Gov.-elect Janet Mills showed up at the Medicaid expansion lawsuit hearing in Maine Superior Court on Wednesday morning and said she would implement expansion immediately upon taking office.

Fresh off a decisive victory in the gubernatorial election, the Democratic attorney general said she was “here to listen” to the hearing on a complaint Maine Equal Justice Partners filed against the LePage administration for failing to implement Medicaid expansion.

Mills is a strong supporter of Medicaid expansion, taking the opposite position of outgoing Republican Gov. Paul LePage.

Her office filed a brief this fall supporting Maine Equal Justice’s position that the law must be implemented, but Mills recused herself from participating in the case at the time.

She did not speak at the hearing Wednesday but said beforehand that “dragging our feet any longer on this is inexcusable at this point.” Medicaid expansion, a key component of the Affordable Care Act, has been approved in 37 states. Utah, Idaho and Nebraska voters gave the thumbs-up to Medicaid expansion in Election Day referendums Tuesday.

Maine voters approved expansion in 2017, but the LePage administration and Maine Equal Justice have been fighting in court for months over implementation.

Mills said she will implement Medicaid expansion immediately after she takes office on Jan. 2 using existing state funds.

Maine voters approved Medicaid expansion in a November 2017 referendum by a 59-41 percent margin. But LePage, an expansion opponent who has vetoed attempts by the Legislature to expand Medicaid, refused to implement it, arguing that there wasn’t enough state funding to do so.

Under expansion, the federal government pays 90 percent of the cost of health care for those who enroll under the expansion population, with the state picking up the rest. In Maine, about 70,000 people, mostly low-income adults, would become eligible for Medicaid under the expansion.

The state would pay about $50 million and receive more than $500 million from the federal government to pay for the expansion that would cover those earning up to 13 percent of the federal poverty limit: $34,638 for a family of three and $16,753 for a single person. Maine Equal Justice Partners filed a lawsuit this spring when the LePage administration failed to implement expansion, arguing that the administration must follow the voter-approved law. The case has been tied up in court ever since.

James Kilbreth, an attorney for Maine Equal Justice Partners, said Wednesday that the LePage administration was demonstrating “contempt and defiance” to the people of Maine for refusing to implement the law.

“(The LePage administration) doesn’t have the ability to say, ‘Oh, never mind, we don’t like this law,’” Kilbreth said.

Jonathan Bolton, an assistant attorney general, argued in court Wednesday that the LePage administration must put Medicaid expansion in place. Bolton said there’s no other law or constitutional issue in conflict with the voter-approved Medicaid expansion, so it should be a clear case.

“This is not the murky middle,” he said. “We don’t think this is a close call.”

Superior Court Judge Michaela Murphy listened to attorneys make their arguments Wednesday, and she must decide whether she will compel Gov. LePage to implement the expansion in the waning days of the administration.

Patrick Strawbridge, an attorney representing the administration, argued that because the referendum did not specifically set aside funds for Medicaid expansion, it is not up to the court to address the funding dispute.

“The court lacks the power to wander into the appropriations process,” Strawbridge said. He said the expansion represents a “permanent structural change” to the Medicaid program, and funding issues must be resolved by the Legislature and the governor. The Legislature approved a $60 million expansion funding bill this summer, but LePage vetoed it, arguing it used one-time budget gimmicks to fund the expansion.

Maine Equal Justice Partners also is attempting to make Medicaid coverage retroactive to July 2 — when the group contends people should have been able to apply for benefits — to about 4,500 Mainers who have applied for coverage under expansion but have been denied. That means those who incurred medical bills would be eligible to get them paid if they absorbed the costs after they should have been covered by the program.

Mills said “ideally” when she takes office, the coverage will become retroactive to July 2 for that population. 

Robyn Merrill, Maine Equal Justice Partners executive director, said even though the Mills administration will quickly implement Medicaid expansion, it’s still important to hold the LePage administration accountable and obtain coverage for Mainers as soon as possible.

“We’re focusing on winning in court,” Merrill said. “The citizens’ initiative process has to mean something. The executive branch can’t just ignore laws passed by Maine people.”

Gov.-Elect Janet Mills poses for a selfie with Allyn Genest of Sanford on her way into Becky’s Diner in Portland on Wednesday, the morning after her historic election. (Shawn Patrick Ouellette/Portland Press Herald)