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Donna Wall cares for her three adult autistic children at her home in Lewiston, Maine. It鈥檚 a full-time job. Sons Christopher and Brandon have frequent outbursts, and the stress of tending to them can be overwhelming.

When her twin sons turned 18 a year and a half ago, Maine鈥檚 Medicaid program dropped her health insurance. Wall is considered a 鈥渃hildless adult鈥� in Maine and other states that didn鈥檛 expand Medicaid, and so she isn鈥檛 eligible for coverage. She can no longer get her antidepressants and anti-anxiety medications. She can鈥檛 see her psychologist or a doctor to check up on a troubling spot on her eye.

She needs to stay whole, she said, for her kids.

鈥淚鈥檓 60 years old. Things start going wrong when you get older,鈥� she said. 鈥淚 haven鈥檛 had a Pap smear or breast exam in two years. I鈥檓 just worried something will happen to me, because who is going to take care of them? It鈥檚 a big job. If I put the boys in a home, it would cost the state a lot more to take care of them than it would be to pay my medical.鈥�

Even on frigid, wintry nights, Wall delivers newspapers, earning $150 a week when her kids are asleep.

鈥淚 go out about 2 in the morning. And it usually takes me four to five hours,鈥� she said. 鈥淚 try really hard not to fall, but I have had a few accidents. One of them was on black ice last winter.鈥�

At one point, Wall thought she might have broken a rib. But she stayed away from the emergency room for fear of a costly medical bill.

At least 70,000 low-income Maine residents like Donna Wall should gain Medicaid health insurance because of the ballot measure that passed last fall. Advocates collected signatures to put the question to voters, and, in November, Maine became the first state to get approval at the ballot box to expand Medicaid, passing with 59 percent approval.

But even though voters here in Maine decided to expand Medicaid, the law鈥檚 fate is unclear. Republican Gov. Paul LePage has said that opening up the program to more poor adults threatens the state鈥檚 financial stability and that lawmakers shouldn鈥檛 raise taxes to pay for it.

鈥淵ou have to pay for the law,鈥� LePage said. 鈥淚t鈥檚 going to cost money. And I intend to implement it, and the Legislature is required to fund it. If they do not fund it, it will not be implemented.鈥�

LePage has been in power for seven years, and, because of term limits, is heading into his final year in office. He vetoed five Medicaid expansion bills passed by the Legislature before voters approved it.

Lawmakers must now pay for the new law without raising taxes or dipping into the state鈥檚 rainy day fund, he said. And he warned that the expansion could threaten services for people with disabilities and the elderly.

鈥淲hen able-bodied people, who are able and should be working, choose not to work, then I don鈥檛 think it鈥檚 society鈥檚 responsibility to cover their insurance at the expense of our mentally ill, our disabled and our elderly,鈥� he said. 鈥淲e鈥檙e asking hardworking Maine families to pick up the extra tab for people who should be working, but elect not to be.鈥�

Sara Gideon, the speaker of Maine鈥檚 House of Representatives and a Democrat, said the governor鈥檚 remarks are not true.

鈥淟et鈥檚 start with the population of people who will actually be eligible for health insurance now,鈥� she said. 鈥淲e鈥檙e talking about people, almost 70 percent of whom are people who are actually in the workforce, who are earning a living, but not actually able to afford health care with the low income that they earn.鈥�

Gideon said LePage must follow the law. Moreover, she is confident the Legislature will find a way to fund the state鈥檚 share of $54 million and keep its promises to the elderly and disabled.

鈥淚t鈥檚 not a choice between people, one group of people over another. It鈥檚 a false choice that this governor is trying to present. And we say, we鈥檙e not going to make that choice. It is the law. And we鈥檙e simply going to make sure that that law is implemented,鈥� said Gideon.

For rural hospitals in Maine, the Medicaid expansion can鈥檛 come fast enough.

鈥淥ur rural hospital is struggling,鈥� said Marie Vienneau, CEO of Mayo Regional Hospital in Dover-Foxcroft. 鈥淲e don鈥檛 make money. We lost a million and a half dollars the last two years.鈥�

Maine鈥檚 rural towns and their hospitals have been hit hard. Factories have closed and many residents have moved away. As workers lost their jobs, more uninsured patients turned to rural hospitals desperate for medical care but unable to pay. Mayo is facing financial uncertainty, and at least three rural hospitals in Maine have closed in recent years.

Deanna Chevery was laid off after 25 years when the Dexter Shoe Co. factory closed in Dexter, Maine. Now 60 years old and uninsured, she鈥檚 recovering from an addiction to pain pills prescribed by her doctor for back pain.

She overdosed five times, costing Mayo Regional Hospital more than $200,000 in unreimbursed care. Before Chevery found the charity recovery program at Mayo Regional, she said she was turned away when she sought help because she couldn鈥檛 pay.

鈥淵ou can only go so many places. Nobody will take you,鈥� said Chevery. 鈥淭hey don鈥檛 care if you鈥檙e crawling on the ground. I鈥檓 just fortunate Dover helps me.鈥�

But Vienneau said the hospital cannot keep up with Maine鈥檚 growing opioid epidemic and ever-rising costs without expanded Medicaid.

鈥淵ou can only go so many years in a row where your business doesn鈥檛 lose money, before you depreciate to the point that you have to start closing services, decreasing services,鈥� said Vienneau. 鈥淎nd then access goes away.鈥�

Medicaid advocates, like Maine Equal Justice Partners, are pressuring lawmakers to put the new law into effect quickly. The group has been receiving postcards from around the country congratulating them on becoming the 32nd state to expand Medicaid, and advocates in many other red states that refused to expand Medicaid are eyeing their own ballot measures, including Nebraska, Utah, Idaho, Florida and Missouri.

Patrick Willard, a senior director at Families USA, a progressive advocacy group based in Washington, D.C., said that after years of Republicans attacking the Affordable Care Act, voters are beginning to shift their views.

鈥淲hat we have heard is that other states suddenly see an opportunity now to figure out a way that they can get around legislatures that have been holding this up,鈥� said Willard.

As state lawmakers in Maine work out the details of the new law, many disagree with LePage about how much it will cost. His administration estimates the price tag will be twice what the Legislature鈥檚 nonpartisan fiscal office has projected.

If they can鈥檛 resolve the impasse, LePage said, he will take legal action, if necessary.

鈥淲e will go to court, because I know 鈥� listen, one thing that I know better than the Legislature is financial responsibility. And I have proven it over the last seven years,鈥� said LePage.

Advocates say those who are eligible for Medicaid could enroll as early as this summer. But if there are delays, they too will sue.

Just days after our interview, Donna Wall fell during her middle-of-the-night paper route and broke her ankle. She still doesn鈥檛 have health insurance and is unsure how she will care for her autistic children and uncertain what the future will bring.

Jason Kane of PBS Newshour contributed to this story.