Federal Judge Again Blocks States' Work Requirements For Medicaid

Enlarge this image toggle caption Timothy D. Easley/AP Timothy D. Easley/AP

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

The ruling Wednesday by U.S. District Judge James Boasberg blocks Kentucky from implementing the work requirements and Arkansas from continuing its program. More than 18,000 Arkansas enrollees have lost Medicaid coverage since the state began the mandate last summer.

Boasberg said that the approval of work requirements by the Department of Health and Human Services "is arbitrary and capricious because it did not address ... how the project would implicate the 'core' objective of Medicaid: the provision of medical coverage to the needy."

The decision could have repercussions nationally. The Trump administration has approved a total of eight states for work requirements, and seven more states are pending.

Still, health experts say it is likely the decision won't stop the administration or conservative states from moving forward.

In a statement, Centers for Medicare and Medicaid Services Administrator Seema Verma suggested the rulings would not dissuade her efforts to approve work requirements in other states.

Many health law specialists predict the issue will ultimately be decided by the Supreme Court.

Kentucky Gov. Matt Bevin, a Republican, has threatened to scrap the Medicaid expansion unless his state is allowed to proceed with the new rules; if he follows through with that threat, more than 400,000 new enrollees would lose their health coverage. He said the work requirement would help move some adults off the program so the state has enough money to help other enrollees.

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

Arkansas officials have not said what they plan to do.

In his decision 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.

Under this reasoning, the judge said, states could threaten to end their expansion or do away with Medicaid "if the Secretary does not approve whatever waiver of whatever Medicaid requirements they wish to obtain. The Secretary could then always approve those waivers, no matter how few people remain on Medicaid thereafter because any waiver would be coverage-promoting, compared to a world in which the state offers no coverage at all."

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

Top Trump administration officials have promoted work requirements, saying they incentivize beneficiaries to lead healthier lives. Democrats and advocates for the poor decry the effort as a way to curtail enrollment in the state-federal health insurance entitlement program that covers 72 million Americans.

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

Critics of the work policy hailed the latest ruling, which many expected since Boasberg last June stopped Kentucky from moving ahead with an earlier plan for work requirements. The judge then also blasted HHS Secretary Alex Azar for failing to adequately consider the effects of the policy.

"This is a historic decision and a major victory for Medicaid beneficiaries," said Joan Alker, executive director of the Georgetown University Center for Children and Families. "The message to other states considering work requirements is clear — they are not compatible with the objectives of the Medicaid program."

Sally Pipes, president of the conservative San Francisco-based Pacific Research Institute, called the ruling "a major blow" to the Trump administration but said this won't end its efforts. "The Department of Health and Human Services is very committed to work requirements under Medicaid," Pipes said.

"It is my feeling that those who are on Medicaid who are capable of working should be required to work, volunteer or take classes to help them become qualified to work," she added. "Then there will be more funding available for those who truly need the program and less pressure on state budgets."

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

Previously the program mainly covered children, parents and the disabled.

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

The legal battle centers on two issues — whether the requirements are permissible under the Medicaid program and whether the administration overstepped its authority in allowing states to test new ways of operating the program.

Alker said that state requests for Medicaid waivers in the past have involved experiments that would expand coverage or make the program more efficient. The work requirements mark the first time a waiver explicitly let states reduce the number of people covered by the program.

States such as Kentucky have predicted the new work requirement would lead to tens of thousands of enrollees losing Medicaid benefits, though they argued that some of them would get coverage from new jobs.

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

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

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

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.

"As long as they hold on to hope that some judge will rule in their favor, states will continue to pursue work requirements," Wilson said.

Kaiser Health News is a nonprofit news service and editorially independent program of the Kaiser Family Foundation. KHN is not affiliated with Kaiser Permanente.</s>A federal judge blocked Arkansas and Kentucky from imposing work requirements on Medicaid recipients, saying the Trump administration needs to go back and examine whether the conditions are consistent with the program’s main mission.

The ruling is a setback for President Trump, who’s tried to rein in President Obama’s vast expansion of the federal-state insurance program for the poor by setting up guardrails that nudge people off the government dole.

His administration is encouraging states to condition benefits on seeking a job, volunteering or otherwise engaging in the community. But opponents have sued, saying the rules are confusing, counterproductive and flout Medicaid’s half-century mission of simply providing health insurance.

