Dirigo Board of Directors
Membership
Voting members:
(3-year terms; up to 2 consecutive; initial appointments are staggered
with differing terms)
Dr. Robert McAfee, Chair
Retired and Former President
American Medical Association
Dana Connors
President
Maine State Chamber of Commerce
Mary Henderson
Executive Director
Maine Equal Justice
Carl Leinonen
Executive Director
Maine State Employees' Association
Charlene Rydell
Policy Advisor
Congressman Tom Allen
Ex-officio members:
Acting Commissioner Christine Bruenn, Professional & Financial Regulation
Commissioner Rebecca Wyke, Administrative & Financial Services
Director Trish Riley, Governor's Office of Health Policy & Finance
Executive Director: Karynlee Harrington
Key Charges
- Develop and implement business plan for Dirigo health insurance
- Hire Executive Director
- Collect Savings Offset Payments
- Develop benefit and subsidies
- Oversee Quality Forum
Important Dates
Dirigo Health Insurance: Must start no later than October 1,
2004.
Maine Care Expansions: Linked to start of Dirigo Health. Non-categoricals
from 100% to 125% FPL; Parents of Children from 180% to 200% of FPL.
Annual Reports: Beginning September 1, 2004, the board shall
report on the impact of Dirigo Health on the small group and individual
health insurance markets in this State and any reduction in the number
of uninsured individuals in the State. The board shall also report on
membership in Dirigo Health, the administrative expenses of Dirigo Health,
the extent of coverage, the effect on premiums, the number of covered
lives, the number of Dirigo Health Insurance policies issued or renewed
and Dirigo Health Insurance premiums earned and claims incurred by health
insurance carriers offering Dirigo Health Insurance.
Quarterly Reports: Board shall collect and report on the following:
- Total enrollment with detailed information on the previous coverage
of enrollees and employment;
- Number of employers, both small employers and large employers, who
have ceased offering health insurance or contributing to the cost
of health insurance;
- Number of employers, both small employers and large employers, who
have begun to offer health insurance or contribute to the cost of
health insurance premiums for their employees;
- Number of new participating employers in Dirigo Health Insurance;
- Number of employers ceasing to offer coverage through Dirigo Health
Insurance;
- Duration of employers participating in Dirigo Health Insurance;
and
- Comparison of actual enrollees in Dirigo Health Insurance to the
projected enrollees.
Savings Offset Payments: Beginning March 1, 2005, health insurance
carriers and health care providers shall report annually information
regarding the experience of a prior 12-month period on the efforts undertaken
by the carrier and provider to recover savings offset payments, as reflected
in reimbursement rates, through a reduction or stabilization in bad
debt and charity care costs as a result of the operation of Dirigo Health
and any increased enrollment due to an expansion in MaineCare eligibility
occurring after June 30, 2004.
Legislative Language
Dirigo Health Plan
Dirigo Health shall:
A. Establish administrative and accounting procedures as recommended
by the State Controller for the operation of Dirigo Health in accordance
with Title 5;
B. Collect the savings offset payments provided in section 6913;
C. Determine the comprehensive services and benefits to be included
in Dirigo Health Insurance and develop the specifications for Dirigo
Health Insurance in accordance with the provisions in section 6910.
Within 30 days of its determination of the benefit package to be offered
through Dirigo Health Insurance, the board shall report on the benefit
package, including the estimated premium and applicable coinsurance,
deductibles, co-payments and out-of-pocket maximums, to the joint standing
committee of the Legislature having jurisdiction over appropriations
and financial affairs, the joint standing committee of the Legislature
having jurisdiction over insurance and financial services matters and
the joint standing committee of the Legislature having jurisdiction
over health and human services matters;
D. Develop and implement a program to publicize the existence of Dirigo
Health and Dirigo Health Insurance and the eligibility requirements
and the enrollment procedures for Dirigo Health Insurance and to maintain
public awareness of Dirigo Health and Dirigo Health Insurance;
E. Arrange the provision of Dirigo Health Insurance benefit coverage
to eligible individuals and eligible employees through contracts with
one or more qualified bidders;
F. Develop a high-risk pool for plan enrollees in Dirigo Health Insurance
in accordance with the provisions of section 6971; and
G. Establish and operate the Maine Quality Forum in accordance with
the provisions of section 6951.
Eligibility/Benefits/Subsidies/Premiums
- Dirigo Health provides access to coverage for:
o Employees of small businesses (an "eligible business"
means a business with at least 2, but not more than 50 employees and
includes municipalities with between 2 and 50 employees).
o Self-employed individuals (includes sole proprietorships).
o Individuals without access to job-based coverage (from an eligible
business).
- There is a 60% ceiling on a small employer's contribution toward
coverage for a full-time employee.
- Dirigo Health provides sliding scale subsidies for individuals with
household incomes between 200% - 300% of the Federal Poverty Level.
o 200% of FPL is $30,528/year for a family of 3 and 300% of FPL is
$45,780/year for a family of 3.
- Start up funding for the program is provided with "one-time"
federal relief funds that were provided to each state last year.
- Future state funding for the program is provided by a 4% health
insurance premium tax. The cost of this tax is intended to be offset
by a 50% reduction in bad debt and charity care in Maine hospitals.
