There was a hint of nostalgia last week when Gov. LePage used part of his last State of the State address to set up a familiar scene – a big fight with the Legislature over Medicaid expansion.

LePage conceded that he would implement the law, which was passed by the voters last year, but only if the Legislature produced an unspecified amount of money that the governor believes would be needed to fund the program beyond his remaining months in office.

If lawmakers don’t meet his demands, the governor let them know he would not budge.

“Appropriate the money so we can implement the law,” he challenged. “The time is now – not after the next election.”

It’s no surprise to see the governor eager for this fight: A bill to accept federal funding to expand health care access to as many as 80,000 Mainers has been passed by Legislature five times since 2013, and each time LePage knocked it down with a veto. Sometimes the vote to override was close, but in all five cases he ended up the winner.

This time, however, he may not get his fight.


A governor can’t veto the people, and expanding eligibility for Medicaid, known here as MaineCare, is not a proposal – it’s the law.

Despite LePage’s demand that legislators raise the money to fund the program before he starts implementing it, this time it’s LePage who is on the spot.

He has the money he needs to get the program started, and he can’t win this fight just by saying “no.”

The issue is confusing to many members of the public, in part because so many numbers have been tossed around during the years of debate.

The program is almost entirely funded by the federal government, with most costs shared on a better than 90 percent-to-10 percent basis. The question in Augusta is: How much does that 10 percent amount to?

According to the Office of Fiscal and Program Review, the nonpartisan state agency that makes economic projections for the Legislature, expanding Medicaid eligibility to people who earn less than 133 percent of poverty – $16,000 for a single person, or $32,700 for a family of four – would cost the state approximately $30 million a year.


That accounts for savings that would come from federal spending that replaces existing state-funded programs.

In most contexts, $30 million would be a lot of money, but it’s a small part of the Medicaid budget. The state currently has approximately $800 million in its Medicaid account for next year, so covering the newly eligible group would be adding less than 4 percent to what has already been budgeted.

If including the newly eligible means that the Medicaid account runs out 4 percent faster as a result, the Legislature and the next governor would need to find new funds to cover the last two weeks (or 4 percent) of fiscal year 2019, which ends June 30, 2019.

But LePage won’t be in office then, and there is very good reason to believe that the account won’t run out of money so quickly.

The estimate is based on the notion that the people who are eligible would sign up immediately. Common sense would say otherwise.

Much more likely would be a gradual ramping up, as people hear about the program and apply for coverage over time, making the real need for the first year to be less than the full estimate.


The same is true for the administrative costs. LePage said last week that the Department of Health and Human Services would need 105 new employees to determine eligibility for expanded MaineCare, and that may be true someday. But they don’t need to be on hand before there is a single new applicant. The Legislature should be able to give the department the resources it would need to start signing people up with funds that already exist in the current budget.

In the next few weeks, the Appropriations Committee will be receiving an updated projection that includes work from the independent national research firm Manatt. The firm did earlier studies of several states’ Medicaid programs that showed how they were able to save state money by taking advantage of the enhanced federal match.

As much as LePage would like one, there shouldn’t be a showdown over Medicaid between the governor and the Legislature this time.

The governor will be gone next January, and he has all the money he needs to follow the law and expand Medicaid coverage.

If he refuses to spend it, it will be likely a judge, not the Legislature, that he will have to battle.

Only subscribers are eligible to post comments. Please subscribe or login first for digital access. Here’s why.

Use the form below to reset your password. When you've submitted your account email, we will send an email with a reset code.

filed under: