Case Title: Maine Equal Justice Partners v. Commissioner, Department of Health & Human Services

Citation: 

Docket Number: 2018 ME 127

State: maine

Court: Maine Supreme Court

Date: 2018-08-23T00:00:00Z

Document:
MAINE SUPREME JUDICIAL COURT 
Reporter of Decisions 
Decision: 
2018 ME 127 
Docket: 
BCD-18-228 
Argued: 
 July 18, 2018 
Decided: 
August 23, 2018 
 
Panel: 
 SAUFLEY, C.J., and ALEXANDER, MEAD, GORMAN, JABAR, HJELM, and HUMPHREY, JJ. 
Majority: 
 SAUFLEY, C.J., and MEAD, GORMAN, JABAR, HJELM, and HUMPHREY, JJ. 
Concurrence: 
 SAUFLEY, C.J., and MEAD, J. 
Dissent:  
 ALEXANDER, J.  
 
 
MAINE EQUAL JUSTICE PARTNERS et al. 
 
v. 
 
COMMISSIONER, DEPARTMENT OF HEALTH AND HUMAN SERVICES 
 
 
JABAR, J.  
[¶1]  Before us is the Department of Health and Human Services’ motion 
asking us to stay the effect of a partial judgment entered in the Business and 
Consumer Docket (Murphy, J.) dated June 4, 2018, and to issue an expedited 
briefing schedule governing the Department’s appeal from that partial 
judgment.  There are substantial unresolved issues surrounding the 
petitioners’ appeal filed pursuant to M.R. Civ. P. 80C, and it is clear from the 
limited record before us that those issues must be resolved before we can 
consider the matter on the merits.  Because an appeal of the Superior Court 
order mandating the implementation of only one provision of the citizen 
initiative expanding Medicaid coverage is interlocutory and because, on these 
 
2 
unique facts, no exception to the final judgment rule exists, we deny the motion 
for an expedited briefing schedule and dismiss the Department’s appeal.   
I.  BACKGROUND 
[¶2]  On November 7, 2017, the voters of Maine approved a citizen 
initiative entitled “An Act to Enhance Access to Affordable Health Care” (the 
Act).  See L.D. 1039, ch. 1, §§ A-1 to B-3 (referred to the voters, 
128th Legis. 2017) (effective Jan. 3, 2018) (to be codified at 22 M.R.S. 
§ 3174-G(1)(H)1).  The Act, which expands Medicaid coverage, was not acted 
upon by the Legislature but nonetheless became the law after enactment by the 
people.  See L.D. 1039, ch. 1, §§ A-1 to B-3; see also Me. Const. art. IV, pt. 3, § 19; 
Opinion of the Justices, 2017 ME 100, ¶¶ 43-44, 162 A.3d 188.  Title 22 M.R.S. 
§ 3174-G(1) requires the Department to “provide for the delivery of federally 
approved Medicaid services to the following persons,” now including, pursuant 
to the Act, 
H.  No later than 180 days after the effective date of this paragraph, 
a person under 65 years of age who is not otherwise eligible for 
assistance under this chapter and who qualifies for medical 
assistance 
pursuant 
to 
42 
United 
States 
Code, 
Section 
1396a(a)(10)(A)(i)(VIII) when the person’s income is at or below 
133% plus 5% of the nonfarm income official poverty line for the 
                                         
1  The Maine Revised Statutes are current only through changes made during the First Special 
Session of the 128th Legislature; because this bill was approved by voters on November 7, 2017, it 
does not yet appear in the Maine Revised Statutes.   
 
3 
applicable family size.  The department shall provide such a person, 
at a minimum, the same scope of medical assistance as is provided 
to a person described in paragraph E.  
 
. . . .  
 
No later than 90 days after the effective date of this paragraph, the 
department shall submit a state plan amendment to the United 
States Department of Health and Human Services, Centers for 
Medicare and Medicaid Services ensuring MaineCare eligibility for 
people under 65 years of age who qualify for medical assistance 
pursuant 
to 
42 
United 
States 
Code, 
Section 
1396a(a)(10)(A)(i)(VIII). 
 
The department shall adopt rules, including emergency rules 
pursuant to Title 5, section 8054 if necessary, to implement this 
paragraph in a timely manner to ensure that the persons described 
in this paragraph are enrolled for and eligible to receive services 
no later than 180 days after the effective date of this paragraph.  
Rules adopted pursuant to this paragraph are routine technical 
rules as defined by Title 5, chapter 375, subchapter 2-A.   
 
L.D. 1039, ch. 1, § A-3. 
 
