Court Orders Maine to Expand Medicaid -- as Voters Intended

by | June 5, 2018

By Dennis Hoey

A Superior Court judge ruled Monday that the Maine Department of Health and Human Services and the LePage administration must follow the voter-approved Medicaid expansion law and submit a state plan amendment next week that sets the health coverage in motion for thousands of low-income Mainers.

The court set a June 11 deadline for the state to file the amendment with the federal government.

In November, 59 percent of voters approved Medicaid expansion, making Maine the first state to expand the program through a citizen-initiated referendum.

However, Republican Gov. Paul LePage has steadfastly opposed expansion, and has called on the Legislature to fund it before he implements it.

On April 30, Maine Equal Justice Partners, Consumers for Affordable Health Care, Maine Primary Care Association, Penobscot Community Health Care and five individuals sued DHHS and the LePage administration . Oral arguments were held May 24, and on Monday, Kennebec County Superior Court Justice Michaela Murphy sided with the petitioners and ordered the state to comply with the voters’ will.

“The governor cannot ignore the law,” Robyn Merrill, executive director of Maine Equal Justice Partners, said in a prepared statement. “Maine voters did not make a request at the ballot, they passed a law, and laws are not optional. Today’s ruling is good for more than 70,000 Mainers who the law says can sign up for health care on July 2.”

However, Murphy’s decision could be appealed.

LePage spokeswoman Julie D. Rabinowitz, in an email response to a request for comment, said the administration is reviewing the court’s decision. The state’s Boston-based attorney, Patrick Strawbridge, did not respond to phone messages left Monday night.

“We won. I think it’s a great decision for all low-income Mainers,” David Kallin, an attorney with Portland-based Drummond Woodsum, said in an interview. “This is the first step on the road to get health care for Mainers who really need it.”

Kallin, James Kilbreth, also of Drummond Woodsum, and Charlie Dingman of Preti Flaherty represented the petitioners on a pro bono basis.

The expansion will open up the program to Mainers who earn 138 percent of the federal poverty level – $16,753 for an individual or $34,638 for a family of four.

Justice Murphy’s ruling requires DHHS Commissioner Ricker Hamilton to file a state plan amendment with the U.S. Department of Health and Human Services by Monday. In her ruling, Murphy disagreed with the state’s position that the executive branch has no obligation to file a plan amendment until legislative appropriations to fund the expansion have been made.

“The court is not persuaded that the executive branch is excused from clear statutory obligations by the Legislature’s failure to follow through with legislative obligations, as defined by the executive branch,” Murphy wrote in her 13-page ruling. “The court concludes that the commissioner’s complete failure to act cannot be considered substantial compliance with (the referendum vote).”

The plan amendment, which Kallin described as a routine, two-page, check-the-box form, establishes a process for ensuring eligibility for people under 65 years of age who qualify for medical assistance.

Congress created Medicaid – known as MaineCare in Maine – in 1965 as a program to provide federal funds to states that pay for medical treatment for the poor. To receive federal funds, states must prepare a plan that defines the category of individuals eligible for benefits and the specific kinds of medical services covered by the plan.

Once the state plan amendment has been filed and approved, Maine will begin receiving federal matching funds that Kallin said will pay for about 90 percent of the costs associated with Medicaid expansion. The law passed by voters in November required the state to file the plan amendment paperwork by April 3.

Although LePage did not react to the court decision Monday, he and his allies have acknowledged that Medicaid expansion is law. The governor also has maintained that his hands are tied until the Legislature appropriates sufficient funds to pay for the expansion.

Estimates of the state’s expansion costs have varied widely, but the nonpartisan Office of Fiscal and Program Review has projected they would be about $45 million in the first year. The LePage administration says it will cost as much as $60 million in the first year and as much as $100 million annually in future years.

Lawyers for the petitioners have argued that there are already enough funds in the state’s Medicaid account to get through the current budget biennium, which ends in June 2019. They also have argued that there is more than $140 million in unallocated funds that the state could draw from at any time.

Murphy’s ruling evoked reactions both on a state and national level.

“Today is a victory for the 70,000 Mainers who stand to gain coverage from Medicaid expansion and for everyone who believes that health care should be a right for all, not just a privilege for a wealthy few,” Democratic National Committee Chairman Tom Perez said in a prepared statement. “Thanks to today’s ruling, Gov. Paul LePage will finally be forced to respect the will of Maine’s voters, who voted overwhelmingly to expand Medicaid last November.”

In a prepared statement, Maine Democratic Party Chairman Phil Bartlett said, “This decision is both a victory for the more than 70,000 Mainers who stand to benefit from Medicaid expansion, and a sharp rebuke of Gov. LePage and his senseless obstruction of the law. The people of Maine have spoken, the court has spoken, and now Gov. LePage and Republicans must listen.”

U.S. Rep. Chellie Pingree, D-1st District, also hailed the court’s ruling, saying, “The order is clear: The LePage administration cannot veto Maine’s voter-approved Medicaid expansion law.”

(c)2018 the Portland Press Herald (Portland, Maine)