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From Health Law Daily, June 8, 2015

Cert denied; young adults in Maine eligible for Medicaid until 2019

By Sarah E. Baumann, J.D.

The Maine Department of Health and Human Services (MDHHS) will be required to provide Medicaid coverage to low-income individuals aged 18 to 20 until 2019, thanks to the U.S. Supreme Court’s decision to deny certiorari in Mayhew v. Burwell. Mary Mayhew, as Commissioner of MDHHS, asked the court to overturn the decision of the First Circuit Court of Appeals, which held that the Patient Protection and Affordable Care Act’s (ACA) (P.L. 111-148) maintenance of effort (MOE) provision (section 2001(b)), requiring states not to implement more restrictive provisions than those already in effect on the date of enactment of the ACA for determining Medicaid eligibility for children above a certain age, did not violate the Spending Clause of the U.S. Constitution. Mayhew claimed that failure to grant certiorari would leave states in limbo as to how Medicaid expansion and establishment of state Exchanges would affect state budgets.

MaineCare coverage. Prior to enactment of the ACA, states were not required to provide Medicaid coverage to non-disabled, non-pregnant children between the ages of 18 and 20. However, Maine, through its MaineCare program, elected to provide such coverage to those individuals and agreed to extend coverage through 2010 in exchange for receipt of federal funds under the American Recovery and Reinvestment Act (ARRA) (P.L. 111-5). As codified at 42 U.S.C. §1396a(gg), the ACA’s MOE provision stated that, as of the date of ACA, states receiving Medicaid funding could not have in effect "any standards, methodologies, and procedures . . . that are more restrictive [than those] in effect on March 23, 2010 . . . that are applicable to determining the eligibility for medical assistance of any child who is under 19 years of age (or such higher age as the State may have elected)." In 2012, Maine sought an amendment to its state plan allowing it to drop coverage for that age group.

First Circuit decision. CMS disapproved the amendment and Mayhew sued, alleging that the MOE provision violated the Spending Clause of the U.S. Constitution as determined by the U.S. Supreme Court in National Federation of Independent Business v. Sebelius (NFIB). The First Circuit differentiated NFIB, noting that the Supreme Court found a violation because the government was conditioning receipt of pre-ACA funds on participation in an entirely new program. The program in Mayhew, in contrast, was applied to a long-standing provision of an already existing program. Mayhew filed a petition for certiorari (see CMS succeeds in constitutional fight over MaineCare coverage drop, November 18, 2014).

Conservative support. The Cato Institute, a conservative think tank, filed an amicus curiae brief suggesting that the outcome of Mayhew could have a significant impact upon state budgets and decisions regarding ACA implementation. According to the Institute, states that have not established state-based Exchanges are subject to the MOE until such time as they establish a state Exchange. The Institute argues that "it is unclear whether establishing a state-based exchange would free states from some of the MOE requirements imposed by §2001(b) of the ACA—or if that burden should have been lifted in response to NFIB." Furthermore, "if states are relieved of the obligation to continue to provide Medicaid coverage for populations that could potentially find coverage elsewhere . . . the saving to state budgets could sway states’ decisions regarding Medicaid expansion. The Institute argued that a Supreme Court ruling would have an important impact on states regardless of the manner in which the High Court rules in the upcoming King v. Burwell decision, which will address the application of subsidies to individuals living in states with federal or federally-facilitated Exchanges versus state-based Exchanges (see SCOTUS hears King v. Burwell: Kennedy voices constitutional concerns, Roberts doesn’t tip his hand, March 5, 2015).

MainStory: TopStory SupremeCtNews HealthReformNews CMSNews CoverageNews EligibilityNews MedicaidNews

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