Gov. Janet Mills signed an executive order Thursday to expand Medicaid, fulfilling a campaign vow that ends the long delays imposed by the fervent opposition of her Republican predecessor, Paul LePage.

More than 70,000 Mainers will be eligible for MaineCare health insurance under the expansion. Mills, who had promised to act on “day one” of her administration, was sworn into office Wednesday evening and signed “Executive Order 1” on Thursday.

Mainers who think they are eligible for coverage can begin applying immediately, Mills’ office said. To find out how to do so, they can visit the Maine Department of Health and Human Services website. About 4,500 Mainers tried to sign up under expansion in 2018, but were rebuffed by the LePage administration.

Naomi Loss of Lisbon Falls said she’s been waiting for this day for nearly a year, ever since her daughter Bethany turned 26 and was no longer eligible to be on her mother’s health insurance. Bethany, who is uninsured, has epilepsy and severe cognitive and developmental disorders, but was denied Medicaid disability and did not qualify for subsidized Affordable Care Act insurance. Bethany’s medications cost more than $1,000 per month, and rebates from the pharmaceutical company that helped their family afford the medications were set to run out this year.

“When I heard the news, it was such a huge sigh of relief,” Loss said. “We have been putting off doctor’s visits because it’s just so expensive. I knew (Mills) said she would do this right away and made these promises, but when someone gets into office, you just don’t know how long it would take.”

Throughout the 2018 gubernatorial campaign, Mills said she would make implementing Medicaid expansion a top priority. Medicaid provides insurance coverage for low-income and disabled residents, and is operated by the states with federal oversight. Funding is a blend of federal and state dollars, with the federal government covering 90 percent of costs under expansion. Maine is expected to spend about $50 million per year on Medicaid expansion and receive more than $500 million in federal money.

“More than a year ago, the people of Maine voted to expand Medicaid. Today, my administration is taking the long-awaited steps to fulfill their will,” Mills, a Democrat, said in a written statement. “I am directing my administration to begin implementing Medicaid expansion as quickly and as efficiently as possible so that we can help more Maine people access the health care they need.”

Maine voters approved Medicaid expansion by 59-41 percent in a November 2017 referendum, but LePage refused to implement it. A lawsuit that attempted to force the LePage administration to implement the expansion won at every stage in court, but LePage dragged out the process, leaving it to Mills to act.

LePage continued his opposition Thursday, posting a statement to his new Twitter account that once again raise his oft-stated objection to expansion:

“The Democrats in the Legislature haven’t yet found sustainable funding for Medicaid expansion. Today’s Executive Order doesn’t have a way to pay.”

He concluded by saying: “I’ll be watching”

‘AS AGGRESSIVELY AS POSSIBLE’

Medicaid expansion is available to those earning up to 138 percent of the federal poverty limit – $16,753 for a single person, and $28,676 for a family of three.

According to a news release, the executive order “directs the Department of Health and Human Services to make changes to process the applications of Mainers seeking health care coverage under Medicaid expansion, including amending the filings of the previous administration to reflect the accurate date of implementation and to seek the earliest possible approvals as allowed under the expansion act.”

The Democrats in the Legislature haven’t yet found sustainable funding for Medicaid expansion. Today’s Executive Order doesn’t have a way to pay. Doctors shouldn’t have to take IOUs from the state. We can’t go back to the days of owing the hospitals $750 million. I’ll be watching https://t.co/5Ef51KFNjK — Paul R. LePage (@PaulRLePage1) January 4, 2019

In a letter Thursday to Seema Verma, administrator of the U.S. Centers for Medicare and Medicaid Services, Mills said the people’s will was “unfulfilled.”

“Today I signed an executive order directing that expansion happen as smoothly, as efficiently, and – importantly – as aggressively as possible,” Mills wrote.

The coverage is retroactive to July 2, so Mainers who applied for Medicaid in 2018 but were denied benefits and incurred expenses that should have been covered by Medicaid will be reimbursed.

Jeanne Lambrew, who was nominated by Mills to be health and human services commissioner, said in a written statement, “Governor Mills and I share a commitment to ensuring that the Department of Health and Human Services achieves its core mission to safeguard the health and well-being of Maine children and families. The executive order is a critical first step in achieving that mission. Full implementation of Medicaid expansion will take time and the collective cooperation of our health system, but with Governor Mills’ leadership, access to affordable health care coverage for Mainers is now on the horizon.”

HOSPITAL NETWORK IS PREPARED

Robyn Merrill, executive director of Maine Equal Justice Partners, the group that campaigned for the referendum and sued the LePage administration for failure to implement it, said having an administration that supports the goals of Medicaid expansion “feels lighter and more hopeful.”

“The implications are significant for people’s lives,” Merrill said. “They won’t be delaying the care they need, like they did when they were uninsured. Medicaid expansion is going to become a reality, finally. It’s taken a long time.”

Thousands of Mainers with substance use disorder – rough estimates suggest 10,000 to 25,000 people – will gain access to treatment under expansion.

Related Drug overdoses killed a record 418 people in Maine last year

Lisa Letourneau, associate medical director of Maine Quality Counts who sees patients with opioid use disorder, said many patients with substance use disorder are uninsured, and Medicaid expansion will remove a barrier for them.

“This is going to be a lifesaving opportunity for a lot of people,” Letourneau said. A record 418 Mainers died of drug overdoses in 2017, and 180 through the first six months of 2018, according to state statistics.

Carol Zechman, director of Access to Care programs at MaineHealth, the parent company of Maine Medical Center and a network of hospitals and health care providers in much of southern and midcoast Maine, said patient capacity in the network should be able to absorb new Medicaid patients. The network has been planning for the expansion since the referendum was approved in 2017.

Joe Lawlor can be contacted at 791-6376 or at:

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Twitter: joelawlorph

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