“Medicaid expansion is the law,” Robyn Merrill, co-chair of Mainers for Health Care, said Tuesday. “Maine people have spoken and the obligation under the law is clear. Voters sent a strong message … they want more than 70,000 Mainers to receive health care coverage under Medicaid expansion.” Staff photo by Joe Phelan

AUGUSTA — Supporters of Medicaid expansion in Maine called on Gov. Paul LePage and lawmakers to work together to begin implementing the voter-approved law as the July 2 implementation date approaches.

But the LePage administration and lawmakers remain locked in a dispute over funding, potentially setting the stage for legal wrangling over an issue that has been debated in Maine for years.

When Mainers voted in November to expand Medicaid coverage to an estimated 70,000 additional adults, the law they approved laid out a series of compliance deadlines for the state. The first deadline – next Tuesday, April 3 – is when the Maine Department Health and Human Services is required to file a plan with federal officials for expanding Medicaid services. The second deadline, July 2, falls 180 days after the law’s effective date and is when the state is supposed to begin offering Medicaid coverage to adults under age 65 who earn up to 138 percent of the federal poverty level, or $16,643 for a single person and $22,412 for a family of two.

On Tuesday – one week before the DHHS filing deadline and 98 days before coverage is supposed to begin – supporters of the Medicaid expansion law converged on the State House to demand action. As a way to fund the law, supporters say, Maine can dip into the projected $140 million state surplus expected to accrue by the end of the current two-year budget in June 2019.

“Medicaid expansion is the law,” said Robyn Merrill, co-chair of the Mainers for Health Care coalition that led last year’s ballot initiative campaign. “Maine people have spoken and the obligation under the law is clear. Voters sent a strong message on Medicaid expansion with 59 percent of the vote, so they want more than 70,000 Mainers to receive health care coverage under Medicaid expansion.”

NO FUNDING, NO MEDICAID FILING

Yet the LePage administration shows no sign of backing down from the governor’s insistence that the Legislature fund the state’s share of expansion – estimated at about $60 million a year – before it takes steps to implement it. The administration reiterated that position – first outlined by LePage in a Dec. 11 letter to lawmakers – in a recent, terse response to lawmakers’ questions on implementing the expansion.

“Per the directives outlined in that (Dec. 11) letter, the Department of Health and Human Services will not be taking any action to implement Medicaid expansion until it has been appropriately funded,” DHHS Commissioner Ricker Hamilton wrote to the leaders of the Legislature’s Appropriations and Financial Affairs Committee and the Health and Human Services Committee on March 20. “Once Medicaid expansion is appropriately funded, the department will submit to the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services a state plan amendment.”

The budget-writing Appropriations and Financial Affairs Committee has been discussing options for funding expansion. But the committee’s Democratic co-chair said the Legislature doesn’t need to allocate money for DHHS to file an amendment plan with federal officials. And if the governor needs money to hire additional DHHS staff, as he claims, then the LePage administration should submit a bill to the Appropriations Committee requesting that funding, said Rep. Drew Gattine, D-Westbrook.

“We sit here every day and he is putting forward tons and tons of bills to let us know about his priorities,” Gattine, a vocal supporter of expansion, said of the governor’s habit of introducing bills in the final days of a legislative session. “If he doesn’t meet that (implementation) deadline, there will be 70,000-plus people in the state of Maine who are aggrieved and won’t be receiving services they are entitled to” under the expansion law.

EXPANSION DONE IN 32 STATES

This is merely the latest in a years-long battle over Medicaid expansion in Maine.

The Affordable Care Act – also known as Obamacare – allowed states to expand Medicaid to provide health coverage to adults earning up to 138 percent of the federal poverty level. To date, 32 states plus the District of Columbia have chosen to expand Medicaid. The federal government agreed to cover 100 percent of the expansion costs during the initial years, followed by gradual annual decreases until the federal government pays 90 percent in 2020.

LePage has rebuffed every effort to expand Medicaid in Maine – 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 eliminate the wait lists for DHHS programs for the elderly and disabled.

“Show me the money,” LePage told lawmakers in his Feb. 13 State of the State address. “It would be fiscally irresponsible for the Legislature to demand we implement Medicaid expansion without adequate funding. It is simply not too much to ask the Legislature to prioritize our truly needy over those looking for a taxpayer-funded handout.”

ABSENCE OF COOPERATION

After Tuesday’s rally, expansion supporters held posters showing a clock face underneath the message “Counting on care” as they sought to pressure LePage and lawmakers to end the deadlock.

Merrill, who is executive director of the progressive legal aid and advocacy organization Maine Equal Justice Partners, said afterward that it was time for both sides to begin working together. There is enough money in Maine’s Medicaid account to cover the costs of expansion through at least next May or June, Merrill said, plus the state can tap into the estimated $140 million surplus to cover any additional administrative costs to hire DHHS staff.

“He certainly could start taking steps today to get this done,” Merrill said. “And also the fact of the matter is he could come to the table and talk and meet with legislators about how to get it done.”

Merrill said she was unsure how her organization and others would respond if the LePage administration ignores the April 3 deadline to file a state amendment plan with federal health officials. But she added they’ll be watching closely.

“If he chooses not to comply with the law, well then he’ll be in violation of the law and we’ll have to decide what action to take,” Merrill said. “There is a legal team that we are working with that is ready to pursue litigation when and if appropriate, but we really don’t want to fight this out in the courts. We are hopeful that the governor, the administration and lawmakers will come together to get this done. And so this next month is going to be really important because this is really their opportunity to do that.”

Kevin Miller can be contacted at 791-6312 or at:

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