AUGUSTA — The Legislature is gearing up for a debate and potential showdown with Gov. Paul LePage over how it will pay for the state’s share of Medicaid expansion, projected at up to $60 million a year.

The Appropriations Committee, which develops the state budget, will meet Wednesday to receive revenue forecasts and begin its review of how the state can fund the expansion, which voters passed in November. Expansion of MaineCare, the state’s Medicaid health insurance program for low-income people, would extend eligibility to an estimated 80,000 Mainers – childless adults who earn less than 138 percent of the federal poverty limit. That’s about $17,000 a year for an individual or $22,412 for a two-person household

“We need to figure out how much we are going to need and when we are going to need it,” said Rep. Drew Gattine, D-Westbrook, the House chairman of the committee.

The expansion law goes into effect 45 days after the Legislature convenes on Jan. 3, but those who are newly eligible for Medicaid coverage will probably not start enrolling in the program until mid-August of 2018. That means the state’s initial costs will have to be accounted for in the current two-year budget, which runs until June of 2019.

Federal law would require the state to cover 10 percent of the cost of the expansion by 2020. The state would have to come up with an estimated $54.5 million a year for its share, according to the Legislature’s nonpartisan Office of Fiscal and Program Review. The Fiscal and Program Review report also shows the annual amount the federal government would pay for the expansion in Maine would be an estimated $525 million.

The report shows the state would have to add 103 employees to the Department of Health and Human Services to administer the expansion and that the federal government would cover 75 percent of that expense for 79 of the new positions and 50 percent of the costs for the remaining 24 new positions.


Each new worker would be expected to handle about 700 cases a year, the report shows. The state’s current two-year budget is $7.1 billion. The state’s current share of Medicaid costs is about $950 million while the federal government’s share is $1.9 billion, according to a report by the Kaiser Family Foundation.

Gattine said the committee’s meeting next week could devolve into a partisan debate over expansion. LePage and other Republican critics continue to make the same arguments about damage to the state budget that they made in their failed efforts to defeat the ballot question. The governor has not offered a proposal for how to fund expansion.

LePage has vetoed Medicaid expansion legislation passed by bipartisan majorities in the Legislature five times since 2013, and he repeatedly rails about the cost of expansion in his weekly radio addresses. LePage’s vetoes were consistently sustained with support from expansion opponents in the House’s minority Republican caucus.

Sen. Jim Hamper, R-Oxford, the Senate chairman of the Appropriations Committee, consistently voted against expansion bills and supported LePage’s vetoes. He said his intent for Wednesday’s meeting is to gather information, but like LePage, he suggested it would be up to expansion proponents, mainly Democrats, to figure out how to fund it.

Hamper said he doesn’t believe all of the expansion costs will be funded at the 90 percent match rate and some will likely be at the 60 percent rate that applies to the existing program. Hamper said he also wants to know how many people DHHS believes will enroll in the program. Cost calculations done by the Legislature’s nonpartisan staff use a conservative figure of 89,000 new Medicaid recipients, Gattine said.

“I don’t expect a plan to be revealed on Wednesday,” Hamper said.


LePage continues to say that expansion must not increase taxes or tap into funds from the state’s emergency reserves. The governor also has said that wait lists for health-related services for the elderly and disabled residents must be eliminated before the state begins offering health care to single adults without children.

“I look forward to expanding Medicaid,” LePage said in his radio address this week. “I just want the Legislature to fund it in a fiscally responsible manner. These politicians like to talk the talk – now they have to walk the walk. Show me the money.”

Gattine said LePage and other expansion opponents need to move past the political debate now that it’s been settled by the voters.

“It sounds like the governor is still in campaign mode,” Gattine said. “All the things he is saying now are things he went around the state saying all summer and all fall.”

Five of LePage’s last nine weekly radio addresses have been on Medicaid expansion.

Gattine also said the ballot measure was decisive, having captured 59 percent of the vote in November, and that LePage and the Legislature were now legally obligated to move forward.


He said if LePage is truly was looking forward to expanding Medicaid, as he said in this week’s radio address, then he would have prepared a supplemental budget proposal to submit to the Legislature to account for the expansion.

“This whole idea that this is not his obligation to participate and to work with us is part of the problem that got us here in the first place,” Gattine said.

He and Hamper both said they invited the LePage administration, specifically representatives from DHHS, to participate in the meeting next week. But the governor’s office declined and instructed lawmakers to submit any questions they had for the department in writing.

Scott Thistle can be contacted at 713-6720 or at:

[email protected]

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