Superior Court Judge Issues Deadline For Next Steps On Medicaid Expansion

Wednesday, a Superior Court Justice ordered the LePage administration to implement Medicaid expansion. The decision is the latest in a protracted legal battle over the law approved by voters in a referendum last year. Patty Wight spoke with Nora Flaherty on Maine Things Considered about the court decision and what comes next.

NF: Patty, what did Justice Michaela Murphy order the state to do in the decision she issued?

PW: Justice Murphy ordered the LePage administration to implement Medicaid expansion quickly. By December 5 - which is two weeks away - the Department of Health and Human Services has to adopt rules for the law so that people can enroll and get coverage. Justice Murphy also issued a decision on when the law was supposed to go into effect, which she says was July 2. That's important because it allows eligible Mainers to get health care coverage retroactively. It's estimated that there are 70,000 Mainers who are eligible for coverage under Medicaid expansion.

What about the funding needed to pay for the expansion? That's been a major sticking point for the LePage administration.

It certainly has been. Within hours of voters approving the law last November, Governor LePage said he would only implement Medicaid expansion after the legislature found funding, and he gave several restrictions: it couldn't come from raising taxes, rainy day funds or budget gimmicks. He subsequently vetoed a bill in the legislature that would have used tobacco settlement money and surplus funds for Medicaid expansion. And without a specific funding allocation, attorneys for the LePage administration have argued in court that the law can't be implemented.

But Justice Murphy disagrees. In her decision, she says there's no law that blocks DHHS from using existing funds already allocated to Medicaid to expand it. Just so we know how much money we're talking about, it's estimated that the state will need to spend about $50 to $60 million per year for Medicaid expansion, and it will receive about $500 million in federal funds.

What's the reaction of the interests behind this lawsuit?

The lawsuit was spearheaded by Maine Equal Justice Partners, which is the advocacy organization that also led the effort to put Medicaid expansion on the ballot last November. Robyn Merrill is the executive director, and she was clearly thrilled when I spoke to her:

"I mean there's also just like a great sense of relief. Because this has been such a long road, and just talking to people waiting for health care, and knowing how important it is and how much it means in people's lives."

Merrill also called the decision a victory for the democratic process - here's what she had to say:

"The executive branch is charged with and responsible for implementing the laws, and this is a law that voters passed. A law that's been on the books for over a year. A law that's been ignored."

Justice Murphy also talked about this in her decision. She pointed out that the DHHS has missed every deadline required to implement the voter-approved law. She also wrote "Although the Governor may believe implementation to be unwise and disagree with the Act as a matter of policy, he may not ignore the will of the people and refuse to take any action toward accomplishing the policy objectives of the Act."

This is a lawsuit that's bounced between different courts since it was first filed back in April. It's already been to the state Supreme Court. Is this decision from Justice Murphy the final word?

The case has bounced around. Justice Murphy initially ordered the state in June to file federal paperwork to begin the process of implementation. The LePage administration appealed to the Maine Supreme Judicial Court, which ordered the state to file the federal paperwork, but it also sent the case back to Superior Court to decide whether the state needs to have a specific funding allocation before it could implement the law. Which, we now know that Justice Murphy says 'no.'

Now, that is not necessarily the final word. A spokeswoman for Governor LePage says that he does plan to appeal Justice Murphy's decision. Of course, he's only got about a month left in office. Governor-elect, Janet Mills, issued a statement saying that Medicaid expansion is the law and she will implement it. She's previously said that she will do that on her first day in office.

Updated 5:25 p.m. Nov. 21

Originally published Nov. 21, 2018 at 12:51 p.m. ET.