 
[¶3]  April 3, 2018, marked the passage of ninety days without action by 
the Department, contrary to the Act’s mandate to file a state plan amendment 
(SPA) within ninety days after the effective date.2  On April 30, 2018, Maine 
Equal Justice Partners (MEJP) and others3 filed a petition for review pursuant 
                                         
2  Although the parties dispute the precise effective date of the legislation, the Superior Court 
found that more than ninety days had passed since either date proposed by the parties.   
3  In addition to MEJP, petitioners consist of Consumers for Affordable Health Care, Maine Primary 
Care Association, Penobscot Community Health Care, and numerous individuals newly eligible for 
MaineCare pursuant to the Act’s provisions.   
 
4 
to M.R. Civ. P. 80C and 5 M.R.S. § 11001(2) (2017) based on the Department’s 
failure to initiate the implementation of the Act.  As relief, petitioners requested 
that the Superior Court: 
a. Declare that the Commissioner is under an existing statutory 
obligation pursuant to 22 M.R.S. § 3174-G(1)(H) to submit a 
state plan amendment to the United States Department of 
Health and Human Services, Centers for Medicare and Medicaid 
Services ensuring MaineCare eligibility for people under 
65 years of age who qualify for medical assistance pursuant to 
42 United States Code, Section 1396a(a)(10)(A)(i)(VIII); 
 
b. Order that DHHS, within 3 days, submit the required state plan 
amendment to CMS; 
 
c. Declare that DHHS is under an existing statutory obligation 
pursuant to 22 M.R.S. § 3174-G(1)(H) to adopt rules, including 
emergency rules pursuant to Title 5, section 8054 if necessary, 
to implement § 3174-G(1)(H) in a timely manner to ensure that 
people under 65 years of age who qualify for medical assistance 
pursuant 
to 
42 
United 
States 
Code, 
Section 
1396a(a)(10)(A)(i)(VIII) are enrolled for and eligible to receive 
services no later than July 2, 2018;  
 
d. Order that DHHS adopt the required rules in a timely manner to 
ensure that eligible individuals are enrolled for and eligible to 
receive services no later than July 2, 2018; and 
 
e. Grant Petitioners such other and further relief as it deems 
appropriate. 
 
[¶4]  On June 4, 2018, the Superior Court entered a partial judgment in 
favor of the petitioners on the merits of a portion of the Rule 80C appeal.  In its 
order, the court addressed the Commissioner’s argument that “because 
 
5 
180 days have not passed since the effective date of [the Act], the question of 
whether or not the Commissioner is required to promulgate rules or provide 
coverage is not yet ripe” and concluded that “only the questions concerning the 
filing of the SPA are ripe, not those pertaining to rulemaking or coverage 
because the deadlines for those actions are still on the horizon.”    
[¶5]  The court’s preliminary order regarding the filing of the SPA did not 
address all of the requests for relief that the petitioners sought or otherwise 
address the Department’s obligation—or lack thereof—to implement the 
statute’s directives regarding rulemaking or the full implementation of 
expansion, because it concluded that those particular issues were not ripe for 
its review.  The court therefore addressed only the relief requested pursuant to 
sections a and b of the petition quoted above and concluded, without factual 
findings, that the plain language of the statute required the Commissioner to 
submit the SPA by April 3, 2018.  It therefore ordered the Department to submit 
the SPA to the United States Department of Health and Human Services, Centers 
for Medicare and Medicaid Services, by June 11, 2018.   
 
[¶6]  On June 7, 2018, the Department filed a notice of appeal and a 
motion to expedite the appeal with us.  In its motion, the Department also 
contended that the judgment on the Rule 80C petition was automatically stayed 
 
6 
pending the resolution of this appeal.  MEJP opposed the Department’s motion.  
On June 11, 2018, the same day that MEJP filed its opposition, we issued an 
order directing the Superior Court “to determine the immediate enforceability 
of [its] order pending appeal or for any stay or injunction pending appeal.”  On 
June 15, 2018, the Superior Court denied the Department’s motion for a stay.   
[¶7]  On June 18, 2018, the Department again asked us to stay the 
execution of the judgment and expedite the appeal.  On June 20, 2018, we issued 
an order setting a hearing on the Department’s renewed motion and issued a 
temporary stay in order to preserve the status quo in the interim.  On July 18, 
2018, we heard argument on the procedural status of this appeal.  We now 
address the partial judgment of the trial court based on our review of the 
limited record before us.   
II.  DISCUSSION 
 
[¶8]  “A final judgment or final administrative action is a decision that 
fully decides and disposes of the entire matter pending before the court or 
administrative agency, leaving no questions for the future consideration and 
judgment of the court or administrative agency.”  Brickley v. Horton, 2008 ME 
111, ¶ 9, 951 A.2d 801 (quotation marks omitted); see also Bank of N.Y. 
v. Richardson, 2011 ME 38, ¶ 7, 15 A.3d 756 (“A judgment is final only if it 
 
7 
disposes of all the pending claims in the action, leaving no questions for the 
future consideration of the court.”) (quotation marks omitted)).  Even where 
neither party has raised the issue of a judgment’s finality, “we may dismiss [an] 
appeal sua sponte[4] if we determine that the appeal is unripe.”  Brickley, 
2008 ME 111, ¶ 9, 951 A.2d 801.  When there is further action to be taken in a 
given case, that case is interlocutory and not ripe for appellate review.  See 
Taylor v. Walker, 2017 ME 218, ¶ 8, 173 A.3d 539.  When a “decision from us at 
this stage would be entirely premature,” dismissal of the interlocutory appeal 
is proper.  Brickley, 2008 ME 111, ¶ 10, 951 A.2d 801.   
 
