Gov. LePage has said he would “love” to expand Medicaid, if Maine lawmakers would only give him the right tools.

The LePage administration argued in a court filing this week that it can’t implement voter-approved Medicaid expansion because the Legislature didn’t make a “specific allocation” to do so.

Without money dedicated to expansion, the state Department of Health and Human Services “plainly lacks legal authority” to spend money on it, says the court brief, which was filed Monday in Superior Court in Augusta and released Thursday by the office of Gov. Paul LePage.

LePage, a Republican and staunch opponent of Medicaid expansion, said in a statement accompanying the release that “now that Medicaid expansion is the law, it is my responsibility to implement it, and I will. But until (the Legislature) adequately funds it, there is nothing we can do. Before we can proceed with expansion, DHHS needs both the staff to implement it and the money to pay the bills that will come due when the state plan amendment is approved” by the federal government.

On April 30, Maine Equal Justice Partners filed a lawsuit that, if successful, would compel the administration to implement Medicaid expansion, which voters approved by a 59-41 percent margin in November 2017.

Maine adults under age 65 who earn up to 138 percent of the federal poverty level – $16,643 for a single person, $22,412 for a family of two and $25,100 for a family of four – could have started signing up for Medicaid in this July had the administration taken steps to begin implementing expansion. But the administration has not prepared for the expansion, and has not filed documents with the federal government to do so, arguing that the Maine Legislature needs to do more to fund the program.

Medicaid is a blended federal-state program, funded with both state and federal dollars but operated by the states. The option for states to expand it and cover more lower-income people is one of the key elements of the Affordable Care Act. About 70,000 Maine residents will be eligible for Medicaid health insurance once the expansion goes into effect.


About 20 million Americans, including more than 70,000 in Maine, have ACA coverage. Thirty-two states and the District of Columbia have approved Medicaid expansion.

Democrats and Maine Equal Justice Partners say the funding is already in place to begin implementing Medicaid expansion now.

“There is more than enough funding already appropriated to last until at least May 2019, maybe longer,” said Jack Comart, litigation director for Maine Equal Justice Partners, a progressive advocacy group. “Plenty of time for the next Legislature to address if needed.”

Lawmakers approved an initial $3.8 million expenditure in April to enable DHHS to hire additional staff and cover administrative costs of expansion. However, that funding was caught up in a partisan standoff when the Legislature adjourned May 2 before funding a number of bills.

The full cost of Medicaid expansion is about $45 million in state funds in the first full year of implementation, according to the nonpartisan Office of Fiscal and Program Review. The office estimates the cost would grow to $55 million by 2021. The state’s current two-year budget is about $7 billion.

Expansion would unlock more than $500 million per year in federal funds that would begin flowing to Maine to cover the health care costs of lower-income Mainers.


LePage has rebuffed every effort to expand Medicaid – including by vetoing bipartisan bills sent to his desk – because he argues that expansion will prove too costly for the state, even with the federal match. After voters intervened last November, LePage sent lawmakers a lengthy letter insisting that the Legislature fund the expansion – without increasing taxes, tapping into the state’s Rainy Day Fund or employing other “one-time funding mechanisms or budget gimmicks” – and also eliminate the wait lists for DHHS programs for the elderly and disabled.

LePage is leaving office in January, which means Medicaid implementation may fall to the next governor. Seven Democrats and four Republicans are running in party primaries to replace him, with several independent candidates also in the race.

Joe Lawlor can be contacted at 791-6376 or at:

Twitter: joelawlorph

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