Advocates for Medicaid expansion on Friday withdrew their request that a court appoint an independent third party to pursue expansion with federal regulators after reaching a technical agreement with the LePage administration’s attorneys.
Last month, Maine Equal Justice Partners asked the court to appoint a “receiver” to take over the process after the LePage administration urged federal regulators to reject a plan it had submitted to expand Medicaid. Alternatively, the group wanted the commissioner of the Maine Department of Health and Human Services to be found in contempt of court for failing to follow an earlier court order.
On Friday, the organization dropped its request after the LePage administration agreed that the effective date of Medicaid expansion is a subject of the larger court cases. That shift, communicated in a two-sentence letter from the administration to the U.S. Centers for Medicare and Medicaid Services, will allow Superior Court Justice Michaela Murphy to focus on the broader issues of the long-running case rather than what day Mainers became eligible for Medicaid coverage.
“It takes that issue off of the table,” said Patrick Strawbridge, the private attorney representing the LePage administration.
Thirty-three states plus Washington, D.C., have expanded Medicaid to allow coverage of individuals earning up to 138 percent of the federal poverty level, which is $34,638 for a family of three and $16,753 for a single person. Under the provisions of the Affordable Care Act, the federal government picks up 90 percent of the expansion costs while states foot the remaining 10 percent.
Maine Equal Justice Partners argues that an estimated 70,000 lower-income Mainers became eligible for Medicaid – or MaineCare, as the state’s program for Medicaid is known – on July 2 under the law approved by voters last November. But the “state plan amendment” that Maine DHHS submitted to the Centers for Medicare and Medicaid Services last month suggested the effective date was Sept. 4.
An estimated 3,500 Mainers have applied for coverage under the expansion but have been rejected by DHHS.
Robyn Merrill, executive director of Maine Equal Justice Partners, said the effective date is important because her organization is seeking retroactive health coverage – back to July 2 – for Mainers who applied for Medicaid but were rejected.
“Our primary concern was the effective date and wanting to ensure that we preserved the opportunity for people to get health care in the first quarter of coverage and for the state to draw down the federal funds to pay for the majority of those costs,” Merrill said Friday.
Earlier Friday, the two sides wrapped up their witness testimony and oral arguments in front of Murphy on the broader case of whether the LePage administration is obligated to expand Medicaid even without dedicated funding from the Legislature. Attorneys will now spend several weeks submitting written briefs before Murphy rules on the case.
Nearly 60 percent of voters endorsed Medicaid expansion at the ballot box last November after Gov. Paul LePage had successfully blocked expansion for years.
LePage has since argued that he cannot implement the expansion law until the Legislature allocates money to cover the state’s share of expansion costs, estimated at around $50 million a year. But advocates counter that the only thing standing in the way of 70,000 people obtaining health coverage is LePage because he vetoed a bill the Legislature passed to provide $60 million for expansion in July.
Last month, the Maine Supreme Judicial Court sent the issue back down to Superior Court after determining there were “substantial unresolved issues” that needed resolution before the court could rule on the funding issue.
In his Aug. 31 letter to the head of the Centers for Medicare and Medicaid Services, or CMS, LePage urged the agency to reject the expansion plan that a court ordered his administration to file.
“Until the necessary funding is in place, however, the federal government can take no assurance that Maine will be able to pay for its share of costs under the program,” LePage wrote. “Under these circumstances, CMS should reject the (state plan) and avoid putting Maine in a situation where it will be unable to meet its obligations to the federal government.”
Attorneys for Maine Equal Justice Partners argued there are sufficient funds in Maine’s Medicaid account to cover expansion costs well into next year. And if additional money is needed, the Legislature that convenes in January can approve a supplemental spending bill, as is routinely done.
Cynthia Mann, a former deputy administrator of CMS from 2009 to 2015, testified Friday that the agency does not require states to demonstrate financial capacity on Medicaid expansion plans, “state plan amendments” on Medicaid expansion or other issues. Testifying via teleconference as a witness for Maine Equal Justice Partners, Mann said that’s because the federal government is typically reimbursing states for money already spent on Medicaid.
But in cross-examination, Strawbridge introduced a letter from the current agency administrator to North Carolina lawmakers seeking financial assurances regarding Medicaid expansion. Strawbridge pointed to the letter as proof that the Trump administration may be interpreting the law differently than the Obama administration while Mann worked for the center.
Afterward, attorneys for both sides expressed optimism in their cases.
“We will continue to press our point vigorously that Medicaid expansion is a serious financial issue for the state,” Strawbridge said. “The last time the state expanded Medicaid without having the wherewithal, it got itself into hundreds of millions of dollars of debts to hospitals that took years to dig out of. The Legislature needs … to appropriate sustainable funding.”
“All along the way, we have remained optimistic that 70,000 people who have been waiting for health care are going to get it,” Merrill said. “At the same time, we feel incredibly frustrated that it has taken this long and that we are forced to fight this out in court when the voters clearly passed a law. It is the law of the land.”
Kevin Miller can be contacted at 791-6312 or at:
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