When Gov.-elect Janet Mills takes office in January, she will likely have the power to torpedo new Medicaid work requirements approved by the federal government last week at the request of outgoing Republican Gov. Paul LePage.

Gov. Paul LePage prioritized “work within our welfare programs.”

Similar work requirements in Arkansas, the first state to implement them, led to nearly 17,000 people losing their Medicaid benefits.

Mills, a Democrat, was noncommittal about her intentions in an interview Thursday. But a national health-policy expert said she believes Maine’s new governor would not be obligated to implement the work requirements granted under a federal waiver. Medicaid is a federal program operated and partially funded by the states, but some deviations from the standard program have to be approved by the federal government.

“I do not think there is anything that would compel the new governor to follow the waiver if she disagrees with it,” said MaryBeth Musumeci, associate director of the Program on Medicaid and the Uninsured at the Kaiser Family Foundation, a national health-policy think tank.

Musumeci noted that in Pennsylvania in 2015, newly elected Democratic Gov. Tom Wolf disregarded a waiver obtained by his Republican predecessor to implement a modified version of Medicaid expansion. Wolf instead implemented Medicaid expansion under the Affordable Care Act without any changes permitted by the waiver. He has since vetoed attempts by the Pennsylvania Legislature to seek work requirements for Medicaid recipients.

Chris Hastedt, public policy director for Maine Equal Justice Partners, a Maine-based advocacy group that successfully campaigned for Medicaid expansion in Maine and has opposed LePage’s work requirements, said the group’s legal team has studied the issue and also concluded that Mills is not required to implement the waiver.


Janet Mills says her incoming administration is evaluating the state’s legal options.

On Thursday, Mills said her administration is evaluating the state’s legal options. Mills has said previously that she will be implementing voter-approved Medicaid expansion in January, which will add about 70,000 low-income Mainers to the program.

“It’s not whether I want to or don’t want to, it’s what the law says, and that’s something we will be looking into in the coming weeks,” Mills said of the work requirements waiver. “I started reading (the waiver) the other night. I fell asleep, sorry, it’s like 36 pages long. I want some health care lawyers in my office and others to look at it more deeply before I can make a decision about what I can do with it and what I can’t do with it. And how I can step back or not step back from it.”


The work requirements are controversial among progressive groups, and Maine Equal Justice Partners has vowed to sue if the waiver is implemented, arguing that it fails to comply with the 1960s-era Medicaid law.

“It violates the purpose of the Medicaid program, to expand health care coverage,” Hastedt said. “Arkansas is a cautionary tale.”

The Arkansas Times reported this month that nearly 17,000 residents had lost Medicaid coverage after that state started implementing work requirements this year. Mills said Thursday that she’s aware of events in Arkansas.


Work requirements to qualify for health insurance remain popular among Republicans. The Trump administration has approved waivers in Indiana, Kentucky, New Hampshire, Michigan and Wisconsin, in addition to Maine and Arkansas.

Maine’s waiver was announced by Seema Verma, administrator of the U.S. Centers for Medicare and Medicaid Services, in a tweet last week.

LePage had touted the new requirements for non-disabled Medicaid recipients as a way to encourage work among low-income Mainers. Some of the state’s 258,000 adult, non-disabled, non-elderly Medicaid beneficiaries would be required to pay premiums of up to $40 per month and work, volunteer or attend school or job training activities for 80 hours per month.

“Under my administration, we have worked to lift Mainers out of poverty by prioritizing work within our welfare programs,” LePage said in a prepared statement last week. “With the approval of the (application), we will be able to replicate that success in our Medicaid program.”


But a study released in August by the Kaiser Family Foundation found that having health insurance helps people with employment.


“Being in poor health is associated with increased risk of job loss, while access to affordable health insurance has a positive effect on people’s ability to obtain and maintain employment,” the study found.

The study did not examine the impacts of work requirements on the Medicaid population because prior to the Trump administration, Medicaid had never approved a work requirement waiver.

Last week, Mills spokesman Scott Ogden said that “making sure people are healthy, of course, is a first step in making them eligible for work.”

Verma likened the Medicaid waivers to a gift from the federal government in her Dec. 21 tweet.

“Christmas came early for these governors and we are proud to support local innovation all across this great country!” she said in the tweet.

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


Twitter: joelawlorph

Comments are no longer available on this story