[¶9]  We conclude that this appeal is interlocutory “because a decision 
from us at this stage would be entirely premature.”  Id.  The initiating petition 
in this case requested numerous forms of relief.  See infra ¶ 3.  No factual record 
was created, and the Superior Court addressed only one component of the 
requested relief because it concluded that certain key components and 
deadlines of the Act were “still on the horizon”—namely, the Act’s mandate that 
the Department “[n]o later than 180 days after the effective date of this 
paragraph . . . shall provide” newly eligible persons “at a minimum, the same 
                                         
4  Sua sponte means “[w]ithout prompting or suggestion; on its own motion.”  Sua sponte, Black’s 
Law Dictionary (10th ed. 2014).   
 
8 
scope of medical assistance as is provided to a person described in 
paragraph E.”  See infra ¶ 2.  On remand, the court will determine whether any 
ripeness issues remain.    
[¶10]  Although much of the analysis developed by the parties and the 
court has focused on the plain language of the Act, the implementation must be 
done in accordance with the Maine Constitution, article IV, part 3, section 19, 
which states that  
any measure referred to the people and approved by a majority of 
the votes given thereon shall, unless a later date is specified in said 
measure, take effect and become a law in 30 days after the 
Governor has made public proclamation of the result of the vote on 
said measure . . . ; provided, however, that any such measure which 
entails expenditure in an amount in excess of available and 
unappropriated state funds shall remain inoperative until 45 days 
after the next convening of the Legislature in regular session. 
 
(Emphasis added.)  Whether the Act has become operative, with or without any 
Legislative action, must be determined initially by the trial court.     
 
[¶11]  To be clear, we do not reach the merits of this appeal at this 
juncture because MEJP’s petition has not been disposed of in its entirety.  
Before an appeal to us is proper, all factual and legal issues and requests for 
relief must be litigated, dismissed, or withdrawn.  That has not happened here, 
and as a result, we must dismiss this appeal as interlocutory.  Because we 
dismiss the appeal, our stay preserving the status quo is lifted, and the 
 
9 
Department’s renewed motion for a stay and to expedite the appeal is denied.  
We direct the Superior Court to dispose of the remaining requests in the 
petition, as well as any issues that may have arisen now that the 180-day 
deadline has passed, in as timely a manner as possible, and we clarify that, in 
the interim, the June 4, 2018, and June 15, 2018, orders of the Superior Court 
remain in effect.   
The entry is: 
Appeal dismissed.   
 
 
 
 
 
  
 
SAUFLEY, C.J., with whom MEAD, J., joins, concurring. 
 
[¶12]  We concur in the opinion of the Court dismissing the appeal as 
interlocutory.    
[¶13]  We write separately to indicate that, although we agree with our 
colleague in dissent that attention must be paid to the Legislature’s 
constitutional authority and responsibility for funding government programs, 
see Me. Const. art. V, pt. 3, § 4, and the specific language of the Constitution 
addressing implementation of the people’s initiative, see Me. Const. art. IV, pt. 3, 
§ 19, we conclude, as has the Court, that any legal determination related to 
those concerns is premature.  Because the order of the trial court is, in practical 
 
10 
terms, wholly preliminary, there is no basis for the Law Court to act in this 
piecemeal appeal from the action of the court.  
[¶14]  Given the current state of the record, the trial court’s mandate 
regarding the submission of a plan will likely have no practical effect.5   
[¶15]  To be clear, the Legislature could have, but did not, repeal the law 
enacted by the people’s initiative.  Cf. Opinion of the Justices, 2017 ME 100, ¶ 52, 
162 A.3d 188.  Accordingly, the law exists, and there are now two identified 
routes to resolving the conflict that is pending before the Superior Court.  Either 
(1) the Legislative Branch can allocate a reasonable amount of appropriate 
funding for the expanded group of recipients, or, in the absence of such funding, 
(2) the Judicial Branch must analyze and effectuate the constitutional 
provisions that address the operation of the people’s initiative and the 
judiciary’s authority to effectuate the provisions of the Maine Constitution.  See 
Me. Const. art. III, § 2; Me. Const. art. IV, pt. 3, § 19; Me. Const. art. V, pt. 3, § 4.    
[¶16]  Neither of those events has been accomplished to date, leaving the 
question of funding unresolved.  Yet, as the parties acknowledge, the federal 
                                         
5  Although, in contrast to the dissent, we assume that the Executive Branch will comply with the 
trial court’s order to submit “a plan,” that submission cannot, in practical terms, meet the 
requirements of the federal law at this stage of the trial court’s proceeding.  Cf. 42 U.S.C.S. 1396a(a)(2) 
(LEXIS through Pub. L. No. 115-108).   
 
