The Trump administration’s choice to run the Medicaid program nationwide is Mary Mayhew, a strident Medicaid critic who has urged states not to join the Affordable Care Act’s Medicaid expansion.

Mayhew previously served in the administration of Maine Gov. Paul LePage, who has refused to implement a Medicaid expansion that voters approved more than a year ago (despite court orders that he do so).

As the Portland Press Herald describes it, Mayhew has “been at the forefront of LePage’s bid to revamp programs that affect thousands of Mainers, including efforts to tighten requirements for Medicaid enrollees, re-establish work requirements for food stamps, clamp down on welfare fraud, and advocate for other changes, such as forbidding junk food purchases with food stamps.”

She has also testified in front of multiple state legislatures (including Florida and Utah) urging them not to participate in the Affordable Care Act’s Medicaid expansion.

“States like Maine and Utah must balance their budgets,” Mayhew wrote in an op-ed earlier this year, published in a Utah newspaper. “With limited resources, safety net programs must fulfill their core mission. Maine fell into the same trap as many other states of expanding Medicaid rolls while the very real needs of seniors and individuals with disabilities went unfunded and unmet. I can only hope Utah will not have to learn these hard lessons the same way.”

In many ways, Mayhew’s views align closely with those of the Trump administration when it comes to Medicaid reform. Mayhew has been an ardent proponent of bringing work requirements into welfare programs; the Trump administration has recently begun allowing states to implement such provisions.

Those requirements are having consequences. Arkansas, the first state to have its work requirement go into effect, announced today that 8,426 low-income people there have lost coverage as a result of the policy change.

Mayhew left the LePage administration in mid-2017, before Maine passed a ballot initiative to expand the Medicaid program that the governor has so far refused to implement. But she was critical of the ballot initiative in her failed 2018 run for the Republican nomination for governor.

Here is the full announcement on Mayhew that Medicare administrator Seema Verma sent out earlier Monday:

Please join me in welcoming Mary Mayhew as the Deputy Administrator and Director of the Center for Medicaid and CHIP Services beginning today. Prior to coming to CMS, she served for several years as the Commissioner for Health and Human Services under Governor Paul LePage in Maine. Her other experience includes being a partner in the public affairs firm of Hawkes & Mayhew and serving for 11 years as a Vice President at the Maine Hospital Association. She has a bachelor’s degree in political science from the University of Arkansas. I look forward to having Mary join the CMS leadership team and would like to thank Tim Hill for his leadership as Acting Center Director.

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