AUGUSTA — Gov. Paul LePage said Tuesday that he’s “absolutely confident” he can get federal approval to make three budget cuts he has proposed to close a $220 million deficit in the Department of Health and Human Services.

Others aren’t so sure.

Lawmakers spent significant time Tuesday grilling Health and Human Services Commissioner Mary Mayhew about the administration’s proposals to reduce or eliminate coverage that helps elderly Mainers pay for prescription drugs, tighten eligibility requirements for parents to be in MaineCare, and end MaineCare coverage for 19- and 20-year-olds.

Those proposals need federal approval to allow the state to deviate from “maintenance of effort” requirements.

As part of the federal Affordable Care Act, states must continue to offer programs that are no more restrictive than those that were in effect in March 2010. But states can ask for waivers.

“The maintenance of effort is tying the state’s hands to effectively manage its program and balance its budget,” Mayhew told members of the Legislature’s Appropriations and Health and Human Services committees.

Last week, hundreds of people gathered at the State House to protest LePage’s proposal, which would drop 65,000 people from MaineCare, the state’s Medicaid health insurance program. On Tuesday, the legislative committees held the first in a series of work sessions to dig deeper into the proposal. Their next meeting is set for Jan. 3.

LePage made a surprise appearance in the committee room Tuesday and spent about 20 minutes listening to the discussion. During a break, he told reporters that he has spoken to U.S. Health and Human Services Secretary Kathleen Sebelius.

LePage’s spokeswoman, Adrienne Bennett, said LePage met with Sebelius in February and May while he was in Washington for conferences.

When asked what made him so confident the waivers would be granted, he said, “I just believe it’s not in her interest or the interest of the administration to see any state go bankrupt or broke.”

A comment from Sebelius’ office was not available Tuesday evening.

While LePage said he’s confident he can get federal approval, Democrats and advocates for the poor said they don’t believe that Maine meets the requirements for a waiver.

Christine Hastedt of Maine Equal Justice Partners said a recent federal appeals court ruling clearly says that waivers can not be granted to support state budget cutting. Waivers are appropriate for pilot programs or those that have research value, the court found.

“We believe a waiver will not be granted simply because the governor is proposing to cut these people from MaineCare to save money,” Hastedt said.

LePage needs federal approval to make three changes:

* Reduce or eliminate coverage in the Medicare Savings Program, which would mean 20,000 elderly Mainers would no longer get help paying for prescription drugs. Advocates say many more people would be affected because some would lose a portion, but not all, of the benefits they now get.

* Change the income eligibility for parents to be in MaineCare, from 133 percent of the federal poverty level ($24,645 a year for a family of three) to 100 percent ($18,530 for a family of three). That would affect 25,000 to 30,000 people.

* End MaineCare coverage for 19- and 20-year-olds, which would affect 8,700 people.

Ending coverage for 19- and 20-year-olds would save $7 million, while the reduction to parents would save $10.6 million. An estimate of the savings from the Medicare Savings Program was not available late Tuesday.

Lawmakers asked several questions about what will happen if they approve the cuts and the federal government rejects Maine’s waiver requests. Mayhew said that during the previous administration, the Legislature authorized the governor to cut spending in other areas if federal money did not come as expected.

But Rep. Peggy Rotundo, D-Lewiston, said in those instances, legislators “were pretty certain” the money would come. “This just seems much more of a roll of the dice.”

Another consideration is timing.

Mayhew said she could not predict how long it would take the federal government to consider the requests. The cuts must take effect by April 1 if they are to save money in this fiscal year, which ends June 30.

Overall, the issues raised Tuesday produced more questions than answers, said Rep. Ken Fredette, R-Newport.

“The question of whether or not the secretary would grant a waiver is an open question,” he said. “How do we make this happen with all this uncertainty?”

LePage was critical of the legislators for asking questions that he said showed they are making decisions based on “economic emotions.”

Bennett said that’s LePage’s way of saying they are playing politics with the issue, rather than addressing it head-on.

House Minority Leader Emily Cain, D-Orono, a former member of the Appropriations Committee, said LePage should share the details of his conversations with Sebelius if he wants legislative support.

“It’s not helpful to make sweeping statements about confidence,” she said. “Tell us why. Why you know that, or what the implications are.”

Susan Cover — 620-7015

scover@mainetoday.com