Gov. Paul LePage and 1st District Rep. Chellie Pingree’s recent spat over cuts to Maine’s Medicaid program and whether they’re legal under the Obama administration’s Affordable Care Act made for a political showdown.
But the dispute fell short of producing an agreed-upon answer to whether the Medicaid cuts that have been approved by Republican lawmakers and signed into law by LePage will pass federal muster — a requirement if they’re to take effect.
That means Maine lawmakers, sooner or later, might find themselves with the job of considering another way to close the budget gap the Medicaid reductions are supposed to fill. But the LePage administration, which would have to propose the budget solution, isn’t working on a backup proposal yet.
“We continue to focus our efforts on implementing the changes to Medicaid approved by the Legislature,” Department of Health and Human Services spokesman John Martins said in an email. “Based on the Supreme Court decision, we are confident that our State Plan Amendments will be approved.”
At issue are about $10 million in cuts to the state’s existing Medicaid program: eliminating coverage for 19- and 20-year-olds and tightening eligibility requirements for low-income parents.
LePage and Republican lawmakers signed off on those cuts even though the Affordable Care Act barred states from cutting existing Medicaid services in advance of the law’s major Medicaid expansion in 2014. Whether that provision still stands after last month’s Supreme Court ruling on the health care law is at the heart of the LePage-Pingree faceoff.
The court ruled it unconstitutionally coercive for the federal government to withhold all Medicaid funds from a state that doesn’t participate in the Medicaid expansion.
The LePage administration sees that portion of the ruling as a sign it’s legal to go ahead with cuts to existing Medicaid services simply by applying to the federal government for a routine amendment to Maine’s Medicaid State Plan — a move that requires a federal sign-off.
Pingree, however, noted the court ruling didn’t directly address the law’s provision barring cuts to existing Medicaid services when she sent a letter to Health and Human Services Secretary Kathleen Sebelius, asking her to block the state’s Medicaid cuts.
LePage shot back that Pingree was “ignoring the will of the Maine Legislature and putting her ideological views ahead of the Maine people.”
Attorney General William Schneider backed up the LePage administration’s view, saying the Supreme Court ruling made the Medicaid cuts legal and that the state could “seek further redress in the courts” if the federal government doesn’t allow them.
Pingree’s reading of the Supreme Court ruling lines up with that of Sebelius, who told governors in a July 10 letter that the Supreme Court’s decision applies only to the Affordable Care Act’s Medicaid expansion and to no other Medicaid-related provision of the health care law.
And the Congressional Research Service, which provides policy and legal analysis to members of Congress, chimed in with a memo on July 16 that found the Supreme Court ruling didn’t strike down the “maintenance of effort” provision that bars states from cutting existing Medicaid services.
Depending on the resolution of legal interpretations, Maine’s budget could stay as it is, or lawmakers could be left with a budget gap to fill.
Sen. Richard Rosen, R-Bucksport, who chairs the Legislature’s budget-writing Appropriations Committee, said he didn’t expect his committee to be called back in the near future to address a budget hole.
“I think the case for allowing Maine to amend its Medicaid plan is stronger now than it was earlier,” he said. “I think the state would likely exercise all options available to make the argument and prevail.”
For their part, legislative Democrats say they proposed a plan this spring for a balanced budget that didn’t scale back Medicaid services.
“When we voted on the budget, there were alternative budgets that would have funded these programs and not caused harm to people,” said Rep. Sharon Treat, D-Hallowell.