As Mainers head to the polls this week, many seniors await the federal government’s decision regarding Gov. Paul LePage’s plan to cut MaineCare benefits by $37 million.

LePage said that cutting off about 65,000 people from MaineCare would bring Maine closer to the average state's enrollment. It would save Maine $66 million in the next 18 months, according to the proposal. Not doing so, LePage maintains, would put the state at risk of defaulting.

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Those who would lose coverage include: low-income adults who are not disabled; the parents of children enrolled in MaineCare, who would not meet tighter income guidelines; nondisabled 19- and 20-year-olds; and low-income senior citizens who qualify for MaineCare to cover a portion of their Medicare premiums.

Democrats on the legislature’s Appropriations Committee said they’ve received letters from the federal agency that manages the Medicaid program, exposing LePage’s cuts as illegal. The letter from Cindy Mann, director of CMS, state that the proposed cuts would violate a federal requirement called “maintenance of effort.”

“The purpose of Medicaid is to provide high-quality health care coverage to needy individuals whose income and resources are insufficient to meet the costs of necessary medical services,” Mann wrote in the letter. “Reductions in eligibility solely for budgetary purposes would not be experimental, pilot or demonstration projects that further the purposes of the program.”

This becomes a dilemma for the Obama administration, which is balancing the feasibility of the Affordable Care Act, with the perception that the law is crippling the governors’ budget decisions.

"If this budget is not approved by Feb. 1 and I don’t get on a plane on Feb. 2 and stay in Sebelius’ office, on April 1 the state of Maine will default," LePage said in an interview on Friday. "Maine will not have the money to pay the fourth-quarter 2012 Medicaid payments."

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Maine is hardly alone in its Medicaid struggles. On the same day as the New Hampshire primaries, in fact, the State Supreme Court heard arguments in the case of Dartmouth-Hitchcock Medical Center vs. Nicholas Toumpas. Toumpas is the commissioner of N.H’s Department of Health and Human Services, which the N.H. Hospital Association is suing over Medicaid reimbursements.

In Florida, meanwhile, Governor Rick Scott’s plans to slash Medicaid funding ahead of health reform have many physicians in the state anxious about the practice of medicine in the future.

Those who will hurt the most from Medicaid cuts are low-income households and the elderly – and in a state such as Maine that holds the eldest population, that is far from ideal.

Mercy Hospital in Portland, for instance, serves many MaineCare patients who would lose their health coverage if the eligibility cuts were made. MaineCare has allowed these individuals to access preventative care and other services in a cost-effective manner. With LePage’s plan going through, nearly one in five MaineCare patients will lose this opportunity. At Mercy’s Recovery Center, that would 40 percent of MaineCare patients would losing coverage and treatment.

For more of our primaries coverage, visit the Elections 2012 page. Follow Kelly Mehler @HITNewsTweet