September 19, 2019
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Federal appeals court rejects LePage administration attempt to trim Medicaid rolls

Seth Koenig | BDN
Seth Koenig | BDN
Gov. Paul LePage

AUGUSTA, Maine — About 6,000 19- and 20-year-old low-income Mainers will continue to receive health insurance coverage under MaineCare, the state’s Medicaid program, after a federal court ruling against Gov. Paul LePage’s administration on Monday.

Maine Department of Health and Human Services Commissioner Mary Mayhew said in a prepared statement that “judges have gone out of their way to defend the unpopular Obamacare law and obstruct the will of the public, made clear two weeks ago, that our welfare funds should be prioritized toward the elderly, disabled and truly needy, not job-ready young adults.”

Monday’s decision by the U.S. Court of Appeals for the First Circuit echoed previous rulings by the U.S. Department of Health and Human Services and the Centers for Medicaid and Medicare Services that Maine cannot drop Medicaid coverage for 19- and 20-year-olds whose individual or family incomes fall below 156 percent of federal poverty guidelines.

For a 19-year-old who lives with her parents, for example, that equals a monthly household income threshold of $2,656 per month.

In 1991, under Republican Gov. John McKernan and during one of state government’s worst financial crises, Maine voluntarily extended coverage to 19- and 20-year-olds who meet the income eligibility criteria. That population has not had its MaineCare coverage interrupted during the appeal process; Monday’s decision means it will continue.

The conflict between Maine DHHS and the feds dates back to a 2012 budget bill in which the LePage administration sought to drop coverage of those 19- and 20-year-olds through an amendment to its state Medicaid plan. The Legislature approved the plan, which was estimated to save $3.7 million in state funds and $6.9 million in federal matching funds.

First the federal DHHS, and then the Centers for Medicaid and Medicare Services, responded that the waiver sought by Maine violated the Patient Protection and Affordable Care Act, otherwise known as Obamacare, which requires states to maintain existing Medicaid eligibility standards for children until October 2019. The law says that states must adhere to that “maintenance of effort” in order to continue receiving federal Medicaid grants.

In its legal argument, DHHS claimed that the federal government’s demand on the state amounted to an illegal unfunded mandate that violated the state’s rights. LePage and DHHS have long argued that they are intent on providing services to the state’s most vulnerable populations, such as the sick and elderly, before they consider doling out services to healthy, able-bodied adults.

“By moving the goalposts and forcing Maine taxpayers to pay for more welfare, the federal government is using its heavy hand to push its agenda of putting as many people as possible on a broken Medicaid system. … We are reviewing our options and remain committed to fighting for the flexibility states need from the federal government to manage their welfare programs, balance their budgets and ensure that the needs of taxpayers and the truly needy are not forgotten,” said Mayhew.

The federal appeals court found fault with that argument.

“We reject Maine DHHS’s argument that ‘the maintenance of effort provisions … are not sufficiently tailored to any constitutional purpose,” wrote Chief Circuit Judge Sandra L. Lynch, who represented a unanimous three-judge ruling. “To the contrary, [the Affordable Care Act] ensures the legitimate purpose of ensuring that children do not lose health insurance as the country transitions from the pre-ACA Medicaid regime to the post-ACA Medicaid regime.”

Jack Comart, litigation director for Maine Equal Justice Partners, which advocates for low-income Mainers, said his group and a coalition of organizations and officials in Maine sided with the Centers for Medicaid and Medicare Services on the case.

“As an organization, we think it’s good that coverage will continue for this group of people,” said Comart. “They don’t have any other options, really.”

Attorney General Janet Mills, who refused to represent DHHS in the case but authorized Mayhew to seek alternative counsel that was paid for out of LePage’s contingency fund, was also an intervenor in the case and argued in an amicus brief that Maine’s request should be rejected. Mills said Monday that she has long voiced her doubts about the constitutionality of the administration’s case.

“We expressed the view that the constitutional claim they were presenting had very little legal merit,” said Mills. “I didn’t feel the need to push that forward on their behalf, but because of the earnestness of their position, I felt they would be able to go forward with outside counsel.”

Aside from the merits of the state’s case, Mills said she acted on principle.

“You shouldn’t have a cliff at age 18 where a lot of needy people lose their health insurance,” said Mills. “That small group of people in this state are extremely unlikely to have health coverage otherwise.”


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