Maine's internal war over Medicaid expansion is nearly over, but is its governor ready to throw in the towel?

While Gov. Paul LePage might have a few options left in his fight against Medicaid expansion, the tea leaves read poorly for the term-limited governor. (Pixabay)

It appears one governor's anti-Medicaid expansion crusade is nearly over following a court ruling and ahead of a critical state election to appoint his successor.

A Maine Superior Court judge ruled (PDF) Monday that the state Department of Health and Human Services and Gov. Paul LePage must follow the voter-approved Medicaid expansion law and submit a state plan amendment to the federal government by June 11. 

Maine Medicaid advocates, including Maine Equal Justice Partners, sued the administration after it missed an April 3 deadline to expand the program. 

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LePage, a long-time expansion opponent, has said he would not expand the program to an additional 70,000 people until legislators came up with funding to cover the state's share of costs. But the governor is mandated to initiate the expansion following a successful 2017 ballot initiative. 

"The governor cannot ignore the law,” Robyn Merrill, executive director for Maine Equal Justice Partners, said in a statement. “Maine voters did not make a request at the ballot, they passed a law, and laws are not optional.”

In an emailed statement, the governor's press office told FierceHealthcare it was reviewing the decision and declined to comment on whether it would appeal the ruling. However, LePage might not have much luck with an appeal.

"The wording of the referendum seems pretty black and white, and it appears that the administration has a pretty difficult road ahead," Ross Margulies, a healthcare attorney at Foley Hoag, told FierceHealthcare. 

RELATED: Is Maine's Medicaid lawsuit a harbinger for other anti-expansion governors?

But even if the government elects not to appeal the decision, he could continue to drag his feet in the five months he has left in office.

"They might just try to drag this process out as long as possible and see what happens in the November elections," Margulies added.

However, the electoral tea leaves don't look good for the term-limited governor either.

Janet Mills, Maine's current attorney general and Democratic front-runner for the November gubernatorial election, not only supports expansion but has refused to represent the LePage administration in its anti-expansion legal battles. 

RELATED: Red-state GOP candidates on the wrong side of healthcare debate

The Republican frontrunners, State House Minority Leader Ken Fredette, State Senate Majority Leader Garrett Mason and former Commissioner of the Maine Department of Health and Human Services Mary Mayhew, have all vocally opposed expansion but have not indicated whether they would refuse to follow the law. 

Additionally, such a strong stance might loosen after the June 12 primary for the GOP nominee, when they try to vet general election voters—especially since 60% of voters supported expansion on the 2017 ballot.

"Such a strong stance might be needed to win a GOP primary, but such a position would come back to haunt them in the general," Julius Hobson, senior policy adviser at Polsinelli PC, previously told FierceHealthcare.

Both Rothenberg Political Report and Sabato's Crystal Ball currently rate the race as "leans Democrat."

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