Why Maine's Supreme Court ruled against LePage on Medicaid

The Maine Supreme Court dealt a blow to Gov. Paul LePage’s efforts to slow voter-approved Medicaid expansion while also extending a broader legal battle over the constitutionally of the ballot measure.

The state’s high court 6-1 decision last week orders the LePage administration to file a plan for expanding Medicaid. He has refused to advance the healthcare initiative after voters approved the proposal with 59% support in a November referendum vote.

The justices however, did not decide the merits of the case and sent LePage’s appeal of a June Superior Court decision back to the lower court.

“There are substantial unresolved issues surrounding the petitioners’ appeal,” Justice Joseph Jabar wrote in the majority opinion. “It is clear from the limited record before us that those issues must be resolved before we can consider the matter on its merits.”

LePage’s press office did not immediately respond to a request for comment on the ruling or what their next step is.

The term-limited LePage, whose eight-year run as governor ends in January, vetoed legislation in early June to fund the Medicaid expansion with surplus monies and tobacco settlement funds. He later proposed paying for the program through a tax on the state’s hospitals that met stiff resistance from Maine medical professionals.

“Voters, and now the Maine Supreme Court have made it clear – implementation of this law is a responsibility and obligation that needs to be fulfilled," House Speaker Susan Gideon, D-Freeport, said in a statement. "Thousands of Mainers cannot afford to wait any longer for the health care they need to be and stay well."

Maine Superior Court Judge Michaela Murphy had ordered in a June 4 ruling for the state to file a Medicaid expansion plan by June 11. The Maine Supreme Court then granted the LePage administration's request for a temporary stay on June 20 before hearing oral arguments in July. The approved 2017 referendum required that Medicaid expansion for newly eligible enrollees begin July 2, 2018.

The LePage administration curtailed Medicaid eligibility in 2011 nine years after Maine last expanded the program, citing stresses on liquidity and reserves. Overdue MaineCare payments were paid to hospitals in 2013 from proceeds of a bond that securitized other state revenue and increased state debt.

Moody’s Investors Service estimated in a report last November that Maine’s Medicaid expansion would generate increased budget risks since the enrollee population would rise by an estimated 70,000. The Moody’s analysis projected that the state’s annual Medicaid costs would increase by at least $55 million when fully implemented in 2021.

Maine has general obligation bond ratings of Aa2 from Moody’s and AA from S&P Global Ratings.