Health Reform WK-EDGE Court order to file state plan amendment did not violate separation of powers
Tuesday, June 12, 2018

Court order to file state plan amendment did not violate separation of powers

By Jeffrey H. Brochin, J.D.

The Superior Court of the State of Maine did not violate the state’s constitutional separation of powers when it ordered the Commissioner of the Maine department of health and human services (MHHS) to file a state plan amendment (SPA) in accordance with recent legislation. Although the court did not have the authority to require the legislature to appropriate funds for the act, it did have authority to engage in statutory analysis and to order the filing of the SPA. (Maine Equal Justice Partners v. Hamilton, June 4, 2018, Murphy, M.).

Expansion of MaineCare. On November 7, 2017, the people of Maine enacted "An Act to Enhance Access to Affordable Health" (2017 I.B. 2) by citizens’ initiative which provided for the delivery of federally-approved Medicaid services to people under 65 years of age, whose incomes met certain poverty line criteria, and who were not otherwise eligible for Medicaid assistance. The expansion of MaineCare coverage allowed the state to take advantage of a provision of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148), that extends Medicaid coverage to this group.

The act provided that no later than 90 days after its effective date, MHHS was required to submit an SPA to CMS ensuring MaineCare eligibility for the qualifying group. After 90 days had passed since the act’s enactment and the Commissioner had not filed the SPA, Maine healthcare advocacy groups filed a lawsuit seeking an order requiring the Commissioner to immediately comply, and to provide coverage within the statutory 180 day deadline.

Measuring the ‘effective date.’ The Commissioner argued that the matter was not yet ripe for adjudication because 180 days had not passed since the act’s effective date, and therefore the question of whether or not the Commissioner was required to promulgate rules or provide coverage was not yet ripe. However, the court found that only the issues of the filing of the SPA were ripe, and not those pertaining to rulemaking or coverage. The court further found that regardless of the "operative" date of 2017 I.B. 2, the effective date of 2017 I.B. 2 was January 3, 2018, and more than 90 days had elapsed since both the effective date proposed by the healthcare advocacy groups and that proposed by the Commissioner.

Separation of powers. The Commissioner also objected that the court was without jurisdiction based on Maine’s constitutional separation of powers doctrine under which a question of funding could only be determined by the Maine legislature. In response, the court ruled that it did not need to delve into the exact figures as to sufficient, unallocated available funds to cover the expenditures required by 2017 I.B. 2. The court recognized that it was without authority to require the Legislature to appropriate funds, especially in a case such as this one where the act in question, namely the submission of the SPA, could be performed without appropriation. However, it remained the court’s duty to interpret the law in the context of a controversy, such as that currently before it regardless of the status of appropriations. Engaging in statutory analysis did not violate the separation of powers doctrine.

The court concluded that the Commissioner’s complete failure to act could not be considered substantial compliance with 2017 I.B. 2.5, and they ordered the Commissioner to submit the SPA to CMS by June 11, 2018.

The case is No. BCD-AP-18-02.

Attorneys: James Kilbreth (Drummond Woodsum) for Maine Equal Justice Partners and Consumers for Affordable Health Care. Patrick Strawbridge (Consovoy McCarthy Park PLLC) for Ricker Hamilton.

Companies: Maine Equal Justice Partners; Consumers for Affordable Health Care

Cases: CaseDecisions NewsFeed AccessNews AgencyNews GeneralNews GroupMarketReformNews HealthInsuranceExchangeNews MedicaidNews MedicaidExpansionNews

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