Maine asks 10-year guarantee on Medicaid expansion

AUGUSTA, Maine (AP) -- The LePage administration is asking the federal government to pick up 100 percent of Maine's costs of expanding Medicaid for 10 years, if Maine is to agree to the expansion through the national health insurance law.

"We need a longer-term commitment and greater support from the federal government in order to move in the direction of expanding Medicaid," Maine Health and Human Services Commissioner Mary Mayhew said Wednesday, two days after making the request to her federal counterpart, DHHS Secretary Kathleen Sebelius.

Mayhew's letter was sent as Gov. Paul LePage considers whether to expand Medicaid — known in the state as MaineCare — under the Affordable Care Act. LePage has resisted expansion in the past out of concern that the state may not be able to meet its long-term obligations from expansion. Mayhew said the state faces a $270 million hole in its two-year budget as a result of increased costs in Medicaid and the latest reduction to the federal reimbursement rate for the program that helps pay for health care for low-income people.

But LePage's opposition has softened in recent days; he said he would consider it if the majority Democrats act quickly on his plan to pay a nearly $500 million hospital debt.

LePage's decision to revisit the issue comes as more than half the nation's governors join the expansion, consider it or look for alternatives. Some other Republican governors have switched positions from opposing expansion to supporting it. LePage's latest position, to even talk about expansion, drew a poke from conservative online publication "As Maine Goes," which asked, "Is LePage Turning Democrat?"

Under the Affordable Care Act, the federal government has offered to pick up 100 percent the cost of Medicaid expansion in the first three years, and 90 percent after that.

It's the "after that" that worries the administration.

"We believe that if the federal government funds 100 percent of our Medicaid costs for expansion populations for 10 years, we can put our Medicaid program on a track to succeed in the long term," Mayhew's letter to Sebelius said. "Maine's last decade was marked by unsustainable growth in our Medicaid program, and our taxpayers have shouldered the burden of early expansion."

Mayhew said the administration wants the coming decade to be marked by financial stability.

Two groups that have been targeted for elimination from Medicaid coverage — 19- and 20-year-olds and childless and non-disabled adults — would likely regain coverage if Maine expands Medicaid, Mayhew said.

Democrats, who strongly favor expansion, said they were encouraged to see the governor looking at accepting federal funds.

"What Commissioner Mayhew has put here seems to be, from my first reading, an unbelievable request," said Senate President Justin Alfond of Portland, adding that he knows of no other state that has received such a promise.

House Speaker Mark Eves, D-North Berwick, called the administration's request "awfully aggressive."

A message seeking comment left with a federal DHHS spokesman was not immediately returned Wednesday.

While doctors gathered in the State House on Wednesday to urge expansion of Medicaid, legislative Republicans said they are hesitant to support such an expansion "despite a sales hook" of three years of a full federal match.

Doctors, backed by the American Medical Association, said expansion would increase access to health care for up to 69,500 Mainers.