LePage Offers Sebelius Quid Pro Quo on Medicaid Expansion

Republican Gov. Paul R. LePage has offered the federal government a quid pro quo regarding his willingness to expand Medicaid under the Affordable Care Act (ACA).

On Monday, Maine Department of Health and Human Services Commissioner Mary C. Mayhew sent a letter to Department of Health and Human Services Secretary Kathleen Sebelius outlining pre-conditions for the Governor to accept an expansion of Medicaid called for in the ACA — more commonly known as Obamacare.

“Ultimately, we must make the decision that is best for the people of Maine,” wrote Mayhew. “While we share the common goal of increasing access to affordable health care, we have serious concerns about the sustainability of the Medicaid expansion as proposed.”

While various news reports have indicated that the Governor has had a change of heart with regard to the ACA and Medicaid expansion, Mayhew’s letter shows that the LePage’s position on Medicaid is contingent upon whether the federal government is open to compromise on several not insignificant issues.

In the letter, Mayhew hints at the Governor’s doubts regarding the federal government’s commitment to sustain financial support for Medicaid expansion.

“Maine has seen its share of Medicaid costs grow exponentially in recent years,” wrote Mayhew.

“Maine’s Medicaid enrollment has increased nearly 80% since 2002. We currently face a $270 million hole in our two-year budget as a result of increased cost in the program and the latest reduction to the federal reimbursement rate of our existing Medicaid program. Our hospitals are owed $484 million in unpaid Medicaid bills,” she wrote.

Mayhew also addressed Maine’s position relative to other states: “Maine is in a unique position as a result of our decision a decade ago to extend Medicaid coverage to the ACA’s “newly eligible” populations.”

According to Mayhew, the federal government penalizes Maine for previous generosity by offering less than 100% funding to cover the “newly eligible” populations that we chose to cover in the past.

Mayhew then proceeds to layout the LePage’s prerequisites for agreeing to expand Medicaid.

“The reduced rate being offered to Maine creates a dismal financial reality. While some argue the state cannot afford to turn down the expansion of Medicaid, the simple truth is that by accepting a lower rate of federal funding than other states are being offered, Maine would continue down an unsustainable and unaffordable path,” wrote Mayhew.

“For the expansion of Medicaid to be a viable option to consider, we would need for this penalty to be lifted, creating parity between Maine and the non-expansion states with regards to the federal match rate,” she wrote.

“For Maine to consider expanding its Medicaid program, we would need to provide for our current populations under a more flexible structure, like a global waiver,” wrote Mayhew. “This would provide us with the independence that is necessary to make holistic changes to our Medicaid program that would best serve Medicaid populations,” she wrote.

“Additionally, for expansion to be a plausible consideration, it would be essential to attain stable financial footing,” wrote Mayhew. “With the addition of tens of thousands of new members under expansion, it would be critical to the success of our innovation and reform projects to have security while we work towards creating an improved Medicaid program.”

“We believe that if the federal government funds 100% 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. Maine’s last decade was marked by unsustainable growth in our Medicaid program, and our taxpayers have shouldered the burden of early expansion,” she wrote.

Although Maine’s newspaper reporters have been buzzing about LePage’s apparent willingness to accept Medicaid expansion, Mayhew’s carefully-worded letter makes it clear that LePage is seeking a quid pro quo.

Mayhew ends her letter writing, “When you are able to provide us with the flexibility and finances required to support these efforts in an expansion environment, we will consider the expansion of Medicaid as a viable option for our state.”

Whether Maine will expand Medicaid, then, depends on whether the Feds are willing to play ball with the Governor.

A spokesman from the Governor’s Office declined to comment for this story.

Read the entire letter here: Medicaid Expansion Letter to Secretary Sebelius.
By S.E. Robinson

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