September 25, 2018
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Funding remains at heart of Medicaid expansion conflict as Maine high court hears case

Robert F. Bukaty | AP
Robert F. Bukaty | AP
In this Tuesday, Nov. 7, 2017, file photo supporters of Medicaid expansion celebrate their victory, in Portland, Maine. The credit rating agency Moody's Investors Service says Maine voters' decision to expand Medicaid might make it more difficult for the state to keep its budget balanced. Voters decided they wanted Maine to expand Medicaid to some 70,000 citizens in a public referendum on Tuesday.
By Michael Shepherd, BDN Staff

PORTLAND, Maine — Justices on Maine’s high court heard arguments Wednesday in a procedural case about Medicaid expansion, but many questions turned to larger issues of whether the state must — or even could — fund it with no revenue dedicated by the Legislature.

Even though it was approved by Maine voters last year, Medicaid expansion has been slow-walked into the judicial branch after inaction by Gov. Paul LePage and the Maine Legislature, which wasn’t able to get a start-up funding plan past a governor’s veto last week.

The lawsuit from advocates against the LePage administration came after the Maine Department of Health and Human Services failed to meet an April 3 deadline to file a simple plan with the federal government to expand Medicaid under the Affordable Care Act to an estimated 70,000 Mainers, beginning coverage July 2.

Lawyers for the state have argued that it doesn’t have to comply with the law because the Legislature hasn’t earmarked money to pay for it, but plaintiffs — led by the progressive Maine Equal Justice Partners — have argued the money could come from existing revenues or state surpluses.

A lower-court judge agreed with advocates in June, ordering the LePage administration to submit the expansion plan. But DHHS appealed that ruling to the Maine Supreme Judicial Court, which put it on hold at least until Wednesday’s arguments at the Cumberland County Courthouse.

The issue before the high court officially in this case is whether that delay should continue until the state’s appeal can be heard. On Wednesday, justices grilled both lawyers on larger questions of whether a funding mechanism is in place and whether courts should intervene in a conflict between legislative and executive branches.

Justice Donald Alexander asked Jamie Kilbreth, a Maine Equal Justice Partners attorney, whether the court should “second-guess” LePage’s past efforts to contain Medicaid costs. Justice Joseph Jabar asked Patrick Strawbridge, a private attorney for the department, if people eligible for coverage under the law will be denied while the status quo is maintained.

Since the July 2 deadline, advocates have urged eligible Mainers to sign up for coverage under the expansion provisions, but it’s still unclear how DHHS is handling applications. It has 45 days to issue rulings on Medicaid applications.

Strawbridge told reporters Wednesday the department is “reviewing those applications within the procedures that it has for reviewing all applications” and it will make decisions “in a timely fashion.” The department has developed an application form asking applicants if applicants are signing up because of expansion.

A DHHS spokesperson hasn’t answered questions from the Bangor Daily News about how many Mainers have cited expansion as a reason for enrolling. A spokeswoman for Maine Equal Justice Partners has said roughly 500 people have used an online tool to check eligibility.

The case before the high court only concerns the April deadline — not the July deadline for coverage. The Maine Supreme Judicial Court will rule on whether or not to keep the delay of the lower court’s decision next, but there is no timeline for a decision.

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