US judge blocks Medicaid work rules in blow to Trump

Phillip Cunningham
March 31, 2019

A federal judge ruled Wednesday that Medicaid work requirements undermine the program's mission of providing health care for the needy, dealing a blow to the Trump administration's efforts to push the poor toward self-sufficiency.

Arkansas Gov. Asa Hutchinson urged the federal government to appeal the ruling against his state's requirement that certain people covered by its Medicaid expansion work or lose their coverage. Arkansas itself has said that 18,000 people just past year were disenrolled from its Medicaid program after these work requirements went into effect.

Last January, the Trump administration invited states to impose these requirements on Medicaid beneficiaries for the first time. Both states want "able-bodied" adults who get health insurance through the Affordable Care Act's Medicaid expansion to work, study, volunteer or participate in "community engagement" activities.

In June, Boasberg blocked the rules from taking effect because he said the Trump administration did not adequately consider how the changes would impact people who receive the health benefits. The Centers for Medicare & Medicaid Services reapproved the Kentucky's request in November, and the state planned to begin the program later this year.

In his ruling on Kentucky, Boasberg criticized HHS officials for approving the state's second effort to institute work requirements partly because Bevin threatened to end the Medicaid expansion without it.

The court "cannot concur that the Medicaid Act leaves the secretary so unconstrained, nor that the states are so armed to refashion the program Congress designed in any way they choose", he wrote in his ruling Wednesday.

Overall, Medicaid is the government's largest health insurance program, covering about 1 in 5 Americans, ranging from many pregnant women and infants, to severely disabled people and elderly nursing home residents. They should have to work for them.

Bevin said Medicaid was meant to provide health coverage for the medically frail, the elderly and the disabled, and is skeptical of offering it with no strings attached to able-bodied, working-age adults who have no dependents. Progressives contend that most poor people who can work already do and that access to health care is a precondition for some to hold jobs. "States are the laboratories of democracy and we will vigorously support their innovative, state-driven efforts to develop and test reforms that will advance the objectives of the Medicaid program". 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. Kentucky had had a regular Medicaid expansion, and they reversed it and tried to add these work requirements.

Boasberg reached the same conclusion when he first ruled on Kentucky's program last summer.

"The effect of Judge Boasberg's order is that the work and community engagement requirements can not be enforced, and Arkansas must provide three months of retroactive coverage instead of the one month allowed under the Arkansas Works approval". Most of those not working cite reasons such as poor health, caring for an elder or child, or going to school.

Eight states have had their requests approved, though not all have put their programs in place, according to the nonpartisan Kaiser Family Foundation.

The 48-page Kentucky opinion is the more emphatic of the two rulings, since the judge walks through the reasons he remains unpersuaded by even a second set of arguments by the administration as to why the program should be allowed to go forward.

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