Medicaid Expansion Ruling Means 'End Is in Sight' for Maine's Health-Care Uncertainty

by | December 7, 2018 AT 6:30 PM

By Joe Lawlor

The judge deciding the Medicaid expansion lawsuit has denied a stay request by the outgoing LePage administration, but set a new Feb. 1 deadline to begin enrolling people in the expanded health insurance program.

From a practical standpoint, the latest ruling makes the lawsuit moot. Gov.-elect Janet Mills, a Democrat who will be sworn in on Jan. 2, has vowed to begin enrolling people as soon as possible after her administration takes over.

Maine voters approved Medicaid expansion in a November 2017 referendum by a 59 to 41 percent vote, but Republican Gov. Paul LePage, an expansion opponent, has refused to implement it. About 70,000 low-income Mainers will be eligible for Medicaid under the expansion.

The advocacy group behind the voter referendum, Maine Equal Justice Partners, sued the LePage administration this spring, arguing that the Maine Department of Health and Human Services failed to follow the law by refusing to implement the expansion.

Despite winning in court, the delays caused by having the court process play out have postponed implementation, and with Mills taking over in January, Maine will be complying with the law.

The ruling by Superior Court Justice Michaela Murphy on Thursday supports Maine Equal Justice Partners but delays the start date for enrollments from Dec. 5 to Feb. 1.

"This is good news in that the court is denying the request for a stay, at the same time the court is extending the deadline for rulemaking and enrollment to February 1st," said Robyn Merrill, executive director of Maine Equal Justice Partners, in a statement. "The extension and the deadline will ensure that the new administration that supports Medicaid expansion will be implementing the law so that it's done right, and people will get the care that they're eligible for."

Benefits will be retroactive to July 2, according to the ruling.

A LePage spokeswoman did not return messages from the Press Herald seeking comment Thursday.

Murphy, the judge, wrote that on the central argument in the case -- whether eligible Mainers should be permitted to enroll in Medicaid despite the LePage administration's objections over funding -- she is siding with Maine Equal Justice Partners.

"The court would emphasize that the extension of the deadline to comply should not be confused with a central holding of the prior order. The people of Maine enacted a law that requires payment of Medicaid benefits to an expanded class of Maine citizens, and any person who meets the qualifications clearly spelled out in the Expansion Act are entitled to those benefits as of July 2, 2018," Murphy wrote in Thursday's ruling.

Merrill said that the case sets an important precedent for future governors who may be reluctant to implement laws they don't like.

"In our democracy, the executive branch much follow the law and needs to be held accountable if they don't," Merrill said in a phone interview. "If they ignore the law and are not held accountable, the system falls apart."

Medicaid expansion is a key component of former President Obama's signature domestic legislation, the Affordable Care Act. Some conservative states have refused to adopt Medicaid expansion, but 37 states and the District of Columbia have done so.

The stay request, filed on Nov. 26 with the state's Business and Consumer Court, argued that implementing expansion would have "far-reaching negative consequences" and would "prompt a fiscal crisis."

Murphy dismissed that argument, calling the fiscal crisis claim "fiction."

Medicaid expansion will cost state taxpayers about $50 million to $60 million per year, but Maine will receive more than $500 million annually in federal funds to help pay for health care for newly eligible Medicaid enrollees. The Legislature approved $60 million in funding for Medicaid expansion this summer, but LePage vetoed it, arguing that the funding package contained one-time "budget gimmicks."

Mainers earning as much as 138 percent of the federal poverty level -- $16,753 for an individual and $34,638 for a family of four -- were eligible to apply for Medicaid coverage on July 2. Thousands did, only to receive letters of denial from DHHS.

Scott Ogden, a Mills spokesman, said the expansion will happen as soon as possible.

"Governor-elect Mills has vowed to begin implementing voter-approved Medicaid expansion as soon as she assumes office," Ogden said in a statement. "It is her goal to see that eligible Mainers are able to enroll for coverage as soon as possible so that they may begin receiving the health care that will improve their lives quickly thereafter."

House Speaker Sara Gideon, a Democrat, said the "end is in sight."

"I am eager to work in partnership with Governor-elect Mills to ensure this law is followed and that more Mainers are accessing the care they deserve to be and stay well," Gideon said in a statement.

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