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Rep. Laurel Libby, R-Auburn, represents District 90 in the Maine House of Representatives and is the executive director of Lead Maine.
Last month, Maine health care providers learned the state would be cutting some MaineCare payments by as much as 30% because of a $62 million shortfall. For many Mainers, it sounds like just another budget issue coming out of Augusta. But it’s much more serious. I believe it is a warning sign that a program meant for the most vulnerable is no longer being managed responsibly.
None of this should have come as a surprise. Over the past several years, warning after warning has surfaced about failures inside Maine’s Department of Health and Human Services (DHHS), particularly within the MaineCare program. Yet state leaders continued expanding it. Now the consequences are becoming impossible to hide.
One came earlier this year when federal auditors revealed that Maine’s autism services program had operated for 16 years without DHHS conducting a single post-payment review to verify whether providers actually delivered the services for which they billed taxpayers. In a sample review of 100 enrollee-months from 2023, auditors found problems in every single one. Estimated improper payments for that one year totaled $45.6 million, forcing Maine taxpayers to repay nearly $29 million to the federal government.
I believe these failures were entirely preventable. Maine DHHS had the authority, funding, and tools to perform basic oversight but simply didn’t use them. Meanwhile, families with children on the autism spectrum were navigating waitlists, searching for services, and trusting the system to work as promised. Millions were paid out with little to no verification that care was actually being delivered.
The same pattern appears elsewhere in the system. Portland-based Gateway Community Services was audited three times between 2018 and 2023 and found to have overbilled MaineCare by more than $1.7 million, much of it tied to interpreter services. Despite repeated findings, the problems continued for years before federal pressure apparently finally pushed DHHS to suspend payments in late 2025 over what were described as “credible allegations of fraud.”
A former federal investigator warned state officials back in 2020 about suspicious billing patterns concentrated among only a few providers, yet meaningful action took five years, when federal agents raided a related Lewiston provider early last year.
During those five years, millions of taxpayer dollars may have been diverted away from the people MaineCare was created to help. At the same time, providers serving vulnerable patients are now being told there is not enough money available to fully reimburse them for care. This is unacceptable.
Even Maine’s Democratic State Auditor Matt Dunlap sounded the alarm this spring, identifying 19 material weaknesses and 62 deficiencies in federal compliance controls, mostly within DHHS. One glaring issue: the department failed to complete a single required nursing facility cost review during fiscal year 2025, despite more than $382 million being paid to nursing facilities through MaineCare.
According to the audit, the same problem has existed year after year since at least 2018.
Mainers deserve honesty. The answer cannot simply be to demand more taxpayer dollars while refusing to address the failures that created the problems in the first place. Maine needs real accountability measures, including regular post-payment reviews, stronger verification systems, transparent reporting, and immediate action on credible fraud concerns. Other states already do these things. There is no excuse for our continued dysfunction.
I believe Mainers are compassionate people. We want programs like MaineCare to work for those who genuinely need help. But compassion without accountability eventually fails the very people it is supposed to protect.
Every dollar lost to waste, fraud, or neglect is not just a dollar stolen from taxpayers but one unavailable for vulnerable children or seniors who need care.