Even In The Best-Case Scenario, Expanded Medicaid Coverage In Maine Won't Kick In Till Late Summer

Nov 9, 2017

Maine voters voted overwhelmingly to expand Medicaid. But how long will it be before the 70,000 or so Mainers who qualify are covered? It could be months.

Maine Public State House Reporter Mal Leary and Maine Things Considered Host Nora Flaherty discussed the implementation of Maine’s Medicaid expansion. This interview has been edited for clarity.

Flaherty: I think when people heard the news that the referendum had passed many thought coverage would start shortly. Why is it going to take so long?

Leary: First of all, everything in government takes longer than you expect, and this certainly will be no exception. Under the state constitution the referendum becomes effective 45 days after the Legislature reconvenes Jan. 3. That’s to give the Legislature time to fund the expansion, and it’s there for any bill that has a price tag on it. Right there we see the first potential slowdown in the implementation. The governor has said very clearly he’ll veto a tax increase or taking the money out of the rainy day fund, which are the two easiest ways to come up with the money to pay for this. So therefore we’re going to immediately have this sort of gridlock between the governor and the Legislature where most will support expansion, as they have in the past, But it’s likely that House Republicans will continue to support him and block the money from either one of those easy sources.

Flaherty: So even if the majority of the Legislature passed a bill that funded expansion, that’s not enough? The governor can still block it?

Leary: The governor can still block it because unlike what people believe, the citizen initiative process simply passes a law just like any law the Legislature enacts, so it can be changed. Voters can force a vote on a proposal, but once that proposal has been adopted, it’s like any other law that’s before the Legislature — they can change it, they can modify it. And remember we saw earlier this year the outright repeal of the surtax to pay for schools that the voters had approved at referendum just a few months previously, so without funding, the expansion of Medicaid is really dead in the water, because most of Medicaid is paid for by the federal government, and they’ll require that the state fund their share of the program at some point down the road.

Flaherty: Let’s say that the Legislature does come up with the funding in the spring. Will people then be able to get the coverage that voters approved?

Leary: I wish it were that simple, but of course it isn’t. This is a joint federal-state program. The expansion and implementation must be approved by the federal government. And that’s a process that takes months to begin with. The voter approved bill itself says coverage should start about six months after the law is effective. So we’re looking at a best case of late summer before Mainers get coverage, and of course it could be longer. The federal government will not approve an expansion that does not provide the state’s share of the cost. And remember, it took a state government shutdown over the Fourth of July weekend a few months ago to get a two-year state budget passed, so lawmakers could put off the law until the new governor and Legislature take office a year from January, hoping there will be less gridlock and more cooperation between the new governor and Legislature.

Flaherty: It’s my understanding that people in all areas of the state voted to expand Medicaid. Is there not a political cost to Republican politicians in the State House to allowing it to get held up?

Leary: There could be a political cost, as you point out, from the rejection of what the voters passed a year ago, and that is additional money for schools. There could be backlash on them going in and changing the tip credit on the minimum wage bill. There’s always that possibility of a backlash. But you’ve got to remember a lot of these folks are also term limited so they’re not going to have to worry about the voters, they’re just voting with their governor.

This story was originally published Nov. 8, 2017 at 5:17 p.m. ET.