Mary Mayhew (pictured), who until now has served as Maine's health care commissioner, grappled with several scandals in her department. | Robert F. Bukaty/AP Photo Health Care Controversial former aide to Maine’s LePage to run Medicaid

The Trump administration has tapped Mary Mayhew — the architect of Maine's aggressive conservative reforms to the social safety net — to oversee the national Medicaid program. She has been an ally of outgoing Maine Gov. Paul LePage, a Republican who has fought as hard as any governor against expanding Medicaid under Obamacare.

CMS announced the move internally Monday, the day Mayhew began as the agency's deputy administrator and director of Medicaid and the Children's Health Insurance Program.


Mayhew served as Maine's health commissioner for six years under LePage, leading efforts to tighten the state's Medicaid eligibility standards, add work requirements to the food stamp program and implement other conservative reforms. She supported LePage as he rejected efforts to expand the state's Medicaid program — repeatedly vetoing legislation and then resisting after nearly 60 percent of Maine voters approved expansion on a ballot measure in 2017. LePage is spending his final months in office fighting a court order to expand the program.

Mayhew stepped down in May 2017 and ran to succeed LePage as governor, losing in the June Republican primary. As part of her campaign, Mayhew touted how safety-net programs had shrunk under her watch, pointing to a 70 percent decrease in enrollment in the Temporary Assistance for Needy Families program — one of the sharpest declines in the nation — and a 24 percent decrease in Medicaid enrollment.

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She has defended the rollbacks as a necessary trade-off. "We don’t live in a world of unlimited resources," Mayhew argued at an Ohio Senate hearing in January 2018, as legislators in that state weighed their own safety-net reforms. "When those ends do not meet at the state level, you all must make difficult decisions to prioritize spending."

Mayhew joins CMS as the agency works to finalize a request Maine submitted in August 2017 to impose work requirements on Medicaid beneficiaries. Mayhew has said she was previously approached about joining the Trump administration to oversee the nation's food stamps program.

Advocates have warned that Maine's safety-net suffered under Mayhew's leadership, noting that measures of hunger and poverty rose even while she oversaw cuts to programs designed to feed and support low-income residents.

“It’s an alarming choice given her track record,” said Claire Berkowitz, executive director of Maine Children’s Alliance. “We saw the results in our data of parents who lost coverage under her leadership and that’s concerning.”

Mayhew's department also grappled with several scandals, including allegations concerning a plagiarized report by an outside consultant on the state's Medicaid system and an HHS inspector's general report that found vulnerable Medicaid patients were placed at risk.

Mayhew is the second failed gubernatorial candidate recently tapped by the Trump administration to join the agency. Paul Mango, who joined CMS this summer as chief of staff and chief principal deputy administrator, unsuccessfully ran for the Republican nomination for governor in Pennsylvania.

