Judge orders Maine to implement voter-approved Medicaid expansion

A judge Monday ordered Republican Gov. Paul LePage's administration to quickly implement the state's voter-mandated Medicaid expansion, which LePage had tried to block.

Kennebec County Superior Court Justice Michaela Murphy ordered the state Department of Health and Human Services to submit a state plan amendment to the CMS by June 11 to implement the expansion.

The voter-passed initiative requires the state to start enrolling low-income adults into the expanded Medicaid program starting July 2. An estimated 70,000 people with incomes up to 138% of the federal poverty level would qualify for coverage under the Affordable Care Act-authorized expansion.

The LePage administration is expected to ask Murphy to stay her order pending an appeal to the Maine Supreme Judicial Court.

LePage and his administration had argued they can't act until the state Legislature passes an appropriation to fund the expansion.

But the judge held that the law overwhelmingly passed by Maine voters in November is clear and unambiguous. She found the statute clearly required the state plan amendment to be submitted to the CMS by April 3 and expansion implementation rules be adopted by July 3.

She also rejected the state agency's argument that it couldn't enter into a binding contract with the CMS to expand Medicaid without funding appropriated by the Legislature for the expansion. She said federal law allows the state Legislature to pass a law withdrawing from the expansion if lawmakers so desire, since Medicaid expansion is optional for the states.

James Kilbreth, the attorney representing Maine Equal Justice Partners, the group seeking implementation of the expansion, said the state could easily submit the two-page state plan amendment form by June 11.

He said he feels his side's chances of upholding the ruling on appeal are strong, given precedent from other legal challenges to citizen initiatives. "I think we're in pretty good shape."

A LePage spokeswoman said the governor's office is reviewing Murphy's ruling.

Maine would become the 33nd state plus the District of Columbia to expand Medicaid. It would be a boost to expansion supporters, even as the Trump administration and GOP state leaders push to impose new Medicaid work requirements on beneficiaries, which are projected to cause coverage losses.

Virginia's Republican-controlled Legislature passed a bill to expand Medicaid last week.

LePage previously had vetoed five bipartisan bills to extend Medicaid. This is his final year in office.