11 
Medicaid program requires that any Medicaid plan or state plan amendment 
must include information regarding the extent of state financing for the plan.  
See 42 U.S.C.S. 1396a(a)(2) (LEXIS through Pub. L. No. 115-108).    
[¶17]  Accordingly, on the limited record before us, where the Legislature 
has not acted and the trial court has not even reached the constitutional 
analysis regarding the implementation of the initiative, it is likely that any plan 
submitted by the Executive Branch will, by definition, have to report candidly 
that no legislative action or judicial adjudication regarding funding has been 
completed.  Because such a plan appears to have no reasonable likelihood of 
meeting the approval of the administrators of the federal Medicaid program, 
there is little risk that “substantial rights of a party will be irreparably lost if 
review is delayed until final judgment.”  Bruesewitz v. Grant, 2007 ME 13, ¶ 8, 
912 A.2d 1255.  Therefore, it is neither appropriate nor necessary for the Law 
Court to consider this interlocutory appeal.     
[¶18]  As the Court indicates, the matter should be returned to the trial 
court for an expedited and thorough analysis of the facts and law, with a careful 
review of the constitutional provisions that must guide the courts in this inter-
branch proceeding, particularly Me. Const. art. IV, pt. 3, § 19.  Court’s Opinion 
¶¶ 10-11. 
 
12 
 
 
 
 
 
  
 
ALEXANDER, J., dissenting. 
 
[¶19]  Today the Court orders that “the June 4, 2018, and June 15, 2018, 
orders of the Superior Court remain in effect” and that “our stay preserving the 
status quo is lifted.”  Court’s Opinion ¶ 11.  With the stay lifted, the Superior 
Court’s mandate to submit the Medicaid expansion implementation plan to the 
federal Centers for Medicare and Medicaid Services is “in effect.”  Id. 
[¶20]  The deadline set for submission of the expansion plan has already 
passed.  If the Commissioner of the Department of Health and Human Services 
is unable to prepare and submit that plan almost immediately after this Court’s 
opinion issues, the plaintiffs will be able to seek action by the Superior Court to 
enforce its mandate.  That enforcement action could result in appointment of a 
receiver, or other judicial action to usurp the executive authority of the 
Commissioner and perhaps the Governor, to draft and submit a plan. 
[¶21]  I respectfully dissent from the Court’s actions lifting the stay and 
freeing the Superior Court to enforce its mandate that the Commissioner 
prepare and file a plan to implement the authorized but unfunded Medicaid 
expansion approved by citizen initiative.  The stay we ordered should remain 
 
13 
in effect, and we should proceed expeditiously to address the merits of the 
Commissioner’s appeal of the Superior Court’s mandate. 
I.  REACHING THE MERITS OF THIS APPEAL 
[¶22]  The Court holds that maintenance of the stay is not possible 
because the Superior Court’s actions are interlocutory and many issues remain 
to be resolved before the Superior Court’s action on the plaintiffs’ complaint 
can be finalized.  Court’s Opinion ¶ 11.  I concur that there is much to be 
resolved—most fundamentally, the limits of judicial authority under the strict 
separation of powers clause, in article III of our Maine Constitution, to order 
submission of a plan to implement a program, without an approved 
appropriation, that all agree will cost tens of millions of dollars to implement. 
[¶23]  In ordering that an implementation plan be submitted to the 
federal government, the Superior Court bypassed those nettlesome questions 
and issued a mandate that can subject state officials to a contempt sanction, see 
M.R. Civ. P. 66, and/or appointment of a receiver if no plan is submitted.  Beyond 
the risk of contempt or displacement of executive authority by a court 
appointed receiver, mandated filing of an implementation plan may also have 
significant cost implications for the State.   
 
