Maine: And just like that*, 70,000 Mainers are instantly eligible for Medicaid after all.

*(Yes, that's sarcasm...it's been anything BUT "just like that" in Maine...)

Openly racist and mini-Trump GOP Maine Governor Paul LePage spent the better part of the past eight years blocking the expansion of Medicaid under the Affordable Care Act. First, he vetoed the Medicaid expansion bills passed by the state legislature a whopping seven times. Then, when Maine voters finally had enough and successfully passed a statewide ballot initiative to force the issue, LePage spent another full year continuing to fight against actually implementing the expansion provision via legal challenges and flat-out violation of court orders.

Thankfully, LePage was finally forced to leave office last month after his inexplicable second term ended (he managed to squeak through twice thanks to an unfortunate third-party spoiler in both 2010 and 2014), leaving the way for newly-elected Democratic Governor Janet Mills, who made good on her campaign promise to finally, after eight years, issue an executive order on her first day in office to implement Medicaid expansion for over 70,000 Mainers:

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.

For what it's worth, Maine closed out the 2019 Open Enrollment Period around 4,800 enrollees short of last year, down around 6.4%. If Medicaid expansion had actually gone into effect sometime last year (as it should have), I had projected that roughly 15,000 ACA exchange enrollees in Maine who earn less than 138% of the federal poverty line would have been shifted over to Medicaid instead, causing roughly a 20% drop in exchange enrollment. This is precisely what happened in Virginia, where 2019 enrollment is indeed down by 18% from last year (the lowest enrollment relative to 2018 in the country) due to their implementing Medicaid expansion earlier.

I presume this means that those 15,000 or so ACA exchange enrollees will only have to pay for one month of premiums before being automatically shifted over to Medicaid, but could be wrong. It does mean that Maine's ACA exchange enrollment number in 2020 will likely indeed be roughly 20% lower, which is fine under the circumstances.

Mills' order indicates that Maine's expansion enrollees will have their coverage actually effectuated on February 1st, 2019...but it also notes that the ballot proposal passed by Maine voters clearly stated that it was to be implemented effective July 2nd, 2018, which was upheld by a judge last year, which I presume means that any eligible Maine resident who applied for Medicaid within the past six months will have their coverage implemented retroactively.

I'm not sure if this means they'll be reimbursed for any hospital/doctor/medication bills from that time period by the state or what, but it's great news nevertheless.

AS AN EXTRA BONUS, it's possible that Gov. Mills won't even have to implement the Medicaid expansion work requirements which LePage tried to shove through on his way out the door either:

When Gov.-elect Janet Mills takes office in January, she will likely have the power to torpedo new Medicaid work requirements approved by the federal government last week at the request of outgoing Republican Gov. Paul LePage.

...Mills, a Democrat, was noncommittal about her intentions in an interview Thursday. But a national health-policy expert said she believes Maine’s new governor would not be obligated to implement the work requirements granted under a federal waiver. Medicaid is a federal program operated and partially funded by the states, but some deviations from the standard program have to be approved by the federal government.

...[KFF associate director MaryBeth] Musumeci noted that in Pennsylvania in 2015, newly elected Democratic Gov. Tom Wolf disregarded a waiver obtained by his Republican predecessor to implement a modified version of Medicaid expansion. Wolf instead implemented Medicaid expansion under the Affordable Care Act without any changes permitted by the waiver. He has since vetoed attempts by the Pennsylvania Legislature to seek work requirements for Medicaid recipients.

I have no idea whether this is an option for other states such as, say, Michigan, where the GOP also passed (and Rick Snyder signed) a Medicaid work requirement waiver law as well, since the law varies widely by state...but it's certainly something I'd advise newly-elected Michigan Governor Gretchen Whitmer to look into.

Again: Elections have consequences.