U.S. District Judge Court Judge James E. Boasberg blocked Kentucky from implementing its rules for the second time, while throwing roadblocks in front of Arkansas, which imposed its rules early on and has nudged at least 18,000 people out of coverage.

He said the administration’s decision to approve of Arkansas’ requirement “is arbitrary and capricious because it did not address — despite receiving substantial comments on the matter — whether and how the project would implicate the ‘core’ objective of Medicaid: the provision of medical coverage to the needy,” Judge Boasberg wrote.

He led off his opinion with anecdotes about people who’d been working and relied on the program, but were kicked off the rolls because they had trouble reporting 80 hours of work per month, notably due to poor internet access.

“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,” Sen. Ron Wyden, Oregon Democrat, said. “There will be more work in the days ahead to ensure this ruling stands, but now it is clear that this cruel scheme is on the wrong side of the law.”

The Health and Human Services Department has approved work requirements in eight states, though several more are awaiting approval through the Medicaid waiver process.

It’s staunchly defended the requirements, saying work gives people purpose and actually makes them healthier in the long run.</s>A federal judge in Washington threw a significant roadblock into the Trump administration’s efforts to require poor people on Medicaid to be compelled to work in exchange for health benefits, rejecting a Kentucky program for a second time while saying that rules in effect in Arkansas “cannot stand.”

The twinned opinions, in a pair of states that have been national leaders in the move towards Medicaid work requirements, cast doubt on the Trump administration’s approvals of efforts to re-envision the public insurance program. The opinions undo the permission the U.S. Health and Human Services Department had given those two states, telling the agency it must reconsider their applications with an eye towards the effect on poor people who depend on the coverage.

Judge James E. Boasberg, of the U.S. District Court of the District of Columbia, concluded that in letting Kentucky go forward with its requirements, HHS had been “arbitrary and capricious” — the same criticism he leveled once before.

The rulings came nine months after Boasberg, a judicial appointee of President Barack Obama, first signaled his disapproval of the way President Trump’s health aides were handling the issue. Two days before Kentucky was to begin its new “community engagement” requirements, the judge stopped the state in its tracks.

Kentucky had been the first state to win permission to impose “community engagement” requirements in January, 2018, a day after Seema Verma, administrator of the U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid, announced that for the first time, the government would allow states to require low-income people to work, prepare for jobs, or volunteer as a condition of coverage.

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

Administration officials, and a growing cadre of Republican governors, contend that such rules motivate low-income people to find work that will help them climb the economic ladder and eventually become self-sufficient, no longer needing public insurance.

The idea had been opposed by Barack 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 as a result of their income. Progressives contend that most poor people who can work already do and that access to health care is a precondition for some people to hold jobs.

In his June 29 opinion, Boasberg held that the federal officials who approved the new rules had been “arbitrary and capricious,” neglecting to consider adequately whether the requirements “would in fact help the state furnish medical assistance to its citizens, a central objective of Medicaid.”

His ruling sent Kentucky’s request to begin its program back to HHS for another review. Five months later, the department reapproved Kentucky’s plan without any changes. The state had been preparing its delayed launch of Kentucky HEALTH, as it calls its program, on April 1, with the work rules to begin this summer.

In the meantime, Arkansas ended up the first state to impose work requirements last June. Between September and December, about 18,000 people were cut off that program, known as Arkansas Works, for failing to comply for three months with requirements to work, train or volunteer for 80 hours per month — or for failing to report to the state that they met the rules.

April 1 is a significant date in Arkansas, as well as Kentucky. Under the Arkansas Works rules, the clock starts over each January, with people removed from the program allowed to reapply and a new three-month countdown for non-compliance. So the next group of people to be cut off will be announced within a few weeks. This time, cutoffs may include for the first time young adults, 19 to 29, for whom the rules have been phased in more slowly.

In legal briefs and court hearings, attorneys for both states and the U.S. Justice Department have argued that the requirements are useful because they help ensure that the states can continue to afford their expansions of Medicaid to include people with slightly higher incomes — less than 10 percent of total costs, with the federal governmnet covering the rest. Kentucky, in particular, has contended that it could not otherwise afford its share of the program’s costs. And the states have argued that the work rules will lead people into jobs.

But at a court hearing earlier this month, the judge, in questioning attorneys, reiterated his view that neither the affordability of Medicaid’s expansion nor incentives to get jobs were at the core of the insurance program’s purpose.</s>WASHINGTON — A federal judge is blocking Medicaid work requirements in two states, dealing a blow to the Trump administration’s efforts to push the poor toward self-sufficiency.

