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Back to State Legislation on Comprehensive Health Care Coverage

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 (external link).” 
• 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 (external link) (PDF).
• 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 (external link).
• 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 (external link).
• Dirigo Health also collects payments from participating employers and plan enrollees to cover the following costs:
  1. The Dirigo Health Program for enrolled employees and dependents in contribution amounts determined by the board;
  2. Dirigo Health's quality assurance, disease prevention, disease management and cost-containment programs;
  3. Dirigo Health's administrative services; and
  4. Other health promotion costs. Me Rev. Stat. Ann. tit. 24-A § 6910(4)(B)(2) (external link)

Coverage

• Dirigo Health is partnered with a private insurer to create a health coverage plan called DirigoChoice.  DirigoChoice (external link)
• DirigoChoice offers traditional health coverage with no pre-existing condition restrictions and no deductibles for preventative care or prescription drugs. DirigoChoice (external link)
• Limits are set for deductibles and out of pocket costs.  Me Rev. Stat. Ann. tit. 24-A § 6908(2)(C) (external link)

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) (external link)

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) (external link) & DirigoChoice (external link)

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 (external link) & Discount Estimator worksheet (external link) (PDF)

For more information on Maine see:

• Guide to Law Online: Maine

Last Updated: 08/02/2012