14 
[¶24]  The plaintiffs in this matter are represented by skilled counsel.  
Pending our reaching the merits, we should assume that the plaintiffs have 
some chance of success on their claim that the courts can mandate filing of the 
Medicaid expansion plan.  Once the plan is filed, the plaintiffs contend, the 
courts can and will mandate payments to those who qualify for benefits, even 
without any additional appropriation.    
[¶25]  Specifically, the plaintiffs contend that once the implementation 
plan is submitted, qualified individuals, some of whom are already applying for 
benefits, may, by court order, begin receiving the expanded Medicaid payments.  
The plaintiffs assert that these additional costs will be paid from funds already 
appropriated to support those presently receiving Medicaid benefits.  See 
Appellees’ Opposition to Motion to Stay Pending Appeal, at 13:  
[T]here are existing appropriations in the Medicaid accounts 
sufficient to fund Maine’s Medicaid program and provide benefits 
for all eligible populations described in . . . 22 M.R.S. § 3174-G(1)—
including the expansion population newly added as Paragraph (H) 
to that subsection—through at least May of 2019. . . .  Accordingly, 
even with no additional legislative appropriation, the Department 
is statutorily obligated to implement newly-enacted Paragraph (H), 
just as it is statutorily obligated to implement Paragraphs (A), (B), 
(C), (D), (E), (F), and (G). 
   
[¶26]  Alternatively, the plaintiffs have contended that courts might 
mandate expenditures of unused funds in other state accounts, such as the so 
 
15 
called “Rainy Day Fund” or other funds, already appropriated, that have not yet 
been spent.  The prospect of the courts reviewing state program accounts, 
identifying unspent funds, and ordering those funds transferred to and spent 
on the Medicaid expansion demonstrates considerable misunderstanding of 
our constitutional separation of powers. 
[¶27]  Based on the plaintiffs’ arguments about how expanded benefits 
can be paid once a plan is filed, the plan filing mandate is a final judgment 
requiring no further trial court action before individuals who qualify can 
become eligible for expanded benefit payments.  Even if the trial court’s 
mandate remains an interlocutory order, as the Court holds it is, an exception 
to the final judgment rule requires that we consider this appeal.   
[¶28]  Under the “death knell” exception to the final judgment rule, an 
interlocutory appeal is permitted when “substantial rights of a party will be 
irreparably lost if review is delayed until final judgment.”  Bruesewitz v. Grant, 
2007 ME 13, ¶ 8, 912 A.2d 1255; see also U.S. Dep’t of Agric., Rural Housing 
Serv. v. Carter, 2002 ME 103, ¶ 12, 799 A.2d 1232 (stating that the death knell 
exception is available when the injury to the appellant’s claimed right, absent 
appeal, would be imminent, concrete, and irreparable).   
 
16 
[¶29]  We have held that the death knell exception to the final judgment 
rule authorizes appeals from a “mandatory” injunction—an injunction, as at 
issue in this case, that requires the enjoined party to affirmatively act and 
change, rather than maintain, the status quo.  Dep’t of Environmental Prot. v. 
Emerson, 563 A.2d 762, 765-67 (Me. 1989).  Unless we are willing to overrule 
Emerson, we must address the merits of the Commissioner’s appeal from the 
Superior Court’s mandatory injunction. 
II.  MAINTAINING THE STAY 
[¶30]  Pending our reaching the merits of the Commissioner’s appeal, the 
conditions in June that led us to order a stay of the Superior Court’s mandate 
have not changed.  If anything, the conditions today more strongly favor a stay 
because the plaintiffs have been quite honest in stating that they hope to fund 
the Medicaid benefits they seek by taking from funds already appropriated for 
current Medicaid beneficiaries and using those funds to pay benefits to the 
70,000 newly eligible individuals. 
[¶31]  Requests for stays or injunctions before the Law Court are subject 
to the same standards for obtaining injunctive relief that are applied in the trial 
courts.  See Bangor Historic Track, Inc. v. Dep’t of Agric., Food & Rural Resources, 
2003 ME 140, ¶¶ 9-12, 837 A.2d 129.  To obtain a stay, the moving party “must 
 
17 
demonstrate that (1) it will suffer irreparable injury if the injunction is not 
granted; (2) such injury outweighs any harm which granting the injunctive 
relief would inflict on the other party; (3) it has a likelihood of success on the 
merits (at most, a probability; at least, a substantial possibility); and (4) the 
public interest will not be adversely affected by granting the injunction.”  Id. ¶ 9 
(citing Emerson, 563 A.2d at 768); accord Respect Me. PAC v. McKee, 622 F.3d 13, 
15 (1st Cir. 2010) (noting that the “most critical” factors in considering a stay 
pending appeal are “(1) whether the applicant has made a strong showing that 
he is likely to succeed on the merits; [and] (2) whether the applicant will be 
irreparably injured absent relief. . . .  Plaintiffs must show a strong likelihood of 
success, and they must demonstrate that irreparable injury will be likely absent 
an injunction.” (citing Winter v. Natural Res. Def. Council, Inc., 555 U.S. 7, 21-22 
(2008))). 
A. 
Irreparable Injury 
[¶32]  Addressing irreparable injury first: The plaintiffs propose to fund 
the Medicaid expansion by taking funds already appropriated to support 
payments to those who qualified to receive Medicaid benefits before approval 
of the citizen initiative.  The plaintiffs recognize that their plan will exhaust the 
fiscal year 2019 appropriation sometime next spring, well before the end of the 
 
