MaineCare at a Crossroads:
The Impact of Maine’s 2019 Coverage Expansion and Implications of Upcoming Medicaid Work Requirements
DOI:
https://doi.org/10.53558/ghjp0f64Keywords:
work requirements, Medicare, MaineCare, medically frail, low-income adultsAbstract
For decades, shifts in the policy environment have resulted in fluctuating access to health coverage for Maine’s low-income childless adult population. Using national survey data, this study conducts two cross-state comparison analyses to examine the impacts of these policy changes, with a focus on the state’s 2019 Medicaid coverage expansion and upcoming Medicaid work requirements. We find that the 2019 coverage expansion led to significant increases in rates of coverage and annual checkups among this population. While Medicaid work requirements will be implemented nationally in January 2027, our findings suggest that the effects of this policy may be felt differentially in Maine due to the state’s older and more rural demographic profile, increased barriers to employment, and higher rates of chronic and acute conditions. These findings may serve useful to policymakers as they continue to debate the future of the Medicaid program and coverage for Maine’s low-income childless adult population.
Downloads
References
Anderson, Nathaniel, and Tina Gressani. 2010. MaineCare for Childless Adults Waiver Year 7 Annual Report, October 1, 2008 – September 30, 2009. University of Southern Maine, Cutler Institute of Health & Social Policy, Muskie School of Public Service. Retrieved from https://www.mecep.org/wp-content/uploads/2017/08/Noncat-Year7_final.pdf.
Becker, Zoe A., and Jordan H. Rhodes. 2025. “Recent Changes in Access to Care among Adults in Rural Maine.” Maine Policy Review 34(2): 44–58. https://doi.org/10.53558/fnzr2154
CMS (Centers for Medicare & Medicaid Services). 2010. MaineCare for Childless Adults Section 1115 Demonstration: Special Terms and Conditions. https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/me/Childless-Adults/me-childless-adults-stc-10012010-12312013.pdf
CMS (Centers for Medicare & Medicaid Services). 2026. “Medicaid Program: Community Engagement Requirement for Certain Individuals.” Federal Register 91, no. 106. (June 3, 2026): 33348. https://www.federalregister.gov/d/C1-2026-11094/page-39028.
Croll, Zach, and Erica Ziller. 2019. “Health Status and Access to Care among Maine’s Low-Income Childless Adults: Implications for State Medicaid Expansion.” Maine Policy Review 28(1): 38–48. https://doi.org/10.53558/DRMB1600.
Dubay, Lisa, Fredric E. Blavin, Laura Barrie Smith, and Julianna Carlyn Long. 2024. “Racial and Ethnic Disparities in Preventive Service Use Among Adults Before and During the COVID-19 Pandemic.” INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 61:1-11. https://doi.org/10.1177/00469580241275319.
Farwell, Jackie. 2011. “Without MaineCare, Childless Adults Say They Won’t Survive.” Bangor Daily News, December 16. https://www.bangordailynews.com/2011/12/16/news/childless-adults-tell-of-dire-circumstances-loss-of-mainecare-would-cause/
Freiden, Joyce. 202). “Court Case Challenging Medicaid Work Rule's 'Frailty' Requirement Gets Moved Up.” MedPage Today, August 7. https://www.medpagetoday.com/publichealthpolicy/medicaid/122523
Lukanen, Emily, and Elizabeth Zylla. 2025. “The Disability Gap in Medicaid: Implications for the Federal Work Requirement Proposal.” State Health & Value Strategies, June 20: https://shvs.org/the-disability-gap-in-medicaid-implications-for-the-federal-work-requirement-proposal/
Lyu, Wei, and George L. Wehby. 2022. “Effects of Virginia’s 2019 Medicaid Expansion on Health Insurance Coverage, Access to Care, and Health Status.” Inquiry: The Journal of Health Care Organization, Provision, and Financing 59:1–11. https://doi.org/10.1177/00469580221092856
Magasi, Susan, ChristinaPapadimitriou, Judy Panko Reis, Kimberly The, Jennifer Thomas, Laura VanPuymbrouck, and Tom Wilson. 2019. “Our Peers—Empowerment and Navigational Support (OP-ENS): Development of a Peer Health Navigator Intervention to Support Medicaid Beneficiaries with Physical Disabilities.” Rehabilitation Process and Outcome. https://doi.org/10.1177/1179572719844759.
