The Importance of Maine Medicaid Expansion for the Disabled

On November 7, 2017, the State of Maine citizenry went to the ballot box and passed the Question 2 ballot initiative calling for expansion of Medicaid.   The ballot initiative called for the state “to provide Medicaid through Mainecare for persons under the age of 65 and with incomes equal to or below 138 percent of the federal poverty line.”

Since that time, the present governor, Paul LePage, has refused to order the Department of Health and Human Services (DHHS) to implement Question 2.    Governor LePage, who had vetoed on 5 previous occasions the expansion of Medicaid coverage (which expansion cost would initially be covered by Federal funds to the tune of 90% of the cost), has refused to allow this citizen passed bill to go into effect, thereby thwarting the will of the people.   What elected officials had previously passed on 5 occasions, was now passed by a significant majority (60%) of the citizenry so as to allow individuals making up to approximately $16,000.00 and families of four with an income of up to $34,000.00 obtain health insurance (thereby allowing  anywhere from 70-80,000 indigent Mainers health insurance the can’t otherwise afford to obtain).   

As a Maine Social Security disability lawyer assisting the long-term injured and disabled for almost 30 years, I have seen first hand how the lack of health insurance coverage and available health care has impacted those with the least in this state.  Every day, disabled individuals call our offices seeking assistance with a potential Social Security disability claim, and yet they remain unable to receive the types of treatment that might allow them 1) to get better and return to work, or 2) make evident to the Social Security Administration just how serious their condition would remain despite treatment.  In either event, these individuals are looking for treatment which will allow them to lead a better quality of life.

The Social Security disability system is meant to address financial support to those suffering from a “severe medically determinable impairment,” and who have remained or will remain totally disabled from all forms of gainful employment for what will be a year or longer despite prescribed treatment.   Day in and day out, we have to advise individuals who do not have health insurance to try and find care (many of whom have applied for “disabled status” Mainecare, only to be told that they do not qualify as they do not have a doctor whose treatment records reflect the fact that their condition remains severe and disabling).    It remains a catch 22, however, for many of these individuals: they can’t prove they remain disabled from a severe “medically determinable impairment” if they can’t be seen by a doctor.  And yet, they can’t prove they remain disabled “despite prescribed treatment” if they can’t be in treatment.

These individuals remain in an impossible situation.   Many are being denied the health insurance they need to get better because they haven’t been able to see a doctor who first confirms that their condition has remained severe and disabling.  By the same token, these individuals find themselves attempting to apply for Social Security disability benefits given the fact that they remain disabled given they remain incapable of  obtaining the ongoing treatment and medication their conditions call for.

Ultimately, with proper care, many of these same individuals’ health might improve to the point where they could attempt to return to work if they were able to obtain the ongoing treatment they require for their conditions.  By the same token, there is a certain share of these individuals who simply will not be able to get better to the point where they are employable.  However, the availability of Mainecare would allow these individuals to come out from the shadows of disability and actually be seen and heard when applying for Social Security disability benefits.  Many Social Security disability applicants are denied simply because there remains “insufficient evidence” as to the nature and severity of their medical conditions because they cannot be seen or treated.

Given the Governor’s failure to order DHHS to begin implementation of Question 2,  and as required under the terms of the bill notify the Federal government of its opting to expand Medicaid coverage within the state by an early April deadline so as to secure the Federal funding for the expansion, the Medicaid expansion which should be taking effect as of July 2, 2018 remains in doubt.   A superior court judge has now ruled that the LePage administration must comply with the results of the election ballot initiative and file its plan for Medicaid expansion with the Federal Department Health and Human Services by June 11, 2018.   We at the Law Offices of Russell J. Goldsmith certainly hope that expanded Mainecare will be available soon for both our clients and those around the State of Maine suffering from disabilities.