18 
fiscal year.  By then, the plaintiffs argue, the Legislature and the Governor may 
authorize new resources to assure that benefits can be paid to all through the 
end of the fiscal year.  In the meantime, current Medicaid beneficiaries and 
health care providers will be irreparably injured by longer wait times for 
treatment, delays in claims processing and payments, and reduced availability 
of out-patient and in-patient care occasioned by a large influx of new patients 
competing to use already too limited staff, facilities, and financial resources. 
[¶33]  The public and the taxpayers will also be harmed if shortfalls in 
Medicaid funding require tax increases or cuts in other programs or services to 
make up for the shortfall in Medicaid funding.  Thus, there is a sufficient 
demonstration of irreparable injury to support maintaining the stay of the 
Superior Court’s mandate. 
B. 
Likelihood of Success on the Merits 
[¶34]  Turning to the question of probable or strong likelihood of success 
on the merits: No matter how much the Commissioner may want to prepare 
and submit a Medicaid expansion plan to the federal government, federal law 
bars him from doing so without an identified source of funds to support the 
expanded program throughout the fiscal year, not just for the first nine or ten 
months of the fiscal year.  
 
19 
[¶35]  The lengthy and detailed federal law that governs filing a state 
Medicaid plan is 42 U.S.C.S. § 1396a (LEXIS through Pub. L. No. 115-230).  
Section 1396a(a)(2) directs, “A State plan for medical assistance must . . . 
provide for financial participation by the State equal to not less than 40 
per centum of the non-Federal share of the expenditures under the plan with 
respect to which payments under [42 U.S.C.S. § 1396b] are authorized by this 
title . . . and . . . provide for financial participation by the State equal to all of such 
non-Federal share or provide for distribution of funds from Federal or State 
sources, for carrying out the State plan, on an equalization or other basis which 
will assure that the lack of adequate funds from local sources will not result in 
lowering the amount, duration, scope, or quality of care and services available 
under the plan.”  (Emphasis added.)   
[¶36]  Later provisions in section 1396a establish that the relevant 
non-Federal share of required state participation in the Medicaid expansion 
program will be ten percent of program costs.  There being no funds 
appropriated for Medicaid expansion, the Commissioner has no capacity to 
submit a plan identifying the required state financial participation, estimated 
to be more than $40,000,000 for fiscal year 2019, according to the record before 
this Court. 
 
20 
[¶37]  The plaintiffs argue that there are sufficient resources to meet the 
plan’s financial requirements by utilizing the existing Medicaid appropriation 
to support the expanded eligibility, and that this resource is sufficient to carry 
the program into next spring.  That argument ignores that second part of 
section 1396a(a)(2), which requires that the financial plan not only serve the 
present but “assure that the lack of adequate funds from local sources will not 
result in lowering the amount, duration, scope, or quality of care and services 
available under the plan.”  42 U.S.C.S. § 1396a.  If the plaintiffs’ funding plan 
were adopted or included in a plan ordered submitted by the court, the 
approved Medicaid plan to serve current Medicaid beneficiaries could be 
placed at risk because, by design, the plaintiffs’ financial plan, by next spring, 
will “result in lowering the amount, duration, scope, or quality of care and 
services available under the plan.”  Id. 
[¶38]  The plaintiffs also argue that if no appropriation of $40,000,000 is 
forthcoming, the state courts, or perhaps the federal courts, could order that 
state funds be gathered from other sources and spent to serve the needs of 
those made eligible for services by the Medicaid expansion law.  In effect, the 
plaintiffs invite the courts to become a last resort appropriations process, 
directing funding for programs and services authorized by law but not funded, 
 
21 
or not sufficiently funded, through the legislative and gubernatorial 
appropriations approval process. 
[¶39]  Court involvement in ordering funding for statutorily authorized 
programs, when appropriations to support such programs fail or are viewed as 
inadequate to meet perceived needs, would violate Maine’s strict separation of 
powers requirements as stated in article III of the Maine Constitution 
(Distribution of Powers).  Article III states:  
 
Section 1.  Powers distributed.  The powers of this 
government shall be divided into 3 distinct departments, the 
legislative, executive and judicial.  
 
Section 2.  To be kept separate.  No person or persons, 
belonging to one of these departments, shall exercise any of the 
powers properly belonging to either of the others, except in the 
cases herein expressly directed or permitted.  
[¶40]  In Sawyer v. Gilmore, 109 Me. 169, 178, 83 A. 673 (1912), when 
called upon to review a legislatively approved school funding formula asserted 
to be an unconstitutional violation of equal protection, we declined, observing, 
“We are not to substitute our judgment for that of a coordinate branch of the 
government working within its constitutional limits.”  Id.  Later in the opinion, 
and relevant to the case at hand, we reminded litigants that  
it is not always borne in mind that the Constitution operates 
differently with respect to these different branches.  The authority 
of the executive and judicial departments is a grant.  These 
 
22 
departments can exercise only the powers enumerated in and 
conferred upon them by the Constitution and such as are 
necessarily implied therefrom.  The powers of the Legislature in 
matters of legislation, broadly speaking are absolute, except as 
restricted and limited by the Constitution.  As to the executive, and 
judiciary, the Constitution measures the extent of their authority, 
as to the Legislature it measures the limitations upon its authority. 
  