Maine DHHS (Department of Health and Human Services). 2026. MaineCare Participation. By The Numbers - Office for Family Independence (OFI). https://www.maine.gov/dhhs/by-the-numbers/office-family-independence
Maine Public. 2014. “MaineCare Cuts Leave Mentally Ill Adrift and at Risk.” Maine Public, July 18. https://www.mainepublic.org/maine/2014-07-18/mainecare-cuts-leave-mentally-ill-adrift-and-at-risk
Maine State Legislature and Grant T. Pennoyer. 2010. Fiscal News, December 2010. Office of Fiscal and Program Review. https://digitalmaine.com/ofpr_docs/49/.
Maine State Legislature and Grant T. Pennoyer. 2012. Fiscal News, December 2012. Office of Fiscal and Program Review. https://digitalmaine.com/ofpr_docs/25/.
Maine State Legislature and Grant T. Pennoyer. 2013. Fiscal News, October 2013. Office of Fiscal and Program Review. https://digitalmaine.com/ofpr_docs/11/.
Murphy, Edward D. 2022. “Maine to Expand Dental Coverage for Nearly 220,000 Adults.” Portland Press Herald, June 29. https://www.pressherald.com/2022/06/29/maine-to-expand-dental-coverage-for-200000-adults/.
Ollstein, Alice Miranda, and Robert King. 2026. “How Sick Is Sick Enough? New Medicaid Work Rule Worries Patient Advocates, States.” Politico, June 7. https://www.politico.com/news/2026/06/07/how-sick-is-sick-enough-new-medicaid-work-rule-worries-patient-advocates-states-00952476.
Rhodes, Jordan H. 2024. “Medicaid Expansion in Maine Significantly Reduced Uncompensated Care Costs during the COVID-19 Pandemic.” Maine Policy Review, 33(1): 29-37. https://doi.org/10.53558/JHQA1678,
Rhodes, Jordan, and Hilary Schneider. 2025. “The Impact on Health Insurance Affordability for Maine Households if Enhanced Tax Credits Expire.” Maine Policy Review 34(1): 89–94. https://doi.org/10.53558/golq6204.
Shao, Yixue, and Charles Stoecker. 2022. “The Effect of Louisiana Medicaid Expansion on Affordability of Health Care.” Public Health Reports 137(5): 912–920. https://doi.org/10.1177/00333549211041410
Siegal, Nicole, Sumedha Gupta, Jennifer Miles, Hillary Samples, Kosali Simon, Matthew C. Aalsma, and Stephen Crystal. 2026. “Medicaid Expansion and Buprenorphine Dispensing in Early vs Recent Expansion States.” JAMA Network Open 9(2): e2559803. https://doi.org/10.1001/jamanetworkopen.2025.59803
Simon, Kosali, Aparna Soni, and John Cawley. 2017. The Impact of Health Insurance on Preventive Care and Health Behaviors: Evidence from the First Two Years of the ACA Medicaid Expansions. Journal of Policy Analysis and Management 36(2): 390–417. https://doi.org/10.1002/pam.21972.
Sommers, Benjamin D., Anna L. Goldman, Robert J. Blendon, John Orav, and Arnold M. Epstein. 2019. “Medicaid Work Requirements— Results from the First Year in Arkansas.” The New England Journal of Medicine 381(11): 1073–1082. https://doi.org/10.1056/NEJMsr1901772.
Star, Jessica, Xuesong Han, Laura A. Makaroff, Adair K. Minihan, Ahmedin Jemal, and Priti Bandi. 2023. “The First Year of the COVID-19 Pandemic: Changes in Preventive Services in Community Health Centers.” American Journal of Preventive Medicine 64(2): 184–193. https://doi.org/10.1016/j.amepre.2022.08.023.
Downloads
Additional Files
Published
Issue
Section
License
Copyright (c) 2026 Zoe Becker, Jordan Rhodes (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
