WASHINGTON — Maine’s effort to cut more than 6,000 low-income young adults from the state’s Medicaid rolls suffered a death blow Monday when the U.S. Supreme Court declined to hear the state’s case.

By declining to hear the case, the court left intact an appeals court ruling that upheld the federal government’s decision to reject the state’s plan to cut 19- and 20-year-olds from MaineCare, the state’s Medicaid program.

The state began covering that population in the early 1990s, but Republican Gov. Paul LePage sought to end the coverage during his first term as governor. However, the federal government said the Affordable Care Act required the state to continue offering coverage.

The state’s Department of Health and Human Services appealed to the Boston-based 1st U.S. Circuit Court of Appeals, which ruled unanimously for the federal government in November.

The LePage administration had argued that the state should not cover the young adults in question because they were all “able-bodied” and able to work.

“Although I am deeply disappointed by the Supreme Court’s decision, we will continue to work tirelessly to reform Maine’s Medicaid program to prioritize our elderly and severely disabled neighbors instead of able-bodied young adults,” said DHHS Commissioner Mary Mayhew in a written statement on Monday.

“They are the case of last resort, if they don’t want to hear it, they don’t want to hear it,” LePage said during an interview Monday afternoon. “So I don’t know who to ask. Do we go by state law or do we go by federal law? So I think we are going to continue to go the path we are going until we are sued and they listen to the case because it needs to be resolved.”

Robyn Merrill, executive director of Maine Equal Justice Partners, which advocates for Medicaid recipients, said the justices’ decision came as no surprise given the general consensus of the weakness of Mayhew’s case.

Still, many other low-income residents have lost MaineCare coverage because of cuts to the program under the LePage administration, she said.

“We’re very pleased that these young people have been able to maintain their coverage, unlike the 40,000 to 50,000 people who have lost their health insurance,” Merrill said.

The case had become politicized because Democratic Attorney General Janet Mills had declined to represent Mayhew, saying she agreed with the federal government’s position that such a cut in the MaineCare rolls was illegal.

Furthermore, Mills filed as an intervenor in the case to take an active position against LePage and Mayhew in court. LePage was authorized to use outside counsel to pursue the appeal.

In an interview Monday, Mills said the Supreme Court had vindicated her position.

“My job is to uphold the rule of law,” Mills said. “My advice to the administration in this matter was based on the law, and the 1st Circuit Court of Appeals and the Supreme Court of the United States has vindicated that.”

Joel Allumbaugh of the conservative Maine Heritage Policy Center called the court’s decision “unfortunate.”

“The ACA often touts flexibility for states yet we continually find none,” he said in an email. “States need flexibility to tailor solutions for their residents. Forcing one-size-fits-all programs is a huge lost opportunity throughout the ACA.”

The case is separate from another challenge to the Affordable Care Act the Supreme Court will hear later this month, which will determine the fate of federal subsidies that help millions of Americans to afford health insurance under the law.

BDN Health Editor Jackie Farwell contributed to this report. Follow Mario Moretto on Twitter at @riocarmine.

Mario Moretto

Mario Moretto has been a Maine journalist, in print and online publications, since 2009. He joined the Bangor Daily News in 2012, first as a general assignment reporter in his native Hancock County and,...