Published: Sun, March 31, 2019
Medicine | By Daryl Nelson

Federal judge rules against Kentucky’s Medicaid waiver

Federal judge rules against Kentucky’s Medicaid waiver

"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".

"As long as they hold on to hope that some judge will rule in their favor, states will continue to pursue work requirements", he said. Hutchinson wants an appeal of that ruling.

Efforts by the Trump administration and Republican-governed states to weed out Medicaid beneficiaries via work requirements hit a major legal hurdle today as a DC District Court judge struck down waivers granted to Arkansas and Kentucky for this objective.

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 CMS has approved work requirement waivers in eight states, and requests are pending from seven others.

Arkansas began implementing work requirements last June. Now, residents are having to skip care after they're dropped from the rolls. 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. Several other states have requests pending with the Trump administration.

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 created to provide safety-net care for low-income individuals.

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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. 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.

Kentucky Gov. Matt Bevin said his state would appeal. "We're thrilled people are going to keep coverage".

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". In January, 16 Kentucky Medicaid recipients again asked the judge to block the rules.

"The day of the free lunch is over", Bevin said. That state's work requirement waiver was originally struck down by Boasberg in July 2018. Verma says she believes work is important to improving the health and well-being of Medicaid recipients. New Hampshire's requirement, which took effect this month, also is being challenged in court.

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.

DeWine has described the OH rules as a possible model for other states. The Trump administration under the Center for Medicare and Medicaid Services really invited states to add these work requirements. Arizona's work requirements are scheduled to begin no sooner than next January, she said. Last year, he signed an executive order directing Cabinet agencies to add or strengthen work requirements for programs including subsidized housing, food stamps and cash welfare. About 18,000 have lost coverage as a result of the work requirements. There are exceptions for people who are ill or taking care of a family member. The Affordable Care Act originally required states to expand Medicaid, but a Supreme Court ruling allowed states to decide whether they wanted to or not.

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