler@mainetoday.com
MaineToday Media State House Writer

AUGUSTA -- Maine's DirigoHealth program will begin accepting new enrollees Aug. 1 as a result of federal funding made available by the new health care law passed earlier this year.

DirigoHealth Executive Director Karynlee Harrington told board members Monday the $17 million provided by the Obama administration would help insure an estimated 900 new individuals with pre-existing conditions.

"This is a good extension of what we do today, it's our target population, people that have been uninsured and they are sick and they need coverage," she said during an interview on Monday. "We are basically going to leverage the existing infrastructure and program we have in place."

The intent of the federal funding is to provide coverage to individuals with pre-existing conditions who may have been denied coverage or who could not afford their insurance premiums due to their existing illnesses.

Covering people with pre-existing conditions who couldn't get health insurance was billed as one of the key reforms of the new health care law.

Maine law currently prevents such discrimination but, in other states, people have been denied coverage. And not all Mainers with pre-existing conditions could afford their premiums even though they were eligible for coverage, which is where the additional federal money will help.

Harrington said there are currently 7,200 people enrolled in what's called DirigoChoice, and an additional 6,500 people who are parents of children in MaineCare and are receiving subsdized health coverage.

"We'll use DirigoChoice and what the federal funds allow us to do is pay for the additional costs associated with individuals who have been uninsured and have serious medical conditions," Harrington said. "So (the money) allows us to do two things: one, cover more people than we would otherwise be able to cover and two, help stabilize the premiums for these folks."

Harrington said she's sure there will be interest in the expansion, but whether or not people will meet the various requirements is unknown.

"We worked with the federal government on our definition (of pre-existing conditions) and the diagnosis are pretty consistent with what you would generally find in terms of conditions for a high-risk pool," she said. "We're still in the process of screening (enrollees). The eligibility criteria is challenging, in that people have to be without credible coverage for six months prior to coming to enroll."

Mia Poliquin Pross, director of policy operations for Consumers for Affordable Health Care, said new federal money for Dirigo is one example of how the new health-care law would improve coverage and access to coverage for Mainers.

"It is the first of many good steps to come," she said.

Pross said other positive reforms in the new health care reform law include the creation of health care exchanges in 2014 -- marketplaces for individuals and small businesses to shop for coverage together across state lines. Officials expect the combination of increased bargaining power and added competition to lower premiums.

Rebekah Metzler -- 620-7016

rmetzler@mainetoday.com