Maine's LePage continues fight against voter-approved Medicaid expansion

Maine Gov. Paul LePage is pushing the federal government to reject a court-ordered, state-voter mandated Medicaid expansion plan citing the fiscal stress that would result.

The Republican governor sent a letter to the U.S. Department of Health and Human Services along with a copy to President Trump Friday urging a rejection of his own administration’s application to expand Medicaid for an estimated 70,000 to 90,000 Mainers. The letter was sent shortly before he submitted required documents for Medicaid expansion by a Sept. 4 deadline after the Maine Supreme Court ordered a plan to be filed.

“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,” said LePage in the letter. “Until funding is in place, Maine will not be able to satisfy the commitments to the federal government that it would be making if the [State Plan Amendment] were accepted.”

LePage has fought efforts to advance Medicaid expansion since voters approved the healthcare initiative with 59% support in a November referendum. The term-limited LePage, whose eight-year run as governor ends in January, vetoed legislation in early June that would have funded Medicaid expansion with surplus monies and tobacco settlement funds. He later proposed paying for the program through a tax on the state’s hospitals.

A Moody’s Investors Service analysis released after the referendum passage projected increased budget risks from Medicaid expansion with costs estimated to rise by at least $55 million when fully implemented in 2021. Maine’s general obligation debt is rated Aa2 by Moody’s and AA by S&P Global Ratings.

Maine last expanded Medicaid in 2002 before the LePage administration curtailed the program in 2011 citing impact to the state’s liquidity and reserves. Overdue MaineCare payments owed to hospitals in 2013 were paid for from proceeds of a bond that securitized other state revenue and increased state debt.

Four governor candidates are running to replace LePage next year: Democratic Attorney General Janet Mills, Republican businessman Shawn Moody, Independent State Treasurer Terry Hayes and Independent businessman Alan Caron. Mills, Hayes and Caron have indicated support for Medicaid expansion while Moody has outlined a stance similar to LePage.