Gov. Paul LePage is urging the federal government to reject his state's voter-approved plan to expand Medicaid. Credit: Robert F. Bukaty | AP

Maine’s Republican governor has urged the federal government to reject the proposal that his administration submitted Tuesday to start rolling out Medicaid expansion as demanded by voters.

Gov. Paul LePage in an Aug. 31 letter asked President Donald Trump’s administration to quash the proposal because Maine doesn’t know how it’ll cover its share of expansion down the road. Previously, LePage has said he’d rather go to jail than jeopardize Maine’s finances by expanding Medicaid.

The governor in his letter said he accepts that Medicaid expansion is the law. “However, not one dime of the hundreds of millions of dollars that will be needed to pay for the state’s share of expansion has been appropriated,” LePage wrote.

Nearly 3 out of 5 Mainers last November voted to allow adults under age 65 with incomes at or below 138 percent of the federal poverty line to apply for Medicaid coverage starting July 2.

Medicaid expansion could eventually send roughly $500 million in annual federal funding to Maine. But the voter-approved law doesn’t include a way for Maine to pay $54 million to $62 million for its annual share of expansion after projected savings.

The governor denies that Medicaid expansion will save Maine between $25 million and $27 million each year. This summer he vetoed a bill to hire over 100 new Medicaid staffers and make sure Maine has enough money for its first year of expansion.

Pro-expansion groups sued the LePage administration for failing to file paperwork to receive federal expansion funding by an April deadline. A legal battle ensued, and state courts have since ordered Maine to file that Medicaid expansion plan.

But Maine courts have yet to settle whether lawmakers have to actually earmark money for Maine’s share of expansion, or whether the state can rely on left-over Medicaid funds in state coffers. A spokesman for the U.S. Centers for Medicare & Medicaid Services told The Associated Press in April that the federal review of Maine’s Medicaid expansion plan could include asking about a state’s funding mechanism.

The LePage referenced the governor’s letter when it submitted its plan Tuesday. A state Department of Health and Human Services spokeswoman said that Maine has complied with the court order.

“I cannot overemphasize the risk that the approval of this (state plan amendment) will place on existing populations based on the fact that our existing budget will be utilized to cover all populations — old and new,” Acting DHHS commissioner Bethany Hamm said in the Tuesday letter to federal regulators.

The fact that Hamm’s letter cited the governor’s letter calls into question whether the plan is complying with the court order in “good faith,” said an attorney for Maine Equal Justice Partners. The LePage administration’s plan proposes to launch Medicaid expansion on Sept. 4, instead of retroactively from July 2.

“For the state instead to do everything it can imagine to delay or defeat approval of expansion represents defiance of the undeniable constitutional power of the voters to enact this law,” Charlie Dingman, a Maine Equal Justice Partners attorney, said.

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