Mary Mayhew: The New Anti-Medicaid Head of Medicaid

Mary Mayhew, a fierce opponent of Medicaid Expansion under the Affordable Care Act, was announced on October 15 as the new Deputy Administrator and Director of the U.S. Center for Medicaid and CHIP [Children’s Health Insurance Program] Services. As the House Ways and Means Committee Democrats put it in a recent tweet, the Trump Administration’s choice “is like hiring an arsonist to be a city’s fire chief.”

Mayhew spent years as commissioner of Maine’s Department of Health and Human Services under outgoing Governor Paul LePage. She stepped down in May 2017. After her time as commissioner, Mayhew pursued an unsuccessful race for Governor of Maine, coming in third in the Republican Primary this past June.

The Maine Department of Health and Human Services’ approach to Medicaid under Mayhew’s leadership does not exactly suggest she will take an expansive approach to Medicaid in her new role. According to the ACLU of Maine, enrollment in MaineCare, Maine’s Medicaid program, decreased by 37 percent during her time in office, eliminating coverage for about 80,000 people.

The state also dropped from 10th to 22nd in national health rankings.

During Mayhew’s tenure in Maine’s DHHS, the state imposed work requirements for SNAP recipients and drug testing requirements for people with prior drug-related felony convictions in order to qualify for welfare. LePage is similarly a staunch opponent of Medicaid expansion, and vetoed five bills passed by Maine’s Legislature to expand Medicaid (which Mayhew repeatedly supported). (He has continued his fight, refusing to expand Medicaid without full funding by the Maine Legislature, despite decisive approval of Medicaid expansion by Maine voters in a November 2017 ballot initiative. However the Maine Supreme Judicial Court issued a ruling in August 2018 ordering LePage to begin implementation.)

And from the beginning of President Trump’s time in office, Mayhew made clear her fiscal focus and the Department’s intention to impose work requirements (which research has found undermine Medicaid’s goals and fail to raise work rates), and other reforms in order to prioritize the state’s resources on covering children, the elderly, and the disabled, rather than “covering even more able-bodied adults.”

But despite Mayhew’s opposition to Medicaid expansion, the announcement of her new role leading the program did not come as a surprise to all.

Drew Gattine, a member of Maine’s House of Representatives, for example, stated, “I think she is someone who was antagonistic toward Medicaid, so she fits into a long line of Trump appointees who are antagonistic about the programs they are asked to oversee.”

Among the functions listed under the Center for Medicaid and CHIP Services’ Functional Statement is “[i]n partnership with States, [to] evaluate[] the success of State agencies in carrying out their responsibilities for effective State program administration and beneficiary protection, and, as necessary, assist[] States in correcting problems and improving the quality of their operations.” Within CMS, the Center is also in charge of Medicaid and CHIP-related budget issues, and CMS’ interactions with States regarding oversight of  these programs.

CMS’ responsibilities include the task of reviewing 1115 demonstration waivers, which are intended to allow states flexibility in experimenting with approaches to Medicaid that will still serve the goals of the program. But the flexibility that was encouraged by past Presidential administrations to expand Medicaid coverage, is being promoted by the Trump Administration as a tool to reduce eligibility and enrollment.

According to Medicaid.gov, there are currently 37 pending 1115 Demonstration Waivers, and Maine and six other states have waivers pending that would impose work requirements on Medicaid recipients.

Given CMS’ openness to states using the flexility 1115 waivers enable to impose new restrictions such as work requirements, the fact that it’s already approved waivers in other states imposing such work requirements, and Mayhew’s track record in Maine and clear opposition to Medicaid expansion, it does not appear likely that the Center for Medicaid and CHIP Services will be taking a progressive approach to Medicaid expansion and demonstration waivers anytime soon.

Rebecca Friedman

Rebecca Friedman

Rebecca Friedman graduated from Harvard Law School in 2019. Prior to becoming a Student Fellow, she participated in the Health Law and Policy Clinic with HLS' Center for Health Law and Policy Innovation. At the time she completed her Fellowship, Rebecca planned to work at Charlotte Center for Legal Advocacy in Charlotte, North Carolina as an Equal Justice Works Fellow sponsored by Kilpatrick, Townsend & Stockton LLP. There, Rebecca will provide direct representation to Medicaid beneficiaries experiencing legal challenges as North Carolina transforms its Medicaid system to managed care, and will work to ensure that Medicaid beneficiaries facing legal issues as a result of social determinants of health receive appropriate support. As a Petrie Flom Center Student Fellow, Rebecca studied the potential for Medicaid to cover doula services and analyzed how racial and socioeconomic disparities in prenatal care and childbirth could be mitigated as a result. The current title of Rebecca’s paper is “The Feasibility and Potential Impact of Broader Medicaid Coverage of Doula Services on Racial and Socioeconomic Disparities in Birth Outcomes.”

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