Maine deferred to the federal government to run its health insurance exchange and, like all exchanges dependent on, had its share of difficulties early on. In terms of the state's commercial insurance market, with limited opportunity for organic growth, managed care organizations throughout the region are looking to hold onto business. Maine's Medicare Advantage lineup is led by local player Martin's Point Generations, which fared well during the most recent open enrollment period. Following more than a year of legal and political battles, Medicaid expansion enrollment is underway in Maine, with new Democratic Gov. Janet Mills signing an executive order on her first day in office to implement expansion.

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