By Matt Byrne

A proposal by the administration of Gov. Paul LePage to remove 19- and 20-year-olds from MaineCare violates the Affordable Care Act and would be illegal, a federal appeals judge ruled Monday.

The decision is consistent with two previous administrative rulings by the federal government that the cuts were illegal. Because of the decision, an estimated 6,000 young people whose families meet financial standards will keep coverage through MaineCare, Maine's version of Medicaid.

"These children had not been cut, so there's going to be no change for them," said Jack Comart, litigation director at Maine Equal Justice Partners, which filed a brief in the case. "It protects them, and it protects their access to healthcare."

Comart said that he is unaware of any other state that has attempted such a cut to access to healthcare for children. Although they are generally considered adults in most circumstances, 19- and 20-year-olds can be considered children under federal Medicaid rules if certain conditions are met.

LePage proposed to cut eligibility for 19- and 20-year-olds in 2012, along with several other changes, as part of a $220 million spending reduction in the state's Department of Health and Human Services to help balance the state's biennial budget.

Much of the other cuts were approved. When federal regulators rejected this particular provision, the state of Maine pursued a review of the decision, which was rejected. The state then pursued a legal challenge, and brought their case in First Circuit Court of Appeals in Boston.

Maine's Attorney General, Janet Mills, traditionally represents the state but in this case declined. Mills said her office performed a legal analysis of the case before the LePage administration pursued the appeal, but found that her office's reading of the law was similar to the federal government's--that the LePage administration's cuts were unconstitutional.

Mills said in an interview Monday that Maine decided to add this group of recipients to MaineCare in 1991 under a Republican governor and with the blessing of a bipartisan legislature. "This is a continuation of a very small part of the MaineCare program that has a great deal of history to it, and is not an expansion," she said.

Without the Attorney General's participation, LePage earmarked $100,000 from his contingency fund to cover the costs of private legal representation. LePage has traditionally used the funds to help communities build veterans' memorials, pay for community programs and to help the under-served.

The governor's office could not immediately provide the precise amount spent to pursue the case.

Maine Department of Health and Human Services Commissioner Mary Mayhew issued a statement saying that provide MaineCare coverage to the 6,000 19- and 20-year-olds costs about $10.6 million a year. The federal government pays roughly $6.6 million of that, with the state of Maine paying abut $4 million a year. The total cost works out to about $1,760 per person annually.

Mayhew said the administration could have spent that money for other priorities, such as reducing waiting-lists for disabled Mainers in need of assistance or increase the amount MaineCare pays to medical providers to help save struggling nursing homes.

"Today, judges have gone out of their way to defend the unpopular ObamaCare law and obstruct the will of the public, made clear (in the election) two weeks ago, that our welfare funds should be prioritized toward the elderly, disabled, and truly needy; not job-ready young adults," Mayhew said in a statement. "By moving the goalposts and forcing Maine taxpayers to pay for more welfare, the federal government is using its heavy hand to push its agenda of putting as many people as possible on a broken Medicaid system. Washington has the luxury of paying for its programs with deficits and debt; in Maine, we must set priorities and balance our budget."

Mayhew said the department is "reviewing our options," which could include another appeal.

U.S. Congresswoman Chellie Pingree, who engaged in a public debate with LePage and took the unusual step of asking the federal government not to grant Maine's requests for cuts, issued her own statement lauding the decision Monday.

"Maine has covered these young adults for over 20 years, and dropping the coverage now clearly violates the provisions of the AffordableCare Act," Pingree said. "This is good news for thousands of low-income 19- and 20-year olds who faced the loss of health care coverage."

Pingree is married to S. Donald Sussman, majority owner of MaineToday Media, which publishes the Portland Press Herald/Maine Sunday Telegram, the Kennebec Journal in Augusta and the Morning Sentinel in Waterville.

The proposed cuts by the governor came during the 2012 biennial budget process. LePage had sought to rein in spending by DHHS, which consumed more than a third of the state's $2.4 billion budget. Cutting coverage for 19- and 20-year-olds represented about 2.5 of that figure, according to the decision.

The Centers for Medicaid and Medicare Services, known as CMS, approved requests by the LePage administration to eliminate MaineCare coverage for parents who earn between 100 percent to 200 percent of the federal poverty level, or $23,850 to $47,700 a year for a family of four.

Federal officials also allowed the state to deny or reduce Medicaid health care and prescription drug coverage for 8,250 elderly and disabled adults in the Medicare Savings Plan and Drugs for the Elderly program. About 2,600 of those people will lose all coverage.

This latest decision preventing the cut to 19- and 20-year-olds, however, is consistent with others around the country requiring states to effectively freeze eligibility standards for children as of March 23, 2010, the day the Affordable Care Act was passed in Congress, with no exceptions. Any alterations that would reduce access for children would be considered illegal under the healthcare law.

(c)2014 the Portland Press Herald (Portland, Maine)