October 16, 2018
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LePage digs in for Medicaid expansion funding battle

Robert F. Bukaty | AP
Robert F. Bukaty | AP
Maine Gov. Paul LePage speaks at a town hall meeting in Yarmouth, March 8, 2017.

Two days before the Legislature’s budget committee is scheduled to discuss how to fund the Medicaid expansion law Maine voters passed last month, Gov. Paul LePage reiterated a set of demands that he said must be met before his administration can fulfill the referendum’s mandate.

But LePage’s office told lawmakers in a separate communication last week that representatives from the Maine Department of Health and Human Services would not attend Wednesday’s meeting.

Democratic House Speaker Sara Gideon said the governor’s recent statements are “just him being backed into a corner on an issue he never wanted to see the light of day.”

In a Dec. 11 letter to legislative leaders, LePage laid out a number of conditions, including that there be no tax increases, that money from the budget stabilization fund is not tapped, that the funding mechanism be ongoing, and that waitlists for services for elderly and disabled people be eliminated before state government pays to expand Medicaid eligibility.

LePage also wrote that the money appropriated by the Legislature for Medicaid expansion must be based on the Department of Health and Human Services estimates of the state’s share of the cost, not on what the Office of Fiscal and Program Review estimated.

The nonpartisan Office of Fiscal and Program Review pegged the cost after full implementation at more than $54 million a year, which would be matched with $525 million in federal matching funds. The Department of Health and Human Services has estimated the cost of expansion will be at least $63 million next year, $82 million in fiscal year 2020, $97 million in 2021 and more than $100 million every year after that, according to the governor’s office.

[What’s next for Medicaid expansion as LePage and Democrats dig in]

The letter represents the latest chapter in LePage’s opposition to expanding Medicaid, a concept he has successfully vetoed five times during his tenure.

“While I remain adamantly opposed to the policy of expanding Medicaid because it threatens our state’s financial stability, the Legislature is allowing it to become the law,” LePage wrote. “You, the Legislature, now must do your job to fund it as quickly as possible so the executive branch can do its job: execute the law. But I will not implement it without adequate funding.”

In an email to lawmakers last week, LePage’s office said no one from the executive branch would attend Wednesday’s meeting and that questions should be submitted to the governor’s office in writing. Those restrictions have been common from LePage throughout his tenure.

LePage argues that expansion proponents are underestimating how many people will sign up and at what cost to taxpayers. Part of the argument from the other side is that the infusion of federal cash will provide health insurance for more people — reducing the amount of unpaid care hospitals provide — while creating health care jobs and stimulating Maine’s economy.

Gideon said lawmakers are considering various funding sources but that the executive branch needs to be involved. She said exactly how much expansion will cost is dependent on work between the Department of Health and Human Services and the Centers for Medicare and Medicaid Services.

Under the new law, the state is required to submit its expansion plan within 90 days of the Legislature convening in January.

“The state of Maine has to work with CMS in order to get this whole plan going,” Gideon said. “No one person gets to decide when we’re talking about this particular issue of Medicaid expansion. … My hope and my belief is that Republicans and Democrats are going to do this together. “

Currently, Maine’s Medicaid program, known as MaineCare, covers a range of groups, such as pregnant women, parents with children younger than 18 and disabled people. Qualifying income thresholds vary. Parents and disabled adults, for example, qualify if their incomes are below 100 percent of the federal poverty level. That’s $12,060 a year for a single person, $20,421 for a family of three and $28,780 for a family of five.

The bill passed in November would raise the qualifying threshold to 138 percent of the federal poverty level. That’s $16,643 a year for a single person, $28,180 for a family of three and $39,716 for a family of five. The bill also expands coverage to adults who are not disabled and don’t have children, which would be a change from current law.

The Legislature’s Appropriations and Financial Affairs Committee is scheduled to meet to discuss the funding issue at 1 p.m. Wednesday at the State House.

Also on the agenda is an update on state revenue projections over the next few years. Though a surplus is projected, LePage has said he wants all or much of it to be added to the state’s rainy day fund.

For a roundup of today’s Maine political news, click here for the Daily Brief. Click here to get Maine’s only newsletter on state politics via email on weekday mornings.

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