National News

Maine Voted to Expand Medicaid. Judge Orders the State to Get Moving.

Posted June 4, 2018 10:13 p.m. EDT

WASHINGTON — Seven months after Maine voters approved a ballot measure to expand Medicaid to tens of thousands of additional residents, a state judge on Monday ordered Gov. Paul LePage’s administration to stop stonewalling and move ahead with the plan.

It was the second victory in a week for Medicaid expansion, which became possible under the Affordable Care Act. Lawmakers in Virginia voted last week to open the program to an additional 400,000 residents. Advocates in Utah have succeeded in getting a question on the November ballot about expanding Medicaid, and similar efforts are underway in Idaho and Nebraska.

In Maine, Medicaid expansion advocates sued the LePage administration in April after it missed the deadline for submitting a plan to the federal government to expand the program. Residents who are newly eligible for Medicaid as a result of the ballot measure were supposed to get coverage starting in July, but LePage, a Republican, has repeatedly said the state doesn’t have the money to pay for it.

Maine was the first state in the nation to expand Medicaid through a public referendum. Governors and legislatures in 17 other states that have refused to expand Medicaid under the Affordable Care Act are watching closely.

In her ruling, Justice Michaela Murphy of Maine Superior Court ordered the LePage administration to submit a “state plan amendment” — essentially updating the terms of its Medicaid program — to the federal government by June 11. She said the ballot measure was “clear and unambiguous” in requiring the state to do so by April 3, and to provide coverage to the newly eligible population by July 2.

The state health commissioner’s “complete failure to act,” Murphy wrote, “cannot be considered substantial compliance” with the law.

Julie Rabinowitz, a spokeswoman for LePage, said he and members of his administration were “reviewing the decision.” She would not say whether LePage was considering an appeal.

LePage has repeatedly vetoed legislation to expand Medicaid during his two terms. He will leave office at the end of the year. He has said it would burden taxpayers and the state budget, and has described it as a form of welfare.

The Affordable Care Act gave states the option to allow citizens with income up to 138 percent of the poverty level — $16,642 for an individual, $24,600 for a family of four — to qualify for Medicaid, which is paid for by states and the federal government.

The law required the federal government to pick up the cost of new enrollees under Medicaid expansion for the first three years; it will continue to pay at least 90 percent. States generally cover a much larger portion of the expenses for the rest of their Medicaid populations.

LePage has estimated a much higher cost to the state for expanding Medicaid (as much as $100 million a year) than the state’s nonpartisan Office of Program and Fiscal Review did (about $54 million). He has vowed not to allow the expansion to proceed unless the legislature finds a way to pay for it at his cost estimate, and without raising taxes or relying on state surpluses.

“The governor cannot ignore the law,” said Robyn Merrill, executive director of Maine Equal Justice Partners, the lead plaintiff in the lawsuit and the group that led the ballot initiative campaign. “Maine voters did not make a request at the ballot, they passed a law, and laws are not optional. Today’s ruling is good news for more than 70,000 Mainers who the law says can sign up for health care on July 2.”