Despite the president’s efforts to undermine the Affordable Care Act, 2018 is shaping up to be a big year for Medicaid expansion.

Virginia’s legislature has now signed on to expand coverage for low-income Americans.  Four more states – Utah, Idaho, Nebraska, and Montana – may do the same in November through ballot initiatives, which are starting to gain steam.  If all four succeed, more than a half-million low-income Americans will gain health coverage.

Utah’s lieutenant governor has certified that the ballot initiative there has gathered enough signatures to get on the November ballot.  Organizers in Idaho believe they have turned in enough votes there as well, but the state has until July 5 to certify the results.  Signature gatherers in Montana and Nebraska face deadlines of June 22 and July 6, respectively.  Montana already expanded its Medicaid program, but only through 2019; the current drive would extend it.

Last November Maine became the first state to approve Medicaid expansion at the ballot box, by a 59-41 percent margin.  But Gov. Paul LePage refused to implement the program, claiming that the legislature had not budgeted enough money to pay for it.  This week a Superior Court judge rejected that argument, ordering the state’s Department of Health and Human Services to abide by the vote and giving the state one week to file the necessary paperwork.  More than 70,000 more residents should now be able to sign up for health coverage by July 2.

“The court is not persuaded that the executive branch is excused from clear statutory obligations by the Legislature’s failure to follow through with legislative obligations, as defined by the executive branch,” Superior Court Justice Michaela Murphy wrote in her 13-page ruling. “The court concludes that the commissioner’s complete failure to act cannot be considered substantial compliance with (the referendum vote).”

Once the state plan amendment has been filed and approved, federal matching funds will reimburse Maine for about 90 percent of the program’s costs.

Update (July 2):  Medicaid signups began in Maine today, but LePage has appealed the state court ruling to the state’s Supreme Judicial Court, which will hear the matter on July 18.  Meanwhile, the legislature appropriated $60M last week to fund the expansion, but the governor has pledged a veto.  A July 9 override vote is now likely.