Access to Care

Quick Take: Federal judge blocks Medicaid work requirements

Andis Robeznieks , Senior News Writer

What’s the news: In separate rulings, a federal judge overturned Trump administration approval of existing Medicaid work requirements in Arkansas and proposed requirements in Kentucky. He ruled that Health and Human Services (HHS) Secretary Alex Azar failed to adequately consider whether the requirements would “help the state furnish medical assistance to its citizens, a central objective of Medicaid.”

Why it matters for patients and physicians: The evidence is clear: uninsured people live shorter, sicker lives. The Arkansas requirements led to 18,164 people losing coverage. About 450,000 had gained coverage through Kentucky’s expansion of Medicaid. An estimated 95,000 people would lose coverage if Kentucky’s proposed work requirements took effect.

Nine states are in various stages of implementing Medicaid work requirements: Arizona, Arkansas, Kentucky, Indiana, Michigan, New Hampshire, Ohio, Utah and Wisconsin. Arkansas began requiring Medicaid patients to work in June 2018. Indiana and New Hampshire are implementing their requirements this year. Kentucky’s had been scheduled to start in July. Utah’s work requirements were approved just days after the federal ruling was issued. Work requirements were approved for Maine, but were then rejected by the state’s new governor.

U.S. District Judge James E. Boasberg heard both cases. In his Kentucky ruling, he cited “the destructive effects of coverage gaps” noted in an amicus brief that the Litigation Center of the American Medical Association and State Medical Societies joined with the American Academy of Pediatrics and several other medical societies and organizations in filing.

“Intermittent, unreliable coverage is little better than being permanently uninsured,” the brief says.

Of the nearly 18,200 people who lost coverage in 2018 under Arkansas work requirements, only 1,910 regained coverage in 2019, according to the Kaiser Family Foundation. The brief in the Kentucky case notes how “any reporting mistake could trigger disenrollment” and failing to check the right box could result in a loss of coverage for six months.

A lawsuit has been filed in federal court challenging New Hampshire’s work requirements as well.

The AMA House of Delegates adopted policy opposing Medicaid work requirements.

What’s next: Both states have indicated they will appeal or ask HHS to appeal on their behalf. For Kentucky, however, this was the second unsuccessful attempt at implementing work requirements. Gov. Matt Bevin has threatened to reverse Kentucky’s Medicaid expansion if these requirements are not allowed.