Federal judge blocks Kentucky, Arkansas Medicaid work requirements

Grant Boone
March 31, 2019

He further criticized Kentucky, which argued that their work requirement does further the mission of expanding health coverage because Gov. Matt Bevin meant to cancel Medicaid expansion entirely if he didn't get his way: "The Court can not concur that ... states are so armed to refashion the program Congress designed in any way they choose".

The Trump administration said it would press on despite the ruling, but did not specify its next steps.

The question of work requirements has emerged as a bright line in the ideological debate over the role and nature of the nation's social safety net.

KODJAK: Yeah, so the Affordable Care Act expanded who could receive Medicaid, and it offered states money. Requests from seven others are pending. "I am just putting it in God's hands", said Elizabeth Cloinger, 47.

In legal briefs and court hearings, attorneys for both states and the U.S. Justice Department argued the requirements help ensure states can continue to afford the additional costs of their Medicaid expansions to include people with slightly higher incomes - less than 10 percent of total costs, with the federal government covering the rest.

But Cara Stewart, chief of staff for the Kentucky House Democratic Caucus, said state law bars Bevin from ending the expansion through executive order, and his action would be immediately challenged in court if he tried to do that. "Additionally, individuals who have not complied with the work and community engagement requirement from January to March 2019 can not be removed from the program for noncompliance going forward". Beneficiaries who did not comply with the work and community engagement requirements for three consecutive months in 2018 and were removed from the program have always been eligible to reapply for coverage through the Medicaid expansion program.

In both cases, the approvals did not address how the requests would align with Medicaid's core objective of providing Medicaid coverage to the needy, the judge said.

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 advocates were seeking to stop the requirement in Arkansas, which yanked coverage from 18,000 people after they failed to meet the new rules.

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The rulings came nine months after Boasberg, an appointee of President Barack Obama, first signaled his disapproval of the way President Donald Trump's health aides were handling the issue.

In Kentucky, expansion supporters fear Bevin will react to the ruling by either trying to end the expansion or by cutting benefits, which he did temporarily after Judge Boasberg first blocked the waiver previous year.

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

Arkansas began implementing work requirements last June.

"Arkansas might use the time while the program is paused to consider whether and how to better educate persons about the requirements and how to satisfy them", he wrote.

Under the work requirements - which vary among the states in terms of what age groups are exempt and how many hours are needed - enrollees generally have to prove they have a job, go to school or are volunteers.

Adam Meier, secretary for the Kentucky Cabinet for Health and Family Services, said the judge's ruling was illogical. Beneficiaries here who fail to report work status for 3 months are locked out of the program for the rest of the calendar year.

Kaiser Health News (KHN) is a national health policy news service.

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