On the same day that advocates for expanding Medicaid coverage delivered more than 67,000 signatures to secure a public referendum on the issue, the state asked the new administration in Washington to let it scale back the federal health care program for the poor.

For Maine Department of Health and Human Services Commissioner Mary Mayhew, there’s no doubt which path makes more sense.

She said Thursday that ramping up the program’s numbers would create “a sea of red ink” and wind up crippling efforts to provide better service for the elderly and people whose disabilities make it impossible for them to work.

The commissioner told the Lewiston-Auburn Rotary Club that the financial stability of the department would suffer if voters agree to take federal funding that would cover tens of thousands of low-income Mainers who can’t afford health insurance and haven’t been able to get help through MaineCare, the state’s Medicaid program.

Instead of adding people to the rolls, she said, the state should be focusing on delivering better service to senior citizens and disabled Mainers.

Mayhew, a possible gubernatorial candidate in 2018, has navigated the treacherous politics surrounding her department since taking its helm after the election of Gov. Paul LePage despite holding “the hardest job in state government,” according to Rotarian Peter Kowalski.

In a four-page letter she sent to the federal government Wednesday, Mayhew sought a green light for “a series of critical changes” that would shift costs onto some recipients.

Among the many revisions Mayhew is seeking are ones that would establish work or education requirements on able-bodied recipients, impose a five-year lifetime limit, add monthly premiums, establish a $20 co-pay for emergency room visits and bar people with significant assets from participating in the program.

Mayhew said she is “incredibly optimistic” the Trump administration will back the request after the state completes a formal, detailed waiver application. She said she hopes to hear quickly whether the concept has support.

In her talk to Rotarians, Mayhew spoke about what she views as a successful six-year effort to turn around a department that had been “a perpetual financial disaster.”

She said it had lunged from crisis to crisis for years, constantly shedding cash and failing to ensure that the most vulnerable Mainers got the care they needed. It was incessantly in “panic mode,” the commissioner said.

In the decade before LePage took office in 2011, Mayhew said, MaineCare had doubled its annual cost, to $2.4 billion, and almost doubled the number of people it served to 354,000 in all.

“That money had to come from somewhere,” she said, so it meant cuts to other state functions or higher taxes. It had the effect of gobbling up other priorities, Mayhew said, leaving the state unable to allocate resources to anything else.

So LePage and Mayhew agreed to tackle the problem.

“We had to make the tough decisions to get our financial house in order,” Mayhew said.

Within four years, they’d slashed enrollment in the program by 24 percent, she said, and stabilized its spending.

The changes allowed officials the opportunity to assess what it needed to do most and “to make critical investments” to help the people it serves, Mayhew said, pointing to a 47 percent hike in nursing home reimbursements as one way it boosted the care for elderly Mainers. It also forked over more money for home care services so seniors could stay in their homes longer.

Mayhew isn’t content yet with the care for those with disabilities such as Down syndrome. More than 1,000 people are on a waiting list for help, she said, and several hundred graduate from high school annually, so she knows the tally will grow.

Mainers for Health Care, though, say it doesn’t make sense to reject the federal funding attached to Medicaid expansion. It basically covers two-thirds of the cost.

The group, which gathered the signatures for a ballot question, said an expansion would add coverage for 70,000 working Mainers and bring $500 million in additional federal funds to Maine.

The Legislature has repeatedly backed the expansion, but hasn’t been able to overcome LePage’s vetoes of the proposal. If voters back the change, the governor’s opposition wouldn’t be enough to stop it.

“Too many Mainers are struggling to pay their doctors’ bills or not going to a doctor at all because it’s too expensive,” said House Speaker Sara Gideon, D-Freeport. “Expanding access to affordable health care would not only have significant impact on the lives of countless Mainers but would boost our economy by adding over 3,000 jobs and improving the health of our workforce.”

The Maine GOP scoffed at the referendum bid, calling it “a moot point and a waste of state resources” given the looming changes Trump is likely to make.

“We are likely witnessing the introduction of a referendum that would have no effect other than misguided demands that Maine taxpayers would be saddled with, and potentially, even more welfare costs,” it said in a prepared statement. “The easiest way to explain this stunt is that Democrats are basically selling tickets on the Titanic as it sinks.”

Mayhew said her possible political interest in the 2018 gubernatorial campaign is motivated by a desire to make sure the state doesn’t return to the fiscally unsound policies that LePage found when he took office.