Id. at 180.  
 
[¶41]  The limitations on the power of the courts to order State spending 
for statutorily authorized programs, for which appropriations have not been 
approved, or for which approved appropriations are deemed inadequate, are 
emphasized by Me. Const., art. V, pt. 3, § 4:  
 
Section 4.  No money drawn except upon appropriation 
or allocation.  No money shall be drawn from the treasury, except 
in consequence of appropriations or allocations authorized by law.  
 
 
[¶42]  In Weston v. Dane, 51 Me. 461 (1862), and Weston v. Dane, 
53 Me. 372 (1865), the Court considered a legislative resolve that had 
authorized George Weston to be paid a commission of twenty percent for his 
successful efforts to obtain federal reimbursement for state expenditures for a 
regiment organized and sent by the State in the Mexican War.  The commission 
was to be paid from the recovered funds, which totaled $ 10,308.28.  Weston, 
51 Me. at 463.  Weston brought an action for a writ of mandamus to recover 
$1,000 that remained unpaid.  Id.   
 
23 
[¶43]  Addressing an older version of Me. Const., art. V, pt. 3, § 4,6 the 
Court held that it could not order reimbursement of authorized funds without 
appropriation and, under the older version of section 4, a governor’s warrant.  
“The petition, stripped of the specious disguise thrown around it by the able 
argument of counsel in its support, asks us to command the treasurer to pay 
money in violation of the clear and distinct provisions of the constitution, by 
virtue of which he and we exercise the several trusts reposed alike in him and 
in us.  The writ is denied.”  Weston, 51 Me. at 465.  The 1865 opinion addressed 
the same claim, but without specific reference to Me. Const., art. V, pt. 3, § 4.  
Weston, 53 Me. At 372-373. 
[¶44]  Relevant, more modern opinions include KHK Associates v. 
Department of Human Services, 632 A.2d 138 at 140-141 (Me. 1993), which, as 
part of its reasoning, applied Me. Const., art. V, pt. 3, § 4, in allowing the State to 
abandon a lease for a building that had been built for the State in Aroostook 
County because of financial cutbacks and lack of an appropriation.  See also 
SC Testing Technology, Inc. v. Department of Environmental Protection, 
                                         
6  The older version of Me. Const., art. V, pt. 3, § 4 stated "that no money shall be drawn from the 
treasury, but by warrant from the Governor and Council, and in consequence of appropriations made 
by law; and a regular statement and account of the receipts and expenditures of all public money 
shall be published at the commencement of the annual session of the Legislature."  Weston v. Dane, 
51 Me. 461, 463-64 (1862).  In the citation, the Weston opinion references “part 4,” but this is a 
citation error. 
 
24 
688 A.2d 421 at 424-425 (Me. 1996), another case where the Court approved 
the State abandoning a contract after the contractor had made significant 
commitments pursuant to a legislative authorization that was not funded by an 
appropriation. 
[¶45]  While not reaching the merits, the Court suggests that the citizen 
initiative portion of Me. Const., art. IV, pt. 3, § 19, may authorize the courts to 
mandate funding for citizen-initiated legislation that requires funding if the 
Legislature fails to appropriate funds to implement the initiative.  Court’s 
Opinion ¶ 10.  Section 19 provides, in pertinent part, “that any such measure 
which entails expenditure in an amount in excess of available and 
unappropriated state funds shall remain inoperative until 45 days after the next 
convening of the Legislature in regular session, unless the measure provides for 
raising new revenues adequate for its operation.” 7   
                                         
7  The “45 days after the next convening of the Legislature in regular session” language was added 
to section 19 in 1951 by Me. Const. amend. LXVI.  Opinion of the Justices, 460 A.2d 1341, 1350 (Me. 
1982).  At the time “there was then only one ‘regular session’ of the Legislature, which convened 
biennially on the first Wednesday of January.”  Id.  “[T]he amendment avoided the possibility that the 
45-day period would be activated by a special session of the Legislature.  Thus, the amendment 
provided ample opportunity for the Legislature to enact funding measures or take any other 
constitutionally authorized steps by insuring that the 45-day period would commence only at the 
next regular session after the regular session to which the measure had been presented.”  Id.   
The Legislature was operating with a First Regular Session and a Second Regular Session at the 
time of the 1982 Opinion of the Justices.  See id.; see also Me. Const., art. IV, pt. 3, § 1.  The Opinion of 
the Justices did not address whether the schedule that applied at the time of the 1951 amendment 
would govern the running of the 45 days, or whether that changed with the later amendment of 
Me. Const., art. IV, pt. 3, § 1, to establish two “regular” sessions.  If the original schedule applied, for 
 
