The Medicaid Expansion Fight Goes From Ballot Initiative to Court in Maine

Medicaid expansion continues to be a hot button issue in the numerous states that have yet to expand the program under the Affordable Care Act of 2010 (“ACA”), and the latest battlefield is a Maine courthouse.

Medicaid expansion continues to be a hot button issue in the numerous states that have yet to expand the program under the Affordable Care Act of 2010 (“ACA”), and the latest battlefield is a Maine courthouse.

Mainers Vote for Medicaid Expansion; Other States May Follow

In November 2017, Maine voters approved a ballot initiative expanding Medicaid in the state, and last month, patient advocacy groups in Maine sued the administration of Governor Paul LePage in an effort to force him to implement a Medicaid expansion plan. Maine was the first state to take the Medicaid expansion issue directly to the voters, and the ballot initiative passed convincingly with 59% voting in support of expansion. The Center on Budget and Policy Priorities, a nonpartisan research and policy institute, estimates that expansion, which applies to individuals with income levels ranging from 100% to 138% of the federal poverty level, will provide health care coverage to more than 70,000 Mainers. Advocates of Medicaid expansion in other states are now pushing for similar ballot initiatives, and in Utah and Idaho, advocates have already gathered enough signatures to place the issue on the ballot in the November elections. Advocates in Nebraska are attempting to do the same.

Administration Opposition to Expansion

The lawsuit stems from Governor LePage’s long standing opposition to Medicaid expansion and his refusal to move forward with an expansion plan, despite the passage of the ballot initiative. LePage, who vetoed five different legislative efforts to expand Medicaid, sent a letter to legislators in December 2017, stating that he would not move forward with expansion unless the legislature met a series of conditions. Among other things, LePage told legislators that they must fully fund the expansion and that the funding may not come from tax increases or from the state’s budget surplus. The legislature did not meet these conditions, and LePage’s administration subsequently missed an April 3, 2018 deadline for submission of an expansion plan to the federal government.

The passage of this deadline without action led directly to the April 30 lawsuit that seeks to force LePage to implement Medicaid expansion in accordance with the ballot initiative. The petitioners argue that the Governor is obligated by law to move forward with implementation. They also seek an expedited hearing with the hopes of resolving the issue in time for eligible Mainers to enroll in Medicaid by July 2.

A Continuing Story

Medicaid expansion continues to be at the forefront of the health care policy battle across the country. As Arent Fox has previously covered, Medicaid expansion developments in specific states have implications for patients and providers across the country. Given Maine’s successful ballot initiative in November 2017, we expect to see more aggressive pushes to force Medicaid expansion in states that have resisted implementing expansion programs thus far. Arent Fox’s Health Care Group will continue to monitor this case and other developments in this area.

Arent Fox’s Health Care Group regularly monitors developments related to Medicaid expansion and other health policy matters. If you have any questions regarding this topic, please contact Sean Clerget in our Washington, DC office or the Arent Fox professional who regularly handles your matters.

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