On January 3, 2019, Maine Gov. Janet Mills (D) signed an order to expand Medicaid, known as MaineCare in Maine, citing the approval of Question 2, a ballot initiative, in 2017.

 

Question 2 was the first citizen-initiated measure to expand Medicaid via Obamacare, expanding the program’s coverage to persons under the age of 65 and with incomes at or below 138 percent of the federal poverty line. In 2018, this amounted to an annual income of $16,753 for an individual or $34,638 for a household of four. Under Obamacare, the federal government was to provide 93 percent of funding for expanded coverage in 2019 and 90 percent in 2020 and thereafter.

 

Gov. Mills’ predecessor, Paul LePage (R), said his administration would not file an application with the federal government to expand Medicaid unless the legislature could fund expansion without tax increases or one-time funding mechanisms. In April 2018, several organizations that supported Question 2 sued the governor’s administration in a case that ended up going before the Maine Supreme Judicial Court. The state Supreme Judicial Court ordered Gov. LePage to submit an expansion plan to the federal government in June 2018. In August, Gov. LePage wrote a letter to U.S. Health and Human Services asking officials to reject the plan that Maine filed to expand Medicaid. In November 2018, the issue was back in court, with a superior court judge ruling that the governor’s actions went against the initiative’s objectives. The judge extended the deadline for implementation to February 1, 2018.

 

In 2018, voters in Idaho, Nebraska, and Utah also approved ballot initiatives to expand Medicaid. Voters in Montana rejected an initiative to re-approve Medicaid expansion with funding from a tobacco tax increase in 2018. As of January 2019, there are several states with the ballot initiative process that have not expanded Medicaid, including Missouri, Oklahoma, South Dakota, and Wyoming. Florida and Mississippi—two additional states that have not expanded Medicaid—allow initiated constitutional amendments but not initiated statutes.