The elimination of Medicaid reimbursements for methadone is part of Gov. Paul LePage’s $6.3 billion biennium budget. Maine Department of Health and Human Services Commissioner Mary Mayhew told the Lincoln County Republican Committee on Feb. 18 that this is one of a series of DHHS reforms the governor is proposing in his budget.

According to Mayhew, opiate addicts receiving treatment would still receive a Medicaid reimbursement from the state. But the reimbursement will no longer cover methadone.  LePage wants opiate addicts treated in a doctor’s office using the drug suboxone.

Mayhew said the proposal is more focused on recovery than lifelong treatment.

“We are promoting a more integrated approach to improve a patient’s recovery, instead of a lifelong dependence on medication in therapy,” Mayhew said.

The governor is also proposing a change in how DHHS disperses money for smoking prevention programs. The proposal calls for putting money directly into primary care instead of through the Healthy Maine Partnership.

Maine has funded HMP anti-smoking programs since 1998. Maine, along with 46 states, received monies from the U.S.’s four largest tobacco companies. The settlement resulted in each state establishing a fund to recover costs for tobacco-related Medicaid care.

According to Mayhew, Maine has spent $200 million on anti-smoking programs since 1998. But the anti-smoking campaign hasn’t achieved the expected results.

“It’s time for a change. We need to do something different,” she said. “That money is now going to be invested directly into primary care.”

The department wants to shift $10 million to provide Medicaid patients greater access to their primary care physicians. The department believe the greater access to primary care will result in more opportunities for physicians to counsel against smoking.

The incident rate of Medicaid patients who smoke is 46 percent, which is about twice the general population’s rate.

The proposed budget also includes $46 million to support people with intellectual development disabilities and $24 million for nursing homes. Mayhew said the proposed DHHS budget prioritizes support for the disabled, those with intellectual development disabilities, and the elderly.

“The money for these programs is available because Gov. LePage has made difficult decisions to right-size the department,” Mayhew said. “When he took office in 2011, DHHS was hemorrhaging money. The department consistently had shortfalls between $50 and $100 million. We’re not standing in a sea of red ink anymore.”

Mayhew also praised LePage for vetoing President Barack Obama’s Medicaid expansion proposal five times. She said the expansion would’ve added 100,000 people to the Medicaid rolls costing $800 million over 10 years.

“We simply couldn’t afford to take on this kind of program,” Mayhew said. “New Hampshire expanded Medicaid, and they are now cutting reimbursements to nursing homes by $7 million. New Hampshire is now in a financial mess caused by Medicaid expansion.”

The LePage administration is also proposing a major change in the general assistance program. The state reimburses all but three municipalities for 50 percent of its general assistance costs. The state reimburses Bangor, Lewiston and Portland at a higher rate.These cities receive a 90 percent reimbursement after reaching a certain spending level.

The governor wants to reel in excess spending by changing the funding formula. The new proposal calls for reimbursing 90 percent of all general assistance payments for up to 40 percent of municipal payments over a six year average.

Mayhew described the current general assistance program as “unmanageable and inefficient.” In 2005, general assistance reimbursements totaled $7 million. In 2014, it was $18 million, according to Mayhew. And Portland accounts for 63 percent of all reimbursements.

According to Mayhew, the city has doubled its general assistance spending in the past five years. In 2009, Portland spent $5 million for general assistance. In 2014, the city spent $10 million.

“This proposal creates more equity and stability into the program. It’s incredibly important to bring integrity into the program and get away from the perverse incentive of spending more to get a better match,” Mayhew said.

Mayhew was one of two guest speakers on Feb. 18 at the Lincoln County Republican Committee’s meeting. LePage spoke first about his proposed budget and energy costs. The meeting was held at the Charles C. Lilly American Legion Hall in Waldoboro.