Maine submitted a state plan amendment to CMS to eliminate Medicaid coverage of 19-20 year olds. CMS denied the SPA on grounds that it would violate the maintenance of effort requirement contained in the ACA. Maine appealed to the First Circuit. NHeLP and Maine Equal Justice Partners, representing a number of child health provider and advocacy organizations, submitted a friend of the court brief in the case. The brief provides the court with information about the serious health care needs of this age group and discusses some of the legislative history to past Medicaid maintenance of effort provisions.