U.S. District Judge James E. Boasberg issued two decisions Wednesday finding that Medicaid work requirements for low-income people in Arkansas and Kentucky pose numerous obstacles to getting health care that haven’t been adequately addressed by federal and state officials.

He sent the federal Health and Human Services Department back to the drawing board.

Work requirements are already in effect in Arkansas, but Kentucky’s program has been on hold because of lawsuits.

Advocates for the poor say Medicaid is a health care program, and work requirements have no place.</s>March 27 (UPI) -- A federal judge ruled Wednesday to block Kentucky and Arkansas from requiring some Medicaid recipients to work.

U.S. District Judge James Boasberg issued the simultaneous rulings, voiding the Trump administration's approvals to implement a Medicaid work requirement as well as sending the requests back to the Department of Health & Human Services for further review and suspending the program in Arkansas.

Boasberg wrote that Department of Health and Human Services Secretary Alex Azar's failure to consider the effects of the work requirement on coverage renders his decision to approve the program arbitrary and capricious.

He added that the department also didn't address the issues that prompted him to block the Kentucky program in June of last year.

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.

Seema Verma, administrator of the Centers for Medicare and Medicaid Services, said the agency would continue to pursue the program.

"We will continue to defend our efforts to give states greater flexibility to help low-income Americans rise out of poverty," she said. "We believe, as have numerous past administrations, that 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."

Consumer groups, including the National Health Law Program, sued the administration over the work requirement, saying it was contradictory to Medicaid's objective of providing the poor with access to health care. The Kentucky program removed 18,000 people from coverage after they failed to meet the new requirements.

"We are gratified by the court's rulings today. They mean that low-income people in Kentucky and Arkansas will maintain their health insurance coverage -- coverage that enables them to live, work and participate as fully as they can in their communities. Coverage matters, plain and simple," said National Health Law Program legal director Jane Perkins.

Arkansas Republican Gov. Asa Hutchinson said he was "disappointed" in the ruling and Kentucky Republican Gov. Matt Bevin said he would eliminate the state's Medicaid expansion if the state is unable to implement the work requirement.</s>A federal judge on Wednesday overturned the Trump administration’s approval of plans by the states of Kentucky and Arkansas to impose new work requirements on people seeking to obtain benefits from the Medicaid health insurance program.

U.S. District Judge James Boasberg in Washington ruled that the U.S. Department of Health and Human Services acted arbitrarily in approving the plans put forward by Kentucky and Arkansas.

The department did not immediately respond to a request for comment.

The decision came in separate lawsuits by Kentucky and Arkansas residents enrolled in Medicaid. It marked a setback for the Trump administration’s efforts to scale back the joint federal-and-state healthcare program for the poor and disabled.

Kentucky and Arkansas are among seven states that have received approval by Health and Human Services under President Donald Trump to impose requirements that people seeking coverage under Medicaid engage in work or work-related activities, like job training.

The waivers to federal Medicaid requirements that the department issued are part of an initiative to put a conservative stamp on Medicaid, which expanded in more than 30 states following the passage in 2010 of the Affordable Care Act, commonly known as Obamacare.

Kentucky’s requirements mandate that able-bodied Medicaid recipients participate in at least 80 hours a month of “employment activities,” including job training, education and community service.

The ruling in Kentucky’s case marked the second time that Boasberg had vacated the approval of a waiver issued to the state. Health and Human Services approved Kentucky’s latest waiver in November, after Boasberg vacated an earlier one in June 2018.</s>(Reuters) - A federal judge on Wednesday overturned the Trump administration’s approval of plans by the states of Kentucky and Arkansas to impose work requirements on people seeking to obtain benefits from the Medicaid health insurance program.

U.S. District Judge James Boasberg in Washington ruled that the U.S. Department of Health and Human Services had failed to adequately consider the extent to which the Republican-led states’ plans would cause significant numbers of people to lose coverage.

The decisions came in separate lawsuits by Kentucky and Arkansas residents enrolled in Medicaid. It marked a setback for efforts by President Donald Trump’s administration to scale back the joint federal-and-state healthcare program for the poor and disabled.

“The court reaffirmed the rights of financially insecure individuals to access health care,” said Sam Brooke, a lawyer for the plaintiffs at the Southern Poverty Law Center.

Arkansas Governor Asa Hutchinson, a Republican, said in a statement he was disappointed by the ruling. Representatives for HHS and Republican Kentucky Governor Matt Bevin did not respond to requests for comment.

