Thousands of low-income Mainers will keep their health care coverage after the U.S. Supreme Court refused Monday to hear a case pitting Gov. Paul LePage against the federal government.

If LePage’s legal challenge had been successful, about 6,500 19- and 20-year-olds would have been kicked off the Medicaid rolls.

The justices’ rejection of the case means the LePage administration must adhere to a lower court’s ruling to continue providing health coverage to the young adults until at least 2019. Removing them from Medicaid would have violated the Affordable Care Act, according to previous court rulings. LePage sought to eliminate coverage for young adults who earn less than about $1,500 a month if they live with their parents, or $2,600 a month if they live alone.

Attorney General Janet Mills, a Democrat, opposed LePage in the case, filing a legal brief opposing the administration’s effort.

Mills had said repeatedly that the case was unlikely to be successful and was a waste of time and money, and she reiterated that view Monday.

“There was no reason for the U.S. Supreme Court to take this case,” Mills said in a prepared statement. “I respect the earnestness with which the governor sought to advance his argument, but I have felt all along that it lacked legal merit. As an independent constitutional officer, I take seriously my duty to offer unvarnished legal advice and to uphold the rule of law, and I will continue to do so.”

LePage hired a private attorney and the state has paid more than $88,000 in legal fees, The Associated Press said in a report Monday that was based on a Freedom of Access Act request. Another roughly $20,000 in payments is pending, according to the AP.

LePage’s office didn’t respond to requests for comment Monday, but Mary Mayhew, Maine’s health and human services commissioner, pointed to the administration’s longstanding view that MaineCare, the state’s name for Medicaid, needs to be reformed to make it a sustainable program.

“Although I am deeply disappointed by the Supreme Court’s decision, we will continue to work tirelessly to reform Maine’s Medicaid program to prioritize our elderly and severely disabled neighbors instead of able-bodied young adults,” Mayhew said in a prepared statement.

But one of those young adults, Jonas Metcalfe, 19, of Portland, who is on Medicaid, said Monday the program has helped bring stability to his life. Formerly homeless, Metcalfe recently landed a part-time job with the Salvation Army and is hoping to attend college this fall to study information technology. He said the weekly mental health counseling he receives from Medicaid to treat anxiety and depression allows him to forge ahead and improve his life.

“What I’m getting right now with the counseling is essential to my life. I don’t think I would be able to hold down a job,” said Metcalfe, whose income is currently too low to qualify for subsidized insurance through the Affordable Care Act. He said he would likely be uninsured if it weren’t for Medicaid.

MAINECARE ROLLS ALREADY SMALLER

The administration has previously estimated that providing MaineCare coverage to the 19- and 20-year-olds costs about $10.6 million a year. The federal government pays roughly $6.6 million of that, with the state picking up the rest.

Most of the cuts to MaineCare have occurred since LePage took office in 2011. Maine has significantly reduced the number of people in the program – from 355,000 in 2011 to 287,000 currently – in part by tightening eligibility requirements. Maine was permitted to reduce eligibility for some populations, but not for children. Nineteen and 20-year-olds are considered children under Medicaid’s definitions.

The number of people on MaineCare also is affected by the strength of the economy. The program’s ranks shrink when people acquire jobs that offer health benefits.

Mayhew has argued that trimming the number of people on MaineCare has allowed the state to reduce waiting lists and better serve those who rely on the program.

The administration also has rejected past efforts by Democrats to expand MaineCare under the Affordable Care Act, despite the federal government’s willingness to pay for most of the expansion costs. Another proposal to expand MaineCare is being debated by the Legislature.

Rep. Drew Gattine, D-Westbrook, chair of the Legislature’s health and human services committee, said Monday that he continues to be perplexed by LePage’s stance against the program.

“I think it indicates a lack of concern in providing health care to low-income folks,” Gattine said. “Why are we putting so much effort into limiting the ability of people to see a doctor and get the medicine that they might need to be successful?”

LEGAL ARGUMENT FALLS FLAT

The Republican governor appealed to the Supreme Court in February after the 1st U.S. Circuit Court of Appeals ruled that rolling back coverage for that age group was illegal because President Obama’s health care law prohibits states from reducing coverage levels for children until 2019. Maine has covered 19- and 20-year-olds for more than two decades.

In urging the justices to hear the case, the LePage administration said the federal government can’t force Maine to keep the young adults on the rolls because the court has previously ruled that states can’t be forced to expand their Medicaid programs.

Jack Comart, litigation director for Maine Equal Justice Partners, an advocacy group for low-income Mainers that joined the legal fight against the LePage administration, said the state’s legal case was always a “long shot,” and that the 6,500 people will get a reprieve until at least 2019. Starting that year, states have more flexibility in restricting Medicaid programs for 19- and 20-year-olds. LePage won’t be in office in 2019, since he won re-election last year and by law can’t serve another term.