The Trump administration has delivered Gov. Paul LePage a little parting Christmas gift in the form of a waiver allowing Maine to impose work requirements for low-income MaineCare recipients. However, the plan could run into trouble as Gov.-elect Janet Mills repeatedly stated on the campaign trail that she is opposed to Medicaid work requirements.

In a letter to the LePage administration dated Dec. 21, Centers for Medicare and Medicaid Services Administrator Seema Verma granted Maine what is called a Section 1115 waiver, which allows states to try experimental pilot projects to meet certain objectives of the Medicaid program. In this case, the Trump administration is allowing the state to eliminate MaineCare coverage for any so-called “able bodied” adult recipients who fail to work, volunteer, attend school or a work training program for at least 80 hours a month. The waiver also allows the state to charge MaineCare recipients premiums of up to five percent of their incomes. In a statement, LePage expressed his glee. 

“Under my Administration, we have worked to lift Mainers out of poverty by prioritizing work within our welfare programs,” said LePage. “With the approval of the 1115 waiver, we will be able to replicate that success in our Medicaid program.”

The work requirements are modeled after a similar mandate in the Temporary Assistance for Needy Families cash assistance program. The Medicaid work requirements are part of a national effort by the far-right Foundation for Government Accountability (FGM), a Florida-based think tank led by Tarren Bragdon, a former Maine legislator, former CEO of Maine Heritage Policy Center, and Governor Le-Page’s transition team leader after his first election. Last year, LePage and Bragdon lobbied Congress to include Medicaid work requirements in the failed House Republican health insurance reform bill. Under the Obama administration, CMS  did not grant any waivers for Medicaid work requirements to states because it argued that the restrictions would not fulfill the requirements of the waiver, but the Trump administration has taken a new direction.

“Maine marks the seventh community engagement demonstration we have approved since announcing this important opportunity earlier this year,” said CMS Administrator Seema Verma in the same press release. “I’m proud that CMS has responded so effectively to the strong interest from states interested in helping connect working-age adult Medicaid beneficiaries with opportunities to improve their health and financial independence through work and community engagement. We look forward to continuing this work in the new year.”

Arkansas was the first state to implement Medicaid work requirements last spring and has since booted nearly 17,000 people from the program due to the new mandate, according to the Kaiser Family Foundation. The Arkansas policy is currently being challenged in court and the low-income advocacy group Maine Equal Justice Partners says it is also considering a lawsuit  if Mills doesn’t terminate the waiver.  

“These proposals are an attempt to undermine the whole purpose of Medicaid and take health care away from very low-income people who are already struggling,” said Robyn Merrill, executive director of Maine Equal Justice. “Mainers made it clear at the ballot box again this year: they want more people to have access to affordable health care, not less.”

In a statement, Mills spokesman Scott Ogden said the governor-elect has not reviewed the waiver but will do so when she assumes office. 

“As a general matter, the Governor-elect supports programs that offer apprenticeships, vocational education, computer science, and other training initiatives to put people to work to fill available jobs, preferably by incentives instead of by bureaucratic mandates,” he said. “Making sure people are healthy, of course, is a first step in making them eligible for work.”

During the Democratic primary, the Mills campaign was much more direct in its stance on Medicaid work requirements. Back in June, Mills campaign spokesman Michael Ambler told The Free Press that Medicaid work requirements are “a cynical attempt to score political points by taking health care away from people who need it — many of whom are caring for young children, disabled, or who live in economically depressed areas where no work is available. And creating a massive new bureaucracy to impose reams of red tape won’t help people find good jobs.”