Judge blocks Trump Medicaid work requirements in Arkansas, Kentucky

Judge blocks Trump Medicaid work requirements in Arkansas, Kentucky

By Jessie Hellmann for The Hill

A federal judge has blocked Medicaid work requirements approved by the Trump administration in Arkansas and Kentucky after more than 18,000 people have already lost coverage.

Judge James Boasberg of the U.S. District Court for the District of Columbia, an Obama appointee, ruled Wednesday afternoon in two separate cases that the Trump administration didn’t consider whether the work requirements met the objective of Medicaid: to provide coverage to needy populations.

It’s the second time Boasberg has rejected the Kentucky program, which has not yet taken effect, and sent it back to the Department of Health and Human Services (HHS) for changes. It’s the first time the Arkansas program has been struck down in court. More than 18,000 people have lost coverage since the program took effect last summer.HHS, under the leadership of Secretary Alex Azar, approved the programs, arguing that it improves health outcomes by encouraging people to work.  But Boasberg wrote in his decisions Wednesday that the Trump administration did not meet Medicaid’s purpose of providing health insurance to the needy.  “Rather than adequately addressing Kentucky HEALTH’s potential to cause loss of medical coverage, the secretary continues to press his contention that the program promotes his alternative proposed objectives of beneficiary health, financial independence and the fiscal sustainability of Medicaid,” Boasberg wrote in the Kentucky opinion.  “The Secretary’s failure once again to adequately consider the effects of Kentucky HEALTH on coverage is alone … fatal to approval,” he wrote.  He cited similar reasoning in his Arkansas opinion, writing that Azar’s approval of the work requirements was unlawful because it didn’t consider potential coverage losses.  HHS originally approved the Kentucky program last summer, but it was blocked by Boasberg, who said Azar didn’t adequately consider its impact on coverage.

Medicaid work requirements are a key part of the administration’s health care agenda. It has approved requirements in nine states, including Indiana and New Hampshire, but Arkansas’s were the first and only to take effect so far.

Boasberg’s rulings will likely raise questions about the future of the administration’s efforts to change Medicaid back to a program that is reserved for very low-income families, the disabled and the elderly. 

ObamaCare allowed states the option to expand Medicaid to childless low-income adults, and 36 states and D.C. have done so. 

But the Trump administration argues that these “able-bodied” adults should be working instead and that only society’s most vulnerable should be eligible for Medicaid. 

HHS had asked Boasberg earlier this month to dismiss the lawsuits, arguing that the new work rules improve the lives and health of participants by helping them find jobs. 

But the plaintiffs — national health advocacy groups — argued the requirements are designed to kick people off the program because the administration opposes ObamaCare’s Medicaid expansion. 

Both programs required beneficiaries to work, volunteer or complete other activities for at least 80 hours a month to keep their Medicaid coverage. 

In Arkansas, enrollees aged 19 through 49 had to file reports with the state detailing how they were meeting the work requirements. Failure to do so for three months out of the calendar year would result in a loss of benefits. 

Between September and December of last year, more than 18,000 people lost coverage — mostly because they weren’t meeting the reporting requirements. 

In Kentucky, childless working-age adults who didn’t complete at least 20 hours of work per week would be suspended from the program until they met the requirements for one month. 

Democrats cheered the rulings, calling the work requirements ideological and cruel. 

“Medicaid was created as a way for vulnerable Americans to get the care they need, not as a testing ground for ideological, anti-health care experiments,” said Sen. Ron Wyden (D-Ore.), the top Democrat on the Senate Finance Committee. 

“This ruling is a victory for working families that were being crushed by mountains of burdensome and unnecessary paperwork designed to take away their health care,” he added.

Jane Perkins, legal director at the National Health Law Program (NHeLP), which brought both lawsuits, said the rulings are proof Azar overstepped his bounds in approving the work requirements.

“Rather than consider the Medicaid Act’s aim of furnishing medical assistance, the Secretary doubled down on his consideration of other aims for Medicaid–notably the administration’s stated aim of exploding the ACA’s Medicaid expansion,” she said in a statement.

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