The First Circuit Court of Appeals has upheld a federal requirement that the state of Maine provide Medicaid coverage to several thousand low income 19- and 20-year-old young adults. The state had sought to drop coverage, but when the federal Department of Health and Human Services disapproved, the state petitioned on constitutional grounds.
Despite providing Medicaid coverage to children whose families met low-income requirements for 20 years, the Maine Department of Health and Human Services sought to exclude coverage for 19- and 20-year-olds in 2012, as a cost saving measure.
But the federal Health and Human Services secretary denied the move, saying that it was a violation of the Affordable Care Act. That Act requires states accepting Medicaid funds to maintain their eligibility standards for children until 2019. The state of Maine appealed, arguing that the denial was unconstitutionally coercive and violates Maine's right to equal sovereignty.
Even Maine Attorney General Janet Mills agreed that the federal government's position was appropriate in this case. "We didn't take this matter lightly," Mills says. "I did a lot of research myself, and the office did alot of research, and we came to the conclusion that the legal merits of an appeal were pretty weak. But I allowed as how the position of the administration was a very earnest one, not a frivolous one."
In the end, Mills says she approved the hiring of outside counsel to argue the case. The First Circuit found that a state's ability to set conditions of eligibility for participation in a federal health insurance program that is funded primarily by the federal government is "not a core sovereign state function."
"We deny the petition for review and find no constitutional violation," the Court wrote.
Jack Comart, with the group Maine Equal Justice Partners, says the decision is important for two reasons. "It's important, not only for the 6,000 19- and 20-year-old children who will continue to maintain their health coverage," Comart says, "but also it means that for all children in Maine who are in the MaineCare program there can be no reductions in eligibility until at least 2019. So it's good for all children in Maine to know that their health care coverage will continue."
Democratic Rep. Drew Gattine, a member of the Legislature's Health and Human Services Committee, says the ruling affects people who are among those least likely to be able to afford insurance because of their age and limited work experience.
"You know, this really impacts people who are really at risk of falling off a cliff, of not having access to health care when they're really just getting started," Gattine says. "They may not have jobs. They may not have jobs that provide them with health insurance. I think this is going to provide a lot of stability for them as they go out into the workforce. So, I think it's a great decision for those people."
In a written statement, DHHS Commissioner Mary Mayhew said the state is now reviewing its options. "Today judges have gone out of their way to defend the unpopular ObamaCare law and obstruct the will of the public, made clear two weeks ago, that our welfare funds should be prioritized toward the elderly, disabled, and truly needy; not job-ready young adults," Mayhew wrote.
She went on to say that if the lawsuit is successful, the state would be able to spend $10.6 million in state and federal Medicaid funds on other priorities.
It's unclear how much it cost the state to pursue the case. The Appeals Court also ordered Maine to pick up attorney's costs for the federal government.