Kentucky and Arkansas are among eight states that have received approval by HHS to impose requirements that people seeking coverage under Medicaid engage in work or work-related activities, like job training.

HHS approved those projects as part of a push to put a conservative stamp on Medicaid, which expanded in 36 states following the 2010 passage of the Affordable Care Act, popularly known as Obamacare.

In Arkansas’ case, the state had already implemented its work requirements, causing about 16,000 Arkansans to lose Medicaid coverage after HHS failed to consider whether the state’s plan would help its citizens, Boasberg wrote.

His ruling in Kentucky’s case marked the second time Boasberg had vacated the approval of an HHS waiver needed by the state to move forward with its work requirements.

In his June 2018 ruling, Boasberg said HHS had failed to grapple with the fact that an estimated 100,000 people would lose Medicaid coverage under Kentucky’s requirements.

HHS, in reapproving Kentucky’s program, sought to address that issue by arguing that figure was dwarfed by the 450,000 who would lose coverage if Kentucky moved forward with repealing its expansion of Medicaid under Obamacare.

But Boasberg said adopting that position would allow the department to justify approving any proposed plan by a state “as long as it is accompanied by a threat that the state will de-expand” Medicaid.</s>A United States District Court judge has once again rejected President Donald Trump’s plan to require Medicaid recipients to meet certain work requirements in states including Arkansas and Kentucky, according to the .

The latest decision will likely be seen as a major setback for the Trump administration, which has long worked to curtail benefits by mandating low-income people participate in some sort of work or community engagement in order to be eligible for health coverage. In early 2018, the Trump administration authorized the first major changes to Medicaid, a 50-year-old entitlement program that has long functioned as a safety net for those close to and below the poverty level. The program changes took effect in Arkansas in June 2018, at which point Medicaid recipients were required to work, search or train for work, or volunteer for a total of 80 hours a month. In December, Vox reported that the Medicaid work requirement in Arkansas had caused roughly 17,000 people to lose their coverage after three months of noncompliance with the new rules.

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. The U.S. Department of Health and Human Services had previously given Arkansas and Kentucky the go-ahead to require low-income individuals to meet work requirements in order to receive assistance.

At least 15 states have proposed changes to Medicaid programs since 2017, according to reporting and analysis by The Pew Charitable Trusts.</s>A federal judge blocked Medicaid work requirements in two states on Wednesday, dealing a blow to one of the Trump administration's marquee efforts to push the poor toward self-sufficiency.

U.S. District Judge James E. Boasberg in Washington issued two decisions finding that Medicaid work requirements for low-income people in Arkansas and Kentucky pose numerous obstacles to getting health care that haven't been adequately resolved by federal and state officials.

He sent the federal Health and Human Services Department back to the drawing board.

Work requirements are already in effect in Arkansas, but Kentucky's program has been on hold because of lawsuits. 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.

But advocates for the poor say that Medicaid is a health care program and that work requirements have no place in it. Boasberg did not resolve that core issue.

Instead, he wrote that HHS approval of the Arkansas requirement was "arbitrary and capricious because it did not address ...whether and how the project would implicate the 'core' objective of Medicaid: the provision of medical coverage to the needy."

He used similar language in his ruling on Kentucky.

Nationally, some 12 million people are covered by the Medicaid expansion, accepted now by more than 30 states. Officials in GOP-led states have argued that work requirements and other measures such as modest premiums are needed to ensure political acceptance for the expansion.

The Trump administration early on encouraged states to apply for Medicaid waivers that would allow work requirements.

Eight states have had their requests approved, though not all have put their programs in place, according to the nonpartisan Kaiser Family Foundation. Requests from seven others are pending. In one of those states, Virginia, a work requirement was key to getting the legislature to approve Medicaid expansion.</s>Federal Judge Strikes Down Medicaid Work Requirements In Arkansas And Kentucky

A federal judge has struck down a Medicaid work requirement in Arkansas and Kentucky. This is a major blow to the Trump administration's vision for the health insurance program for low-income people.
Judge James Boasberg of the U.S. District Court for the District of Columbia blocks Kentucky from implementing Medicaid work requirements and Arkansas from continuing its program, stating the program's approval by the Department of Health and Human Services "... is arbitrary and capricious because it did not address ... how the project would implicate the 'core' objective of Medicaid, the provision of medical coverage to the needy".