As governor of Maine, Paul LePage refused to carry out the MaineCare expansion that voters approved in November 2017, and in August 2018 he asked federal officials to reject the plan that would have covered what his own letter put at 70,000 to 90,000 people. Coverage under the expansion began only after he left office.
Before that, LePage vetoed every MaineCare expansion bill the Legislature sent him in 2013 and 2014, and his administration cut about 24,500 parents and adults without children from MaineCare at the end of 2013.
As a candidate for Maine's 2nd District in 2025, LePage backed the Medicaid work requirement in the 2025 tax and spending law, a rule under which Maine's health department estimated that tens of thousands of MaineCare members could lose coverage during the rule's first year. At an October 2026 debate he told voters they would not lose Medicaid.
Paul LePage's Actions as Governor and His Statements on MaineCare and Medicaid
- LePage Asked Federal Officials in 2018 to Reject Maine's Voter-Approved Medicaid Expansion. On August 31, 2018, Governor Paul LePage wrote to the federal Medicaid agency: "I strongly encourage CMS ... to reject the State Plan Amendment that may soon be submitted by the Maine Department of Health and Human Services pursuant to court order." His own department filed the plan only because a Maine court ordered it to. LePage's letter said the plan would extend MaineCare to "an additional 70,000 to 90,000 individuals." Court fights over his refusal lasted until the end of his term, and the expansion began only when Governor Janet Mills started it by executive order in 2019. MaineCare enrollment rose from roughly 330,000 in 2018 to 476,000 by 2026.
- LePage Vetoed the $60 Million Bill to Fund the Expansion and Said He Would Go to Jail First. In July 2018 Governor Paul LePage vetoed the bill lawmakers passed to fund the voter-approved expansion, and the override attempt failed. On July 10, 2018, he told WVOM radio: "I'd go to jail before I put the state in red ink." The vetoed bill carried $60 million to start the expansion, which the voter-approved law required MaineCare to provide to newly eligible adults within 180 days.
- LePage's Administration Let the April 2018 Deadline to Start the Expansion Pass. Under Governor Paul LePage, Maine's Department of Health and Human Services did not file the expansion plan that the voter-approved law required within 90 days; Maine's highest court recorded that April 3, 2018 passed without action. Low-income Mainers, Maine's primary care association and Penobscot Community Health Care had to sue the state to force the filing.
- LePage Vetoed MaineCare Expansion Bills in 2013 and 2014. Governor Paul LePage vetoed LD 1546 on May 28, 2013, LD 1066 on June 17, 2013 and LD 1578 on April 29, 2014, each a bill to expand MaineCare with federal funds, and each veto was sustained; in the House the override votes were 95 to 52 in 2013 and 94 to 53 in 2014, short of two-thirds. Maine House Speaker Mark Eves told KFF Health News in 2014 that the Legislature had passed five expansion bills, and KFF Health News reported that LePage vetoed each one. Had Maine expanded MaineCare then, about 45,000 more people would have gained coverage, KFF Health News reported.
- LePage Cut About 24,500 Mainers From MaineCare at the End of 2013. Paul LePage's administration restricted MaineCare eligibility, ending coverage for 14,500 parents and roughly 10,000 adults without children at the end of 2013, KFF Health News reported. Early in his tenure he had proposed cutting about 65,000 people from Medicaid. They lost coverage on January 1, 2014, just as the Affordable Care Act rolled out nationwide; safety-net hospitals and clinics reported a surge in uninsured patients, and many hospitals cut staff.
- LePage Backed the 2025 Law's Medicaid Work Requirement. The Bangor Daily News reported on July 8, 2025 that Paul LePage "backs key parts of President Donald Trump's tax and spending megabill, including Medicaid work requirements," after he signaled support the week before for its 20-hour weekly work rule for most adults without children. The newspaper noted the federal rule resembles one he tried to put in place as governor. The requirement starts in Maine on January 1, 2027, and MaineCare estimated that upwards of 31,000 members could lose coverage in its first year.
- LePage Told Mainers They Would Not Lose Medicaid. At an October 1, 2026 debate, Paul LePage answered his opponent's warning about Medicaid: "No, you're not. There's $50 billion that's going to be spent across the nation in rural communities to help sustain and have healthcare provided to those in need." Maine's health department estimates the 2025 law will cost MaineCare $5.0 billion over ten years, and said its change to immigrant eligibility ends MaineCare coverage for about 3,000 enrollees, including refugees and asylees, from October 1, 2026. KFF estimates the law cuts federal Medicaid spending in rural Maine by $1.118 billion over ten years.
- LePage Claimed Fraud in Maine's Medicaid and Welfare Programs. At the same debate Paul LePage said: "I'm sorry to say that there's fraud in Maine, fraud across the country in Social Security, and in our Medicaid and in our welfare programs and I experienced it." Federal reviewers most recently put Maine's Medicaid payment error rate at 2.4 percent, below the 3.2 percent national average, and confirmed only about 0.1 percent of program spending as definitively incorrect.
What Paul LePage's Medicaid Record Means for Maine's 2nd District
- Nearly a third of 2nd District residents depend on Medicaid, including 53,400 expansion adults the work rule targets. KFF counts 220,400 Medicaid enrollees in Maine's 2nd District in 2025, 31 percent of residents, including 62,400 children and 39,300 seniors. Among them are 53,400 adults covered through the expansion LePage blocked as governor, the group the work requirement he backed applies to from 2027.
Frequently Asked Questions About Paul LePage on Health Care
What is Paul LePage's record on health care under Trump?
Paul LePage, Maine's governor from 2011 to 2019, vetoed MaineCare expansion bills in 2013 and 2014 and then refused to carry out the expansion Maine voters approved in 2017, asking federal officials in 2018 to reject it. In 2025, running for Maine's 2nd District, he backed the federal Medicaid work requirement in the tax and spending law signed by President Trump. In October 2026 he told debate viewers they would not lose Medicaid, although Maine's health department estimated in 2025 that tens of thousands could lose coverage under that rule.
Did Paul LePage veto Medicaid expansion in Maine?
Yes. Paul LePage turned down every MaineCare expansion bill lawmakers passed in his first term, and in 2018 he vetoed the bill to fund the expansion voters had approved. In June 2013 the Maine House voted 95 to 52 to override his veto of LD 1066, short of the two-thirds required, so the veto was sustained and the bill died.
What did Paul LePage say after Maine voters approved Medicaid expansion?
Paul LePage issued a statement on November 8, 2017, the day after the vote, saying "my administration will not implement Medicaid expansion until it has been fully funded by the Legislature at the levels DHHS has calculated." Five months later his health department missed the law's deadline to file the expansion plan.
Does Paul LePage support Medicaid work requirements?
Yes. Paul LePage sought a MaineCare work requirement as governor, saying in January 2018 that "people who receive Medicaid and are able bodied will need to work, be training for a new career, or volunteer," and federal officials approved his waiver on December 21, 2018, days before he left office. In 2025 he backed the federal requirement that applies to Maine's expansion adults from January 2027.
Last updated: 2026-10-26