The Affordable Care Act – called the ACA for short – gave states the authority and financial support to expand their Medicaid health insurance programs. Beginning in 2014, states could expand coverage for all adults aged 18-64 whose family earned collectively less than 138 percent of the Federal Poverty Level. Before the ACA, only select groups of low-income adults (primarily parents and people with permanent disabilities) were eligible for Medicaid coverage, although a small number of states had expanded Medicaid on their own. Maine had been one of those states, but allowed its pre-ACA expansion to lapse at the end of 2013. Initially, only 28 states opted to expand Medicaid in 2014 (including the District of Columbia). That number had risen to 36 as of 2019.
Following the ACA’s passage, Maine made several legislative attempts to expand MaineCare (its Medicaid program) to low-income, non-elderly adults. While the Maine Legislature passed five bills to authorize the expansion, each of these ultimately failed under gubernatorial veto. In response to this apparent impasse, Maine groups organized the nation’s first citizen referendum on Medicaid expansion and, in November 2017, Maine voters approved the initiative with 59 percent of the vote. In January 2019, Maine officially began accepting residents into its expanded MaineCare program. By the end of June 2019, Maine had enrolled more than 26 thousand adults eligible for the expanded coverage.