A Superior Court judge ruled Monday that the Maine Department of Health and Human Services and the LePage administration must follow the voter-approved Medicaid expansion law and submit a state plan amendment next week that sets the health coverage in motion for thousands of low-income Mainers.

The court set a June 11 deadline for the state to file the amendment with the federal government.

In November, 59 percent of voters approved Medicaid expansion, making Maine the first state to expand the program through a citizen-initiated referendum.

However, Republican Gov. Paul LePage has steadfastly opposed expansion, calling on the Legislature to fund the expansion before he implements it.

Maine Equal Justice Partners, Consumers for Affordable Health Care, Maine Primary Care Association, Penobscot Community Health Care and five individuals sued the DHHS and the LePage administration on April 30. Oral arguments were held May 24 and on Monday, Maine Superior Court Justice Michaela Murphy sided with the petitioners and ordered the state to comply with the voters’ will.

“The governor cannot ignore the law,” Robyn Merrill, executive director of Maine Equal Justice Partners, said in a statement. “Maine voters did not make a request at the ballot, they passed a law, and laws are not optional. Today’s ruling is good for more than 70,000 Mainers who the law says can sign up for health care on July 2.”

However, Murphy’s decision could be appealed.

LePage spokeswoman Julie D. Rabinowitz, in an email response to a request for comment on the ruling, said that the administration is reviewing the court’s decision. Telephone messages left with the state’s Boston-based attorney, Patrick Strawbridge, were not returned Monday night.

“We won. I think it’s a great decision for all low-income Mainers,” David Kallin, an attorney with Portland-based Drummond Woodsum, said in an interview. Kallin, James Kilbreth, also of Drummond Woodsum, and Charlie Dingman of Preti Flaherty represented the petitioners on a pro bono basis. “This is the first step on the road to get health care for Mainers who really need it.”

Kallin estimates that more than 70,000 low-income Mainers will be able to apply for Medicaid health insurance beginning July 2 as a result of Murphy’s ruling. Those individuals now face a delay in obtaining medically necessary and potentially life-saving health coverage.

The expansion will open up the program to Mainers who earn 138 percent of the federal poverty level – $16,753 for an individual or $34,638 for a family of four.

Justice Murphy’s ruling will require DHHS Commissioner Ricker Hamilton to file a state plan amendment with the U.S. Department of Health and Human Services by Monday. In her ruling, Murphy disagreed with the state’s position that the executive branch has no obligations to file a plan amendment until legislative appropriations to fund the expansion have been made.

“The court is not persuaded that the executive branch is excused from clear statutory obligations by the Legislature’s failure to follow through with legislative obligations, as defined by the executive branch,” Murphy wrote in her 13-page ruling. “The court concludes that the commissioner’s complete failure to act cannot be considered substantial compliance with (the referendum vote).”

The plan amendment, which Kallin described as a routine, two-page, check-the-box form, establishes a process for ensuring eligibility for people under 65 years of age who qualify for medical assistance.

Congress created Medicaid — it is known as MaineCare in Maine — in 1965 as a program to provide federal funds to states that pay for medical treatment for the poor. To receive federal funds, states must prepare a plan that defines the category of individuals eligible for benefits and the specific kinds of medical services covered by the plan.

Once the state plan amendment has been filed and approved, Maine will begin receiving federal matching funds that Kallin said will pay for about 90 percent of the costs associated with Medicaid expansion. The law that was passed by voters in November required the state to file the plan amendment paperwork by April 3.

Though LePage did not react to the court decision on Monday night, he and his allies have acknowledged that Medicaid expansion is law. The governor also has maintained that his hands are tied until the Legislature appropriates sufficient funds to pay for the expansion.

Estimates of the cost of expanding Medicaid have varied widely, but the non-partisan Office of Fiscal and Program Review has projected that it would cost about $45 million in the first year. The LePage administration claims it will cost as much as $60 million in the first year and as much as $100 million annually in future years.

Lawyers for the petitioners have argued that there are already enough funds in the state’s Medicaid account to get through the current budget biennium, which ends in June 2019. They also have argued that there is more than $140 million in unallocated funds that the state could draw from at any time.

Murphy’s ruling evoked reactions both on a state and national level.

“Today is a victory for the 70,000 Mainers who stand to gain coverage from Medicaid expansion and for everyone who believes that health care should be a right for all, not just a privilege for a wealthy few,” Democratic National Committee Chairman Tom Perez said in a statement. “Thanks to today’s ruling, Gov. Paul LePage will finally be forced to respect the will of Maine’s voters, who voted overwhelmingly to expand Medicaid last November.”

“This decision is both a victory for the more than 70,000 Mainers, who stand to benefit from Medicaid expansion and a sharp rebuke of Gov. LePage and his senseless obstruction of the law. The people of Maine have spoken, the court has spoken, and now Gov. LePage and Republicans must listen,” Maine Democratic Party Chairman Phil Bartlett said in a news release.

U.S. Rep. Chellie Pingree, a Democrat reprsenting the 1st Congressional District, also hailed the court’s ruling, saying, “The order is clear: the LePage administration cannot veto Maine’s voter-approved Medicaid expansion law.”

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