People who receive MaineCare — the state’s version of Medicaid — may soon have to work and pay monthly premiums in order to get benefits.

Maine’s Department of Health and Human Services officially filed an application this week to the federal government to make those changes. Critics say Maine’s plan would erect barriers to health care that will drive up costs for everyone.

If DHHS’s waiver application is approved, people who receive MaineCare would be required to work 20 hours per week, pay monthly premiums and chip in $10 if they go to an emergency department for a nonemergency issue. The goal, according to DHHS, is to preserve its limited financial resources for the neediest and to encourage financial independence and personal responsibility for health.

“Well they sound nice, but what are they doing to achieve that? Charging people who have no money a premium or a copayment for using the emergency department?” Jack Comart with Maine Equal Justice Partners, an advocacy group for low-income Mainers, said.

The waiver Maine is seeking, known as the 1115 waiver, is to test new ideas to improve health care and lower costs. But Comart said Maine’s proposal is for an old idea that doesn’t work.

“There’s 40 years of research on charging premiums and copays to low-income individuals, and it consistently shows that they lose eligibility,” he said.

DHHS announced its intentions earlier this year and held two public hearings in May. The comments they received prompted some changes.

In its final application, DHHS lowered monthly premiums to a maximum of $40 per month versus nearly $70. It expanded the pool of people who would be exempt from work requirements. The Department also removed a penalty to pay for missed appointments.

But the changes are not enough to sway people like Marty Sabol, board president of the Maine Primary Care Association.

“To be eligible for MaineCare, you’re basically living very close to the poverty line anyway. And to put these extra cost burdens on people who really don’t have the money has the effect of canceling their health insurance coverage,” he said.

Sabol sees this as an effort by the LePage administration to further reduce the number of people on MaineCare. David Winslow of the Maine Hospital Association said that may save the state money, but it will shift costs to others.

“The number of people on MaineCare is down by 76,000 people from the last time we checked in the last five years. And during that same period, this has shown a dramatic increase in hospital uncompensated care. It’s grown by about $124 million in the past six years,” he said.

The cost of that uncompensated care, Winslow said, ultimately gets shifted to consumers who have insurance.

Maine is one of about a half-dozen GOP-led states seeking approval to tighten eligibility requirements for Medicaid. Democratic U.S. Rep. Chellie Pingree of Maine’s 1st District called Maine’s waiver request “nonsensical” in a written response, saying it would cause undue harm to the most vulnerable. She said she’ll convey her concerns to the Centers for Medicare and Medicaid Services.

Comart said if Maine’s application is approved, Maine Equal Justice Partners will file suit.

This report appears as part of a media partnership with Maine Public.