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Medicaid Expansion Opponent Picked to Lead Medicaid

By Steven Porter  
   October 16, 2018

The former aide to Maine Gov. Paul LePage and former Maine Hospital Association lobbyist was picked by the Trump administration after she lost her bid to succeed LePage earlier this year.

A former hospital lobbyist who spent most of the past decade as Maine's health commissioner under Gov. Paul LePage has been tapped to lead Medicaid on the federal level.

Mary Mayhew earned a reputation in Maine as someone who, alongside LePage, championed additional limits on the public benefit programs she oversaw, reducing enrollment in the state's Medicaid program by 67,000 beneficiaries between 2011 and 2015 then opposing Medicaid expansion under the Affordable Care Act.

"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," Maine state Rep. Drew Gattine, a Democrat, told the Portland Press Herald.

Mayhew started Monday as a deputy administrator in the Centers for Medicare & Medicaid Services and director of Medicaid and the Children's Health Insurance Program. The hire, which was announced internally, comes as CMS considers whether to finalize a waiver request Maine submitted last year to authorize work requirements for Medicaid beneficiaries, as Politico reported.

In an interview last April with Maine Public Radio, Mayhew described her initiatives as state health commissioner as part of an effort to help beneficiaries climb out of poverty.

"There has been such a failure to fully appreciate that at the end of the day, the true compassion that has been core to our efforts, is that if you are on any of those welfare programs it means that you are living in poverty. What the governor said, what I said, is that's no way of life for anyone," Mayhew said at the time, as Maine Public reported.

That same sentiment has been cited by the Trump administration in its push for policies expected to result in fewer beneficiaries on public benefit programs.

"The purpose behind this is not about reducing the Medicaid rolls," CMS Administrator Seema Verma said of work requirement requests from  11 states during an American Hospitals Association webinar in January, "but it's really centered around helping individuals gain self-sufficiency, helping them to rise out of poverty."

Mayhew—who began her career as a Democrat in the 1980s before working as a lobbyist for the Maine Hospital Association—left her post as health commissioner last year then traveled the country touting a conservative approach to welfare in coordination with the Opportunity Solutions Network, as the Bangor Daily News reported.

Mayhew takes over for Tim Hill, who had been serving as acting director of Medicaid and CHIP since Brian Neale's resignation in January.

Steven Porter is an associate content manager and Strategy editor for HealthLeaders, a Simplify Compliance brand.


Mary Mayhew's rise-out-of-poverty rhetoric around Medicaid policymaking aligns with statements made by Trump administration officials.

Mayhew oversaw a shrinking state Medicaid program and opposed Medicaid expansion.

One critic, a Democrat, described her as "antagonistic toward Medicaid."

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