After the Centers for Medicare & Medicaid Services denied Maine an expedited review for its $20 million Medicaid reduction plans, the state's attorney general is seeking a federal court review to prompt a decision.
On Tuesday, Maine Attorney General William Schneider filed a request in the 1st Circuit Court of Appeals in Boston, asking the court to order CMS to either approve the plan or order CMS to pay Maine's share for coverage of the Mainers the state is trying to remove from the program.
Republican Governor Paul LePage's administration had requested an expedited decision by Sept. 1 when it first sought CMS's permission for the reductions in an application submitted Aug. 1. CMS Acting Administrator Marilyn Tavenner told LePage in a letter last week that the agency has 90 days to review the request.
That means CMS might not respond until the end of October -- potentially throwing a wrench in Maine's plans to start cutbacks Oct. 1. As part of its efforts to balance the state's budget, Maine officials want to remove 36,000 people from Medicaid by eliminating coverage for 19- and 20-year-olds, decreasing income eligibility requirements for lower income parents and reducing for elderly people who also qualify for Medicare.
Even with CMS's lack of permission, Maine Health and Human Services Commissioner Mary Mayhew said the department is going to start implementing the cuts.
Maine Democrats have opposed the Medicaid reduction plans. As the Lewiston Sun Journal reported, Democratic State Representative Peggy Rotundo called the attorney general's legal action "unconscionable."
Either way, the whole ordeal many end up as legal experiment testing the U.S. Supreme Court's ruling on the Medicaid expansion provisions of the Patient Protection and Affordable Care Act.
As the Washington Post reported, the LePage administration's legal argument for its Medicaid reduction plans revolves around the "maintenance of effort" provision in the law requiring states to maintain Medicaid eligibility levels from 2010 until 2014 when national standards will be implemented. If Maine doesn't comply, it could lose federal Medicaid funding.
The LePage administration argues that the Supreme Court rejected much of that provision its ruling, holding that states could not lose all Medicaid funding for not participating in the expansion.
"This 'economic dragooning' is unconstitutional," the attorney general argues. "This is exactly the type of federal action rejected by the Supreme Court in NFIB."