Health experts say it's likelythe decision won't stop the administration or conservative statesfrom moving forward. Many predict the issue will ultimately bedecided by the Supreme Court. (Photo: Shutterstock)

|

For a second time in nine months, the same federal judge hasstruck down the Trump administration's plan to force some Medicaid recipients to work to maintainbenefits.

|

The ruling Wednesday by U.S. District Judge James Boasbergblocks Kentucky from implementing the work requirements andArkansas from continuing is program. More than 18,000 Arkansasenrollees have lost Medicaid coverage since the state began themandate last summer.

|

Boasberg said that the approval of work requirements by theDepartment of Health and Human Services “is arbitrary andcapricious because it did not address … how the project wouldimplicate the 'core' objective of Medicaid: the provision ofmedical coverage to the needy.”

|

Related: Medicaid work requirements bring confusion,lawsuits

|

The decision could have repercussions nationally. The Trumpadministration has approved a total of eight states for workrequirements, and seven more states are pending.

|

Still, health experts say it's likely the decision won't stopthe administration or conservative states from moving forward. Manypredict the issue will ultimately be decided by the SupremeCourt.

|

Kentucky Gov. Matt Bevin, a Republican, has threatened to scrapthe Medicaid expansion unless his state is allowed to proceed withthe new rules, a move that would drop more than 400,000 newenrollees. He said the work requirement will help move some adultsoff the program so the state has enough money to help otherenrollees.

|

Bevin, who is running for re-election this fall, had threatenedto end the Medicaid expansion during his last campaign but backedoff that pledge after his victory.

|

Kentucky had been slated to begin its work requirement nextMonday, but current provisions will instead stay in place,according to Adam Meier, who heads up the state's Medicaid program.He said officials there believe they have “an excellent record forappeal and are currently considering next steps.”

|

Arkansas Gov. Asa Hutchinson said he was disappointed with thedecision. He added that he would review the opinion overnight andannounce Thursday how the state would respond.

|

In his decision on Kentucky, Boasberg criticized HHS officialsfor approving the state's second effort to institute workrequirements partly because Bevin threatened to end the Medicaidexpansion without it.

|

Under this reasoning, he said, states could threaten to endtheir expansion or do away with Medicaid “if the Secretary does notapprove whatever waiver of whatever Medicaid requirements they wishto obtain. The Secretary could then always approve those waivers,no matter how few people remain on Medicaid thereafter because anywaiver would be coverage promoting compared to a world in which thestate offers no coverage at all.”

|

In a statement, Seema Verma, the head of the Centers forMedicare & Medicaid Services, suggested the rulings would notdissuade her efforts to approve work requirements in other states.The administration wants “to give states greater flexibility tohelp low-income Americans rise out of poverty,” she said, and will“vigorously support their innovative, state-driven efforts todevelop and test reforms that will advance the objectives of theMedicaid program.”

|

The decision by federal officials in 2018 to link work or otheractivities such as schooling or caregiving to eligibility forbenefits is a historic change for Medicaid, which is designed toprovide safety-net care for low-income individuals.

|

Top Trump administration officials have promoted workrequirements, saying they incentivize beneficiaries to leadhealthier lives. Democrats and advocates for the poor decry theeffort as a way to curtail enrollment in the state-federal healthinsurance entitlement program that covers 72 million Americans.

|

Despite the full-court press by conservatives, most Medicaidenrollees already work, are seeking work or go to school or carefor a loved one, studies show.

|

Critics of the work policy hailed the latest ruling, which manyexpected since Boasberg last June stopped Kentucky from moving ahead with an earlierplan for work requirements. The judge then also blasted HHSSecretary Alex Azar for failing to adequately consider the effectsthe policy.

|

“This is a historic decision and a major victory for Medicaidbeneficiaries,” said Joan Alker, executive director for theGeorgetown University Center for Children and Families. “Themessage to other states considering work requirements is clear —they are not compatible with the objectives of the Medicaidprogram.”

|

Sally Pipes, president of the conservative San Francisco-basedPacific Research Institute, called the ruling “a major blow” to theTrump administration but said this won't end its efforts. “TheDepartment of Health and Human Services is very committed to workrequirements under Medicaid,” she said.

|

“It is my feeling that those who are on Medicaid who are capableof working should be required to work, volunteer, or take classesto help them become qualified to work,” Pipes said. “Then therewill be more funding available for those who truly need the programand less pressure on state budgets.”

|

Several states, including Virginia and Kentucky, have used theprospect of work rules to build support among conservatives tosupport Medicaid expansion, which was one of the key provisions ofthe Affordable Care Act. That expansion has added more than 15million adults to the program since 2014.

|

Previously the program mainly covered children, parents and thedisabled.

|

Particularly irksome to advocates for the poor: Some states,including Alabama, which didn't expand Medicaid, are seeking workrequirements in the traditional Medicaid program for parents withincomes as low as $4,000 a year.

|

The legal battle centers on two issues — whether therequirements are permissible under the Medicaid program and whetherthe administration overstepped its authority on allowing states totest new ways of operating the program.

|

Alker said that state requests for Medicare waivers in the pasthave involved experiments that would expand coverage or make theprogram more efficient. The work requirements mark the first time awaiver explicitly let states reduce the number of people covered bythe program.

|

States such as Kentucky have predicted its new work requirementwould lead to tens of thousands of enrollees losing Medicaidbenefits, though states argued some of them would get coverage fromnew jobs.

|

Under the work requirements — which vary among the states interms of what age groups are exempt and how many hours are needed —enrollees generally have to prove they have a job, go to school orare volunteers. There are exceptions for people who are ill ortaking care of a family member.

|

In Arkansas, thousands of adults failed to tell the state theirwork status for three consecutive months, which led todisenrollment. For the first several months last year, Arkansasallowed Medicaid recipients to report their work hours only online.Advocates for the poor said the state'swebsite was confusing to navigate, particularly forpeople with limited computer skills.

|

While the administration said it wanted to test the workrequirements, none of the states that have been cleared to beginhave a plan to track whether enrollees find jobs or improve theirhealth — the key goals of the program, according to a story in the Los Angeles Times.

|

Craig Wilson, director of health policy at the Arkansas Centerfor Health Improvement, a nonpartisan health research group, saidhe believes policymakers will appeal court rulings all the way tothe Supreme Court.

|

“As long as they hold on to hope that some judge will rule intheir favor, states will continue to pursue work requirements,” hesaid.

|

Kaiser HealthNews (KHN) is a national health policy news service. It is aneditorially independent program of the Henry J. Kaiser Family Foundation whichis not affiliated with Kaiser Permanente.

|

Read more: 

Complete your profile to continue reading and get FREE access to BenefitsPRO, part of your ALM digital membership.

  • Critical BenefitsPRO information including cutting edge post-reform success strategies, access to educational webcasts and videos, resources from industry leaders, and informative Newsletters.
  • Exclusive discounts on ALM, BenefitsPRO magazine and BenefitsPRO.com events
  • Access to other award-winning ALM websites including ThinkAdvisor.com and Law.com
NOT FOR REPRINT

© 2024 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.