Maine Gov. Paul LePage’s crusade to block Medicaid expansion in his state took another hit on Thursday, after the state’s highest court ruled that he must submit a plan to implement the Medicaid expansion voters overwhelmingly approved in 2017.

When a lower state court issued the same order to LePage back in May — scolding his administration for its “complete failure to act,” the governor appealed, and was granted a stay of the order to submit the plan while the higher court heard the appeal. That stay is now gone, and LePage is under a court order to get the ball rolling, even though Maine’s lower court is still hearing arguments about other legal issues around the embattled Medicaid expansion push.

LePage, who will be term-limited out of office in January, has vowed to do everything in his power to prevent roughly 70,000 Mainers from gaining coverage through the ACA’s Medicaid expansion, claiming the largely federally-funded program would bankrupt the state.

Maine’s legislature has voted five times in the past five years to expand Medicaid, and LePage vetoed the effort five times. Health care advocates then turned to the ballot box, where they got expansion on the 2017 ballot and saw it pass with nearly 60 percent of voters in favor — making the state the first in the nation to expand Medicaid by popular vote.

Under Maine’s Constitution, the governor can’t veto a law passed by citizens’ initiative, so LePage chose instead to simply refuse to move forward with its implementation, citing concerns about its cost. The lawsuit was filed after LePage blew past the April deadline to submit a simple, two-page State Plan Amendment that allows the state to draw millions in federal funding for the Medicaid expansion.

What happens next may depend on the state’s electorate. The Republican running to succeed LePage has promised to continue fighting against Medicaid expansion, while the Democrat has said she will implement the expansion on day one of her term if elected.