The Maine Supreme Judicial Court dismissed an appeal by the LePage administration and lifted a court’s stay last week, which means the Maine Department of Health and Human Services must submit a State Plan Amendment to the federal government that will allow the state to draw down federal dollars to expand Medicaid for 70,000 low-income Mainers. But the legal battle is not yet over, as the court also ruled that the Superior Court must settle questions related to the state’s share of funding for the law.

In its 6-1 decision, the justices noted that the law requires the administration to provide Medicaid to newly eligible individuals once 180 days have elapsed. But since 180 days had not elapsed when the Superior Court first ordered the administration to file the amendment back in June, it did not rule on the question of whether the governor must provide the state’s share of funding for expansion. The governor has argued that he shouldn’t have to file the paperwork because he vetoed a bill that would have provided the necessary start-up funding for the law. Chief Justice Leigh Saufley and Justice Andrew Mead wrote that there are two options — either the Legislature passes a bill to fund the law or the judicial branch decides whether it has the constitutional authority to mandate that a citizen-initiated law be funded.

“Neither of those events has been accomplished to date, leaving the question of funding unresolved,” the justices wrote. “Yet, as the parties acknowledge, the federal Medicaid program requires that any Medicaid plan or state plan amendment must include information regarding the extent of state financing for the plan.”

Under the Affordable Care Act, the federal government will provide 94 percent of the Medicaid expansion funding in 2018, or $525 million, while the state must match it with about $54.5 million once the federal match drops to 90 percent in 2021, according to the Legislature’s nonpartisan Office of Fiscal and Program Review (OFPR). However, OFPR also estimates that Maine has enough resources budgeted to fund Medicaid until next May, so advocates say it’s unnecessary to pass a funding bill until next year.







In his dissenting opinion, Justice Donald Alexander agreed with the governor that he shouldn’t have to fund Medicaid expansion until the Legislature appropriates the money. He wrote that by ordering the governor to submit a state plan amendment, the court could end up subjecting state officials to contempt charges and/or appointment of a receiver if no plan is submitted. And once the plan is submitted, he reasoned, a court may order the administration to pay out of unspent appropriations.

“The prospect of the courts reviewing state program accounts, identifying unspent funds, and ordering those funds transferred to and spent on the Medicaid expansion demonstrates considerable misunderstanding of our constitutional separation of powers,” wrote Alexander.

In a statement, Maine Equal Justice Partners, which led the referendum campaign and the legal challenge, called the court decision a “step forward.”

“Medicaid expansion is the law. More than 70,000 Mainers became eligible for health care coverage on July 2. We welcome the court’s opinion that the state must file for federal matching funds immediately,” said Jack Comart, litigation director at Maine Equal Justice. “Since July 2nd, I have spoken nearly every day with families and individuals who are qualified for care and have unmet, urgent medical needs. This decision will bring them that much closer to getting the care they need and that Maine voters enacted on their behalf.”

MEJP has been encouraging eligible Mainers to apply for the coverage despite the the governor’s obstruction. Under the new law, Mainers ages 21 to 64 whose income is at or below 138 percent of the federal poverty level, which is about $16,643 per year for a single person and $34,000 for a family of four, are MaineCare–eligible. However, recent news reports have indicated that the LePage administration has been denying coverage to eligible individuals. The governor’s spokesman Peter Steele did not answer a request for comment, but LePage has vowed to go to jail before implementing the Medicaid expansion law, which nearly 60 percent of voters supported.