After months of back-and-forth legal battles, Gov. Paul LePage submitted a plan Tuesday to the federal government for voter-approved Medicaid expansion, but he “strongly” encouraged officials to reject it.

In a letter to sent Friday to U.S. Health and Human Services Secretary Alex Azar and Seema Verma, Center for Medicare and Medicaid Services (CMS) administrator, LePage said the state would be “obliged under federal law” to provide Medicaid coverage to an estimated 70,000 residents without proper funding.

“If accepted, the SPA would commit Maine to expanding its Medicaid program to an additional 70,000 to 90,000 individuals,” LePage said in the letter. “However, not one dime of the hundreds of millions of dollars that will be needed to pay for the state’s share of the expansion has been appropriated. Until funding is in place, Maine will not be able to satisfy the commitments to the federal government that it would be making if the SPA were accepted. For these and other reasons described below, I encourage you to reject the SPA.”

The Maine Supreme Judicial Court ruled on Aug. 23 that LePage had to submit the State Amendment Plan. Maine Department of Health and Human Services (DHHS) sent the plan on Tuesday.

Once the plan is fully implemented, the state will have access to more than $500 million in federal funds to support the newly Medicaid-eligible residents.

Legislators pushed a bill forward that would have provided $60 million for the state’s initial expansion efforts,  but LePage vetoed it and conservative legislators upheld the veto in an 85-59 vote.

Maine’s non-partisan Office of Fiscal and Program Review estimated the state would have to pay more than $54 million in its first year to cover its share of expansion costs, rising to $81 million by 2021. LePage’s DHHS estimated a much higher state cost—$63 million in 2019, $82 million in 2020, and more than $100 million every year after 2021.

LePage also said he would deny any plans that relied on tax hikes or dipping into the state’s “rainy day” fund, which grew to $175.8 million this year.

Want to know why Medicaid expansion is so important for traveling healthcare professionals? Check out our guide.

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