25 
[¶46]  Section 19 does not specify any remedy if no appropriation is 
adopted.  Considering that, as specified in Sawyer, 109 Me. at 180, the court’s 
authority to act must be found in our Constitution, section 19 provides no 
invitation or authority for the courts to mandate funding to implement an 
unfunded citizen initiative.   
[¶47]  In addition, section 19 does not exempt citizen-initiated legislation 
from the requirement of Me. Const., art. V, pt. 3, § 4, that no state funds “be 
drawn from the treasury, except in consequence of appropriations or 
allocations authorized by law.”  The two Constitutional provisions must be read 
consistently, so that each remains in effect.  See Penobscot Nation v. Stilphen, 
461 A.2d 478, 481 (Me. 1983) (“We will not read a statute to conflict with 
another statute where an alternative, reasonable interpretation yields 
harmony.”).  
[¶48]  Neither the Maine Constitution, nor these precedents, suggests 
that the courts cannot order the State to pay benefits to individuals who are 
found to qualify for certain benefit payments when there is an appropriation to 
support payment of benefits.  In Manirakiza v. Department of Health & Human 
                                         
this case, the 45 days would not begin to run until the convening of the new Legislature following the 
2018 elections.    
 
26 
Services, 2018 ME 10, ¶¶ 7-15, 177 A.3d 1264, the Legislature had appropriated 
funds to support payment of benefits to certain food stamp applicants, but had 
imposed a fiscal cap on those benefit payments in the initial years of the 
program.  Manirakiza would have been excluded from eligibility for benefits 
had he applied for benefits in the years in which the appropriations cap applied.  
Id. ¶¶ 3, 15.  Manirakiza applied for benefits at a time when we held that the 
appropriations cap had expired.  Id. ¶ 15.  Accordingly, we held that Manirakiza 
was entitled to be paid benefits because he qualified for benefits and 
appropriations had been made to pay for the benefits.  Id. ¶¶ 1, 15. 
[¶49]  The appeal was decided based on statutory interpretation of the 
cap, not constitutional issues.  Id. ¶¶ 4, 7-15.  Inferentially, the opinion suggests, 
as a matter of statutory interpretation, that although Manirakiza was eligible 
for benefits under the particular food stamp program to which he applied, the 
Court could not and would not have ordered benefits to be paid to him if the 
cap had applied or if, as is before us today, there was no appropriation at all for 
the particular program. 
III.  CONCLUSION 
[¶50]  Because the Commissioner has established that our refusal to 
continue the stay will cause irreparable harm to the existing Medicaid program, 
 
27 
its beneficiaries, and the public, and because the Commissioner has established 
a strong likelihood of success on the merits of his appeal, the stay should 
continue in effect pending our resolution of the appeal of the trial court’s 
mandate to prepare and file a Medicaid expansion plan, despite the lack of an 
appropriation to fund the expansion.  
 
[¶51]  Prior to the November 2017 initiative vote to approve the 
Medicaid expansion, the Secretary of State’s Maine Citizens Guide to the 
Referendum Election for that November 7, 2017, election, addressing the 
Medicaid Expansion Initiative, stated that if the Medicaid expansion was 
“approved by the voters, additional implementing legislation will be required 
to provide the additional appropriations and allocations."  That observation, 
explaining the implications of the initiative, was a correct statement of the 
prerequisites to implement the citizen initiative then, and it remains a correct 
statement today. 
[¶52]  Before implementation of the program can begin, and before an 
implementation plan can be submitted to the federal government, there must 
be an appropriation to support the program properly enacted into law by the 
Legislature.  Without an appropriation for the Medicaid expansion program, the 
separation of powers mandated by article III of the Maine Constitution bars the 
 
28 
courts from ordering appropriation and expenditure of state funds for that new 
program.   
 
 
 
 
 
 
 
Patrick Strawbridge, Esq. (orally), Consovoy McCarthy Park PLLC, Boston, 
Massachusetts, for appellant Commissioner, Department of Health and Human 
Services 
 
James T. Kilbreth, Esq. (orally), and David M. Kallin, Esq., Drummond Woodsum 
& MacMahon, Portland; Jack Comart, Esq., and Robyn Merrill, Esq., Maine Equal 
Justice Partners, Augusta; and Charles F. Dingman, Esq., PretiFlaherty, Augusta, 
for appellees Maine Equal Justice Partners et al. 
 
 
Business and Consumer Docket docket number AP-2018-02 
FOR CLERK REFERENCE ONLY