The Trump administration has tapped Mary Mayhew — the architect of Maine's aggressive conservative reforms to the social safety net — to oversee the national Medicaid program. She has been an ally of outgoing Maine Gov. Paul LePage, a Republican who has fought as hard as any governor against expanding Medicaid under Obamacare.
CMS announced the move internally Monday, the day Mayhew began as the agency's deputy administrator and director of Medicaid and the Children's Health Insurance Program.
Mayhew served as Maine's health commissioner for six years under LePage, leading efforts to tighten the state's Medicaid eligibility standards, add work requirements to the food stamp program and implement other conservative reforms. She supported LePage as he rejected efforts to expand the state's Medicaid program — repeatedly vetoing legislation and then resisting after nearly 60 percent of Maine voters approved expansion on a ballot measure in 2017. LePage is spending his final months in office fighting a court order to expand the program.
Mayhew stepped down in May 2017 and ran to succeed LePage as governor, losing in the June Republican primary. As part of her campaign, Mayhew touted how safety-net programs had shrunk under her watch, pointing to a 70 percent decrease in enrollment in the Temporary Assistance for Needy Families program — one of the sharpest declines in the nation — and a 24 percent decrease in Medicaid enrollment.
She has defended the rollbacks as a necessary trade-off. "We don’t live in a world of unlimited resources," Mayhew argued at an Ohio Senate hearing in January 2018, as legislators in that state weighed their own safety-net reforms. "When those ends do not meet at the state level, you all must make difficult decisions to prioritize spending."
Mayhew joins CMS as the agency works to finalize a request Maine submitted in August 2017 to impose work requirements on Medicaid beneficiaries. Mayhew has said she was previously approached about joining the Trump administration to oversee the nation's food stamps program.
Advocates have warned that Maine's safety-net suffered under Mayhew's leadership, noting that measures of hunger and poverty rose even while she oversaw cuts to programs designed to feed and support low-income residents.
“It’s an alarming choice given her track record,” said Claire Berkowitz, executive director of Maine Children’s Alliance. “We saw the results in our data of parents who lost coverage under her leadership and that’s concerning.”
Mayhew's department also grappled with several scandals, including allegations concerning a plagiarized report by an outside consultant on the state's Medicaid system and an HHS inspector's general report that found vulnerable Medicaid patients were placed at risk.
Mayhew is the second failed gubernatorial candidate recently tapped by the Trump administration to join the agency. Paul Mango, who joined CMS this summer as chief of staff and chief principal deputy administrator, unsuccessfully ran for the Republican nomination for governor in Pennsylvania.
Former Maine DHHS Commissioner Mary Mayhew Appointed As Federal Medicaid Director
By Steve Mistler Maine Public October 15, 2018
Former Maine Health and Human Services Commissisoner Mary Mayhew has been tapped by the Trump administration to become the deputy administrator and director of Medicaid and the Children’s Health Insurance Program, or CHIP.
Mayhew’s appointment was confirmed Monday by a spokesman for Centers of Medicare and Medicaid Services. It drew a swift reaction from opponents of the policies she pushed at the Maine Department of Health and Human Services.
“Maine’s national health ranking fell during her time, from 10th to 22nd. The number of uninsured children in Maine rose. Maine’s infant mortality rate spiked. So this is not a person who should be running any kind of public health system, much less the national public health system,” says Zach Heiden, the legal director for the ACLU of Maine, which is among several groups that has sued DHHS over policies implemented while Mayhew led the agency.
Mayhew was picked to become the DHHS chief by Republican Gov. Paul LePage in 2011. For nearly seven years she oversaw an agency that administers an array of public health programs, including welfare cash assistance and MaineCare, the state’s version of Medicaid.
Over that time, Mayhew helped implement changes that limited cash assistance through the Temporary Assistance for Needy Families program to five years, resulting in 23,000 fewer Mainers receiving benefits and in the accumulation of $146 million in unused TANF funds.
She also helped spearhead restrictions to MaineCare and led LePage’s staunch opposition to expansion of the program to roughly 70,000 low-income Mainers through the Affordable Care Act. That effort included the administration’s granting of a $1 million no-bid contract to evaluate Maine’s welfare system.
The report’s findings were widely rejected and significant portions turned out to be plagiarized.
Mayhew weathered the controversy, and her efforts to fight Medicaid expansion were applauded by conservatives. She parlayed her experience as the DHHS chief into a bid for governor, finishing third in a four-way Republican primary in June.
She was endorsed by Deb Sanderson, a Republican state representative from Chelsea who also serves on the Legislature’s Health and Human Services Committee. Sanderson said Mayhew helped prioritize essential government services while getting the DHHS budget under control.
“And I’m really hopeful that she’ll be able to do that for the entire nation,” she said.
But her oversight of DHHS has left a bitter taste for Democrats like state Rep. Drew Gattine, who clashed with Mayhew repeatedly. He says Mayhew’s appointment by the Trump administration follows its trend of picking people to lead the same federal agencies and programs that they’ve long opposed.
“[She’s] certainly a person who I would categorize as being antagonistic to Medicaid as opposed to a person who’s going to be supportive of its mission of supporting people’s health care,” he said.
In an interview with Maine Public Radio in April, Mayhew said all of the changes she pursued at DHHS were designed to help people get 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,” she said.
Mayhew did return phone calls seeking comment on her new job. She succeeds Brian Neale, who had been the director of Medicaid and CHIP until his resignation in January. Tim Hill has been serving as acting director since then.
The CMS spokesman says Mayhew’s appointment does not have to be confirmed by the U.S. Senate.