AUGUSTA — In a forceful letter to legislative leaders Monday, Gov. Paul LePage again laid down his demands for funding a voter-approved Medicaid expansion in Maine, emphasizing his position that the estimated $60 million a year cost be paid for without any tax increases.

“The Legislature must now step up and identify a way to fund this, and it is your duty to the people of Maine to identify a way to pay for expansion that is both fiscally prudent and sustainable, ” LePage wrote in the three-page letter.

The state’s share of the expansion would draw down an estimated $525 million a year in federal matching funds under the Affordable Care Act.

LePage issued four principles he wants the Legislature to abide by as it begins the process of working out how to pay for the expansion voters endorsed last month. The expansion would make MaineCare health care benefits available to about 80,000 Mainers earning less than 138 percent of the federal poverty level, or about $17,000 a year for a single adult.

The principles include:

• No tax increases on Maine families or businesses.

• No use of the Budget Stabilization Fund, the state’s rainy day account.

• No use of other one-time funding mechanisms or “budget gimmicks.”

• Full funding of home and community-based services for elderly and disabled residents and no reductions in funding for other populations now receiving state-funded health care benefits.

The governor, who has vetoed five Medicaid expansion bills passed by the Legislature since 2013, also wants lawmakers to cover the state’s debt to the federal government following Riverview Psychiatric Center’s decertification by the federal Department of Health and Human Services, a tab of about $60 million.

“Let me be clear,” LePage wrote. “I believe it is both contradictory and disingenuous for Democrats, the hospitals, the advocacy groups, and the wealthy out-of-state special interests who campaigned for this bill to claim that adding 80,000 people to an entitlement program will save money, but maybe it’s time to take them at their word.”

The letter was sent to both Republican and Democratic leaders in the Maine Senate and House of Representatives.

The Legislature’s budget writing Appropriations Committee is expected to discuss expansion costs and draft questions for the Maine Department of Health and Human Services, which would oversee the expansion, when it meets Wednesday.

This story will be updated.

Gov. Paul LePage at Simones’ Hot Dog Stand in Lewiston on Dec. 7, 2017. (Sun Journal file photo)

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