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Maine Governor Submits Medicaid Expansion Application -- and Asks Feds to Reject It

The LePage administration complied with a court order Tuesday and finally submitted required documents to the federal government to expand Medicaid to 70,000 Mainers, but there's a catch. Gov. Paul LePage -- an expansion opponent -- is asking federal officials to deny the application.

By Joe Lawlor

The LePage administration complied with a court order Tuesday and finally submitted required documents to the federal government to expand Medicaid to 70,000 Mainers, but there's a catch. Gov. Paul LePage -- an expansion opponent -- is asking federal officials to deny the application.

"I strongly encourage CMS (U.S. Centers for Medicare and Medicaid Services) to reject the State Plan Amendment that may soon be submitted by the Maine Department of Health and Human Services pursuant to court order," LePage wrote in an Aug. 31 letter to Seema Verma, CMS administrator, and U.S. Health and Human Services Secretary Alex Azar. "If accepted, the SPA would commit Maine to expanding the Medicaid program to an additional 70,000 to 90,000 individuals. However, not one dime of the hundreds of millions of dollars that will be needed to pay for the state's share of the expansion has been appropriated."

The State Plan Amendment is a required first step toward implementing expansion, and Maine's highest court on Aug. 23 ordered the LePage administration to file the plan. Maine DHHS filed the plan on Tuesday.

LePage vetoed a $60 million Medicaid expansion funding bill that state lawmakers approved in June, arguing that the funding contained one-time budget gimmicks. Democratic lawmakers countered that $60 million was more than enough to fund the expansion, and that a permanent funding solution should be decided by the next governor and Legislature.

LePage is finishing his final term, and will be out of office in January. Democratic Attorney General Janet Mills, Republican businessman Shawn Moody and independents Terry Hayes, the state treasurer, and businessman Alan Caron are running in the general election to succeed LePage.

Mills noted Tuesday night that Medicaid expansion is supported by groups ranging from hospitals to the Maine State Chamber of Commerce and those "fighting the opioid epidemic."

"Like a lot of Mainers, I've had enough of this administration standing in the way," Mills said in an emailed statement. "The money is there, and, as governor, I'll implement Medicaid expansion on day one. From the health of our people to the health of our economy, there's too much at stake not to."

The other candidates had not responded to requests for comment.

Voters approved Medicaid expansion by a 59 to 41 percent margin in November 2017, and the law passed at the ballot box required the state to file a State Plan Amendment in April. But the LePage administration has refused to implement it. The expansion, a key component of the Affordable Care Act, would provide health insurance for low-income Mainers earning up to 138 percent of the federal poverty limit, or $34,638 for a family of three and $16,753 for a single person.

Robyn Merrill, executive director of Maine Equal Justice Partners, which is suing the state for failing to expand Medicaid, said asking the federal government to reject the expansion plan is unprecedented.

"They submitted a plan, but said, 'Don't approve it.' This is not over," Merrill said. "The governor is doing everything he can to block the will of Maine voters, trying to stop 70,000 Mainers from having health insurance."

Merrill said that given the stance of the LePage administration, the legal battle will continue.

Maine Equal Justice Partners has so far won its court fights with the LePage administration, and in August the court ordered Maine DHHS to file the State Plan Amendment.

Merrill has maintained that there is enough funding to start Medicaid expansion, and that the federal government does not get involved in how the state comes up with its share of dollars for the expansion.

The federal government pays for 90 percent of the cost of expansion, so Maine would pay about $50 million per year, according to nonpartisan estimates, and would draw down more than $500 million in federal funds to expand Medicaid.

LePage argued in his three-page letter that an "activist court" forced his administration to file the State Plan Amendment. He said the federal government will likely have to reject the application because of the lack of state funding, and that the "failure of the Legislature to provide any funding for additional staff leaves DHHS in serious jeopardy of being unable to meet its obligations to accurately make eligibility and program integrity determinations."

LePage wrote that "if the SPA is approved, the state will become obligated under federal law to fund the full range of Medicaid services to tens of thousands of additional individuals. Until the necessary funding is in place, however, the federal government can take no assurance that Maine will be able to pay for its share of costs under the program."

The Maine Supreme Judicial Court kicked the core issue in the lawsuit, whether the LePage administration could be forced to implement expansion without a specific funding source -- back to Superior Court. The Superior Court is still considering constitutional and other questions regarding the case.

Also unresolved, Merrill said, is what happens to people who signed up for Medicaid under expansion starting on July 2. Maine issued denial letters to at least some of the applicants, according to documents provided by Maine Equal Justice, but according to the law voters approved, Mainers could begin applying for coverage in July.

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

Caroline Cournoyer is GOVERNING's senior web editor.
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