Federal judge rejects Medicaid work or 'community engagement' requirements for Arkansas and Kentucky

"Medicaid work requirements in Arkansas and Kentucky approved last year by the Trump administration were blocked by a federal judge on Wednesday," Bill Lucia reports for Route Fifty. "It was the second time in less than a year the same District of Columbia district court judge, James Boasberg, rejected Kentucky’s plan."

Republican lawmakers in recent years have increasingly supported work requirements for "able bodied" Medicaid beneficiaries as a more politically palatable way of thinning them out than rolling back the Medicaid expansion under the Patient Protection and Affordable Care Act. Eight of the 36 states that expanded Medicaid to people with income up to 138 percent of the federal poverty level have received approval from the Centers for Medicare and Medicaid Services for a waiver that clears the way for work requirements.

When Arkansas implemented its work requirements last year, more than 18,000 people lost Medicaid coverage. "Arkansas’ requirements called for most able-bodied adults between 19 and 49 years old to complete 80 hours of work or other approved activities each month," Lucia reports. "These people had to report that they were complying each month mostly using an online portal—a provision that was widely criticized as recipients said they weren’t computer savvy or lacked reliable internet access." Rural residents are less likely to have reliable internet access.

Kentucky's work or "community engagement" requirements were similar, mandating that certain Medicaid enrollees spend at least 80 hours a month on a job, community service, substance abuse treatment, or job training. The plan was to take effect last July 1, but Boasberg blocked it just days before on grounds that, like the Arkansas program, federal approval of it was "arbitrary and capricious" because the Department for Health and Human Services hadn't considered the state's forecast that the Kentucky Medicaid rolls would have 95,000 fewer people in five years under the new plan than without it, in large measure for noncompliance with the work and reporting rules.

Kentucky slightly revised its plan, but Boasberg said it was mostly the same. Rather than follow Boasberg's direction to create a plan that doesn't take coverage away from so many people, "the Secretary doubled down on his consideration of other aims of the Medicaid Act," Boasberg wrote. "Given a second failure to adequately consider one of Medicaid’s central objectives, the Court has some question about HHS’s ability to cure the defects in the approval."

Adam Meier, the secretary of the Cabinet for Health and Family Services in Kentucky, said in a press release that Boasberg was "illogical" in presuming Medicaid "is all about paying for health care for as many people as possible without regard to whether this coverage actually makes people healthier. . . . We want more than to simply give someone a Medicaid card they can put in their wallet. We want a program that focuses on actually improving health outcomes. . . . Kentucky HEALTH is precisely in line with the objectives of the Medicaid program."