Judge strikes down Medicaid work requirements, again

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In addition to Kentucky, Arkansas, and New Hampshire, there are five other states with Medicaid waiver approvals that include work requirements: Arizona, Indiana, Michigan, Ohio, and Wisconsin.

The US Department of Health and Human Services (HHS) approved Kentucky's work requirement plan in January 2018, but the plan has yet to go into effect. Early in the administration, top officials invited states to apply for waivers that would allow Medicaid work requirements.

He used similar language in his ruling on Kentucky.

But the 35-page Arkansas decision has more immediate impact.

The Trump administration reapproved the rules in November.

Craig Wilson, director of health policy at the Arkansas Center for Health Improvement, a nonpartisan health research group, said he believes policymakers will appeal court rulings all the way to the Supreme Court.

This latest ruling is not the first of its kind from U.S. District Court Judge James Boasberg, who has previously ruled against "engagement" requirements that mandate Medicaid recipients perform some sort of labor in exchange for federally subsidized healthcare coverage.

Arkansas Gov. Asa Hutchison, R, said in a statement he was "disappointed in the decision".

Arkansas was the state that had already implemented a work requirement, and had already kicked 18,000 people off Medicaid between September and December of past year for non-compliance (or actually, for the most part, failure to promptly report compliance). The administration wants "to give states greater flexibility to help low income Americans rise out of poverty", she said, and will "vigorously support their innovative, state-driven efforts to develop and test reforms that will advance the objectives of the Medicaid program".

Both states' initiatives were part of a broader conservative effort to subvert the expansion of the Medicaid population via the Affordable Care Act's optional provisions allowing coverage of low-income people (mostly childless individuals) who otherwise had no meaningful access to health insurance.

President Donald Trump supports work requirements for public programs across the government.

In the case of Kentucky's waiver, the Trump administration argued that HHS did not have to consider the issue of whether it would cause people to lose coverage because Kentucky's Republican Gov. Matt Bevin had warned that if the waiver was not granted, he would end the state's entire expansion program.

Kentucky's work requirement, known as Kentucky HEALTH, was the first to be approved by the Trump administration but was struck down past year by the same judge, and the newly revised rules were scheduled to take effect on April 1. They should have to work for them.

The idea had been opposed by Obama's HHS and many Democrats, who regard it as a sharp break in Medicaid's half-century history as an entitlement program, open to anyone eligible. I should also note that most people on Medicaid, especially if they are able to work, do work. In the Kentucky opinion, Boasberg states that the Azar made no finding that Kentucky's changes would promote fiscal sustainability to Medicaid, such as by achieving savings, even though budget contraints were among Kentucky's stated reasons for the requirements.

Boasberg sent both states' requests back to the HHS for additional review. Last June, Boasberg blocked them from taking effect. Arkansas' program was the first in the country. Approximately 18,000 people were cut off coverage between September and December for failing to comply for three months with requirements to work, train or volunteer for 80 hours per month - or for failing to report they met the rules.

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