Monday, July 02, 2018

Judge blocks Ky.'s bid to make 'able-bodied' adults on Medicaid work, volunteer, get training or drug treatment

A federal judge threw out Kentucky's plan for changes in Medicaid, casting doubt on efforts in several other states to require "able-bodied" adults on the program to work, volunteer, take job training or get treatment for substance abuse.

Kentucky is one of four states where the U.S. Department of Health and Human Services has approved Medicaid work requirements. "Seven others — Arizona, Kansas, Maine, Mississippi, Ohio, Utah, and Wisconsin — have proposals waiting for approval," Dylan Scott of Vox reports.

U.S. District Judge James Boasberg of Washington, D.C., said in his ruling that HHS Secretary Alex Azar "never adequately considered whether" Kentucky's plan "would in fact help the state furnish medical assistance to its citizens, a central objective of Medicaid." The state had estimated that its Medicaid rolls would have 95,000 fewer people in five years than without the plan, partly due to non-compliance with its rules and reporting requirements.

Boasberg sent the issue back to HHS for review. State Health Secretary Adam Meier issued a statement calling the ruling "very narrow" and saying the state would work with the Centers for Medicare and Medicaid Services "to quickly resolve the single issue raised by the court so that we can move forward."

"However, other issues may stand in the way," Al Cross writes for Kentucky Health News. "Boasberg said he didn't have to rule on some issues raised by the plaintiffs because Azar's omission was enough to invalidate the waiver."

UPDATE, July 3: Writing for The Commonwealth Fund, Sara Rosenbaum has "three takeaways" from Boasberg's ruling:  "1. Work requirements may not be unlawful per se, but any Medicaid waiver demonstration conducted under Section 1115 of the Social Security Act must be carefully assessed for its impact on people’s health care coverage. Providing health insurance, after all, is Medicaid’s reason for being.  2. Where Medicaid’s fundamental purpose and statutory protections are concerned, expansion beneficiaries stand on equal footing with 'traditional' populations. Judge Boasberg spends considerable time debunking what has become an especially contested aspect of the debate surrounding the Affordable Care Act (ACA)’s Medicaid expansion population: namely, that these individuals are somehow less worthy . . . 3. Comprehensive, high-quality evidence is the heart of lawful administrative decision-making."

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