LePage Refuses To Implement Medicaid Expansion Until Legislature 'Fully' Funds It

Nov 9, 2017

The ballot campaign to expand Medicaid is over. But making sure roughly 70,000 low-income Mainers actually receive that health coverage? Far from it.

Republican Gov. Paul LePage is threatening to block implementation of Maine’s landmark Medicaid expansion law, which voters overwhelming approved Tuesday. The move was expected, but it sets the stage for yet another pitched battle over Medicaid in the Legislature.

Robyn Merrill, executive director of Maine Equal Justice Partners, has been battling Gov. LePage over the expansion of Medicaid through the Affordable Care Act for over four years. And on election night, she and supporters of Question 2 finally delivered a resounding blow to the governor’s strident — and successful — opposition to expand eligibility of the taxpayer-funded health program.

They went directly to voters.

The victory at the ballot box was historic, and potentially a road map for the 18 other GOP-controlled states that have refused to expand Medicaid under the ACA. But LePage isn’t accepting defeat.

“Give me the money,” LePage told Maine Public Radio Wednesday.

In a brief interview with Maine Public Radio, LePage reiterated what he said in a written statement less than 10 hours after Question 2 was ratified by voters. He won’t implement Medicaid expansion until the Legislature appropriates funds to pay for the state’s share of the program.

“As soon as the Legislature gives me the funds, I will enforce the referendum, but without money there’s nothing I can do,” he said.

The governor says implementation requires state money. The feds, who pay for 94 percent for the first two years of the expanded program, will pay over half a billion dollars annually. But LePage says he won’t initiate the rulemaking process to trigger the release of federal funds until the Legislature passes a new spending bill to pay for the state’s share.

That’s roughly $55 million a year, according to an analysis by the Legislature’s nonpartisan budget office.

But Robyn Merrill, with Maine Equal Justice Partners, says the governor doesn’t have a choice.

“The bill that people passed yesterday requires the governor and his administration to implement the law and to provide coverage to over 70,000 people,” she said. “It’s incredibly urgent and people have waited long enough. And this is going to happen.”

In other words, the law is the law. And Merrill says her organization will do whatever is required to make sure the administration adheres to it. That includes legal action, if necessary.

“This is the law of the land. The people passed this yesterday. It will be become effective 45 days after the Legislature convenes,” she said.

But while a court battle may loom in the distance, the political fight is already underway.

Democratic House Speaker Sara Gideon and Senate Minority Leader Troy Jackson both released statements Wednesday blasting the governor for threatening to block the will of voters. Meanwhile, House Republican leader Ken Fredette, of Newport, once again aligned with the governor.

Fredette’s caucus has outsize influence in a Legislature divided between the Democratic-controlled House and the Republican-led Senate. That’s because circumventing LePage often requires a two-thirds vote in both chambers, which is how Fredette and House Republicans blocked a bipartisan budget deal and shutdown state government last summer.

And it appears LePage and House Republicans are preparing for a similar standoff over Medicaid expansion. He was asked Wednesday whether he’ll veto any bill that attempts to fund Medicaid expansion with tax revenues.

“That is correct,” LePage said.

“The administration and DHHS have an obligation, within some very strict time frames, to move forward with everything they need to do to implement this,” said Westbrook Representative Drew Gattine, the Democratic lead on the Legislature’s budget-writing committee.

Gattine reiterated Merrill’s point, that the administration should adhere to the voter-approved law and that he hopes Republicans will help fund the state’s share. But he also says the Legislature doesn’t need to get into a big budget fight to implement expansion.

“The vast majority of money that needs to come from the state actually comes when we start paying claims,” he said. “The state share is obligated on a claim-by-claim basis.”

In other words, Gattine says the Legislature doesn’t need find $55 million to fund Medicaid expansion right away. After all, the federal money isn’t required to roll in until 180 days after the law takes effect in March. That means people eligible for Medicaid under expansion won’t likely receive benefits until next summer, even if everyone in Augusta agreed to implement the law as voters intended.

But given the governor’s immediate declaration to halt expansion, it’s possible the 70,000 Mainers who will soon qualify for Medicaid will have to continue to wait to receive health coverage.

This story was originally published Nov. 8, 2017 at 1:38 p.m. ET.