AG goes to court to get LePage’s Medicaid cuts approved

AUGUSTA, Maine — Maine’s attorney general Tuesday asked for a court review of the federal government’s decision not to rule on the state’s request to make about $20 million in cuts to the state’s Medicaid program as quickly as the LePage administration had asked.

Attorney General William Schneider filed documents with the 1st Circuit Court of Appeals in Boston on Tuesday asking for the court to review the federal Centers for Medicare and Medicaid Services’ failure to act by Sept. 1 on Maine’s request for an amendment to its Medicaid state plan.

Schneider also asked the court to order federal officials to issue a ruling on Maine’s request to cut Medicaid and to pay Maine’s state share of related Medicaid expenses for the time they take to consider the request.

In filing the court documents, Schneider is following through on a threat he made to take legal action if Maine didn’t get its way in its efforts to trim about 36,000 people from the Medicaid rolls as a budget-balancing measure. The cuts in question are related to reductions approved as part of two supplemental budget packages passed by lawmakers this year.

“The failure of the [Centers for Medicare and Medicaid Services] to take action in consideration of the State’s critical time constraints is in effect a denial of Maine’s proposed [State Plan Amendment],” Schneider said in a prepared statement. “Given the response from CMS, Maine has no choice but to present this matter to the United States Court of Appeals for the First Circuit.”

A spokesman for the Centers for Medicare and Medicaid Services said he couldn’t comment on pending litigation.

The court action follows a letter the federal government issued Friday to tell state officials the Centers for Medicare and Medicaid Services still was reviewing Maine’s request for an amendment to its Medicaid state plan and it wouldn’t make a decision by Sept. 1.

The LePage administration had requested a decision by Sept. 1 when it submitted its request for the Medicaid plan amendment on Aug. 1. In Friday’s letter to LePage, acting administrator Marilyn Tavenner noted that the Medicare and Medicaid office has 90 days to review such a request.

The state Department of Health and Human Services had been planning to implement the Medicaid cuts by Oct. 1. But if the federal government uses the full 90-day time frame it’s allowed to rule on the state’s Medicaid-trimming request, the state might not have a decision in hand until the end of October.

The state cuts would eliminate coverage for 19- and 20-year-olds, tighten income eligibility requirements for low-income parents and scale back Medicaid access for elderly residents who also qualify for Medicare benefits.

State Health and Human Services Commissioner Mary Mayhew said her department will move ahead with preparations to implement the Medicaid cuts, pending approval from the federal government or the outcome of the state’s court action.

“I am disappointed to receive the letter from the Centers for Medicare and Medicaid Services stating that they will not act on our request for an expedited approval of our State Plan Amendment within 30 days, and that we are forced to take legal action to make reductions that were approved by the Maine State Legislature,” she said in a prepared statement.

Democrats opposed the Medicaid cuts that were part of a May supplemental budget package. Rep. Peggy Rotundo of Lewiston, the lead Democrat on the Legislature’s Appropriations Committee, said Tuesday it was “unconscionable” that the LePage administration was taking legal action to advocate for the cuts.

“The governor’s choosing to spend taxpayer money to go to court to take away health care from the elderly and disabled in Maine,” she said.

Whether the LePage administration is allowed to make many of the proposed Medicaid cuts has been uncertain since lawmakers approved them.

The Affordable Care Act, the Obama administration’s health care reform law, largely prohibits states from making cuts to existing Medicaid services before a 2014 expansion of Medicaid, a program funded by states and the federal government that provides health insurance to low-income residents.

While the Supreme Court in June largely upheld the federal health care reform law, 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 saw 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.