Gov. Janet Mills expanded Medicaid eligibility as soon as she took office, but enrollment so far is behind expectations. Joe Phelan/Kennebec Journal file photo

Mills moved to expand Medicaid on her first day in office, but her administration immediately faced a backlog of applications and a need to put in place regulations to roll out Medicaid.

The AP’s analysis finds just 865 residents now have coverage under expansion in rural Hancock County, which saw a 68 percent spike in drug-related deaths from 2005 to 2015. That’s out of 3,000 residents that the liberal-leaning Maine Center for Economic Policy projected would sign up.

The state’s most populous county, Cumberland County, has signed up roughly 4,400 residents – less than a third of those eligible.

Some rural counties have bucked the trend. Androscoggin County has signed up over 2,600 childless adults, parents and caretakers, out of 4,000 eligible.

Meanwhile, Washington County has signed up over half of 2,000 potentially eligible residents.

It’s unclear why enrollment is lower in some counties.

But looking at enrollment figures by county can help advocates figure out where to focus their enrollment efforts, said Maine Equal Justice Partners Executive Director Robyn Merrill.

Department of Health and Human Services Commissioner Jeanne Lambrew has promised to accelerate sign-ups by working with hospitals and advocacy groups and making it easier for residents to enroll.

Maine has spent $1.4 million in existing state and federal funds to open up a temporary call center and hire 35 additional eligibility specialists, according to department spokeswoman Jackie Farwell.

“We continue our efforts to reach all those eligible for Medicaid to ensure people throughout Maine have access to affordable, quality health care,” Farwell stated.

Nationwide, about three dozen states have expanded Medicaid by roughly 13 million people. Enrollment was higher than expected early on in more than half of states that expanded, but that growth has since slowed, according to the Medicaid and CHIP Payment and Access Commission.

Maine voted to expand coverage for low-income residents in a 2017 referendum that the state nonpartisan fiscal office estimated would qualify 70,000 more residents for the program. Lambrew’s agency has told lawmakers it expects to reach that target by December, according to Luke Lazure, an analyst for the Office of Fiscal and Program Review.

Over 30,000 Mainers at one point gained Medicaid coverage under expansion this year, a figure the department says is in line with other states.

At least one independent study, commissioned by the Maine Health Access Foundation, estimated Maine would have signed up roughly 50,000 residents with incomes up to 138 percent of the federal poverty level by now.

But such projections assumed Maine would expand coverage by last July.

“That was before we knew the LePage administration was going to successfully drag out the legislation to keep actual enrollment from starting until the beginning of this year,” said policy analyst Eliot Fishman of national advocacy group Families USA.

Such efforts may have discouraged and confused potential applicants, according to policy analyst James Myall. He added that fewer Mainers may be eligible for expansion under an improving economy.

“What people were hearing for a long time was that Medicaid expanded, but the governor was getting in the way of it,” Myall said.

Mills originally proposed $150 million for Medicaid expansion in the next two years, but lawmakers ended up budgeting $125 million amid spending negotiations because of lower-than-expected enrollment. Maine expects nearly $700 million in federal funds.

Advocacy groups and federally qualified health centers expect expansion to pick up and said it’s already helping thousands.

“We talk to people all the time who are accessing health care for the first time in a long time and getting care that they desperately need,” Merrill said. “You can feel the relief in their voices.”

Expansion was “slow going at the start,” said Bryan Wyatt, spokesman for Maine Primary Care Association, but health centers around the state are seeing more people sign up to receive treatment for substance use disorders.

Observers agree signing up more enrollees isn’t enough.

Drug treatment providers are continuing to close, and new ones aren’t opening, according to Malory Shaughnessy, executive director of the Maine Alliance for Addiction and Mental Health Services.

“You’ve got hundreds of people waiting on waiting lists to get medication management for their schizophrenia or their Suboxone for their addiction,” she said. “And so we’re just seeing those numbers go up because they can only afford to hire so many people at the rates.”

Bruce Arral, a prep cook in Saco, received his MaineCare card this spring, but then lost it this month because he exceeded the income limits.

“Now they took it away from me, and it’s all because I’m making a little bit more money,” Arral, 58, said, adding he needs coverage to ensure he can receive monitoring for prostate cancer and polyps in his nose. “I’m almost ready to cry about it.”