UPDATE, January 4, 4:45 p.m.: Mary Mayhew resigned from her post leading Medicaid to take a job with the administration of incoming Florida Gov. Ron DeSantis (R), according to the Portland Press Herald.

The Trump administration announced the appointment Monday of Mary Mayhew, the former Maine commissioner of Health and Human Services, to head the federal Medicaid program. The decision shocked Maine residents and health care advocates who pointed to Mayhew’s long history of advocating for and executing deep cuts in social safety net programs and her opposition to expanding Medicaid access in the state.

“From the perspective of someone who thinks that we should be providing people with more health care, not less, it’s hard to imagine someone less suited for this job than former commissioner Mayhew,” said David Farmer, former communications director for Mainers for Healthcare, in an interview with Rewire.News. Mainers for Health Care ran a successful ballot initiative last year to expand Medicaid in the state under the Affordable Care Act, but the expansion has since been stonewalled by Republican Gov. Paul LePage.

“I can’t imagine anyone who would bring the same mix of ideological cruelty and history of mismanagement to a high-level job like this,” Farmer said. “The only way that Mary Mayhew would be a candidate for this position is if your goal is to dismantle the Medicaid program.”

Mayhew, who ran Maine’s Department of Health and Human Services (DHHS) until May 2017, finished a distant third in the state’s Republican primary for governor. Under LePage—a vocal opponent of Medicaid expansion who has continuously blocked its implementation in the state—she oversaw massive cuts to programs like Medicaid and food stamps. “She’s not just hostile to Medicaid; when she was part of Governor LePage’s administration in Maine, she was front and center in that administration’s quest to burn down pretty much the entirety of the social safety net,” said Rebecca Vallas, vice president of the Poverty to Prosperity program at the Center for American Progress. “She was a vocal proponent of taking nutrition assistance through food stamps away from people who were trying to find work or couldn’t get enough hours at their job.”

LePage lauded Mayhew when she left the department last year, saying in a statement that she “spearheaded” his efforts to make cuts to Medicaid and other social safety net programs. On Mayhew’s watch, enrollment in Maine’s Medicaid program, MaineCare, dropped by 37 percent, taking healthcare away from about 80,000 people according to the ACLU of Maine. As a result, the percentage of uninsured children has risen, and Maine dropped from tenth to 22nd in national health rankings, according to a United Health Foundation report.

Mayhew’s record of mismanagement has also alarmed advocates. In 2014, Maine’s DHHS revoked a $900,000 contract with conservative consultant Gary Alexander after he produced a heavily plagiarized report for the department. At the time, Mayhew blamed the controversy on “the media and Democrats.”

With Maine now in her rearview mirror, however, Mayhew will have broad authority to continue her track record of making deep cuts to Medicaid, though she will excuse herself from matters involving Maine. “It’s almost like the Trump administration went looking for the biggest critic of the Medicaid program and found her and then decided she should be in charge of Medicaid,” said Vallas, who pointed out that Mayhew has gone to other state legislatures to lobby against expanding Medicaid under the ACA. “She appears to hate Medicaid so much that she wasn’t just going to stand in the way of Maine expanding it and enabling more people to have health insurance, but she actually felt the need to go to Florida and Utah and tell them also not to give more people health insurance through Medicaid.”

Mayhew replaces Brian Neale as deputy administrator and director of the Center for Medicaid and CHIP Services. Before leaving his post in January, Neale rescinded a memo that protected abortion care providers from state attacks without evidence of wrongdoing and pushed to allow states to implement work requirements for Medicaid access. With Mayhew in charge, the more than 70 million people who depend on Medicaid could be at risk.

News of Mayhew’s appointment coincided with a report from Arkansas, the first state to implement work requirements for Medicaid eligibility, finding that roughly 8,500 people from the state have been stripped of their health care in the two months since the new policy was implemented.

It’s a policy that advocates worry Mayhew may try to take nationwide. “This is the very policy that Mary Mayhew wants to see in every state, in lockstep with what Trump has been trying to do,” Vallas said. “For anyone who has been still wondering what the agenda behind these Medicaid work requirements is, they need to look no further than Arkansas to see what it really is. It’s an attack on Medicaid, an attempt to drop as many people from coverage as possible. When it’s sort of thinly disguised, it doesn’t look like cuts.”