A Maine judge ordered the LePage administration to implement Medicaid expansion on Monday, but what happens next – and when 70,000 newly eligible Mainers can begin signing up for the health insurance – is unclear.

The governor’s office didn’t respond to a request for comment Tuesday on how the administration plans to respond to the court order, which directs the state to submit an expansion letter to the federal government by Monday.

Republican Gov. Paul LePage has long been a staunch opponent of Medicaid expansion and has refused to implement it, despite voters approving it by a 59 to 41 percent margin in November.

Senate Assistant Majority Leader Amy Volk, R-Scarborough, said in a tweet on Tuesday that she supports implementing Medicaid expansion.

“I think this is a good thing,” said Volk, responding to the court ruling. “Conservative states across the country have models we can learn from. It’s time to implement what voters approved.”

Rob Poindexter, spokesman for House Minority Leader Ken Fredette, R-Newport, said LePage “obviously has to submit a plan. But what we don’t know is, will it be approved? And when will it be approved? That could take a year. Nowhere in the court’s decision did the judge say the Legislature must act.”

Other top Republicans in the State House did not respond to requests for comment Tuesday on whether they agree that the administration should do as the court directed. During legislative debates on Medicaid expansion bills, some Senate Republicans supported expansion, but House Republicans stood with LePage. Democrats have long pushed for expansion.

Jack Comart, litigation director for Maine Equal Justice Partners, which sued the LePage administration in April over its failure to act on expansion, said there’s no reason Mainers eligible for Medicaid shouldn’t be able to begin signing up on July 2, as is required by law. He said if the administration refuses to accept eligible enrollees in July, Maine Equal Justice will file another lawsuit against LePage for failing to comply with the law.

“There’s nothing stopping them from having the program in effect July 2,” Comart said. “They have people there to take applications.”


About 70,000 Mainers would be newly eligible for Medicaid under expansion, which would cover people who earn up to 138 percent of the federal poverty limit, $16,753 per year for an individual or $34,638 for a family of four.

Superior Court Justice Michaela Murphy on Monday sided with Maine Equal Justice Partners, ordering the LePage administration to file a state plan amendment with the U.S. Centers for Medicare and Medicaid Services, a necessary step to implement the expansion, by next Monday, June 11.

The plan amendment is a routine two-page form that the LePage administration was supposed to submit in April but never did, spurring the lawsuit. Medicaid is a blended federal-state program, with 90 percent or more of expansion funding coming from federal dollars. Thirty-four states and the District of Columbia have approved Medicaid expansion, but Maine was the first state to do so at the ballot box.

LePage’s attorneys argued that the Legislature must approve separate funding for the expansion, but Murphy rejected that argument on Monday.

The state’s nonpartisan Office of Fiscal and Program Review has projected the cost of Medicaid expansion would be about $45 million in the first full year of implementation.


Ann Woloson, executive director of Consumers for Affordable Health Care, said Medicaid would have many benefits for the health of Mainers, and would also help keep insurance premiums for everyone lower. A federal study in 2016 showed that insurance premiums were 7 percent lower in Medicaid expansion states compared to non-expansion states.

MaryBeth Musumeci, associate director at the program on Medicaid and the uninsured for the Kaiser Family Foundation, a Washington-based health nonprofit, said that expanding Medicaid, while it could take some time, is not a complicated task for state governments because states already operate Medicaid programs.

“This is not a heavy lift,” Musumeci said. “This is essentially adding a coverage group to existing Medicaid groups. There’s already an existing infrastructure and delivery system for the program.”

New Hampshire first approved Medicaid expansion in late March 2014, and it was implemented by mid-August of that year.

Gov. Paul LePage

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