U.S. judge bars Kentucky from requiring
Medicaid recipients to work
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[June 30, 2018]
By Nate Raymond and Yasmeen Abutaleb
BOSTON/WASHINGTON (Reuters) - A U.S.
federal judge on Friday blocked Kentucky from implementing work
requirements in its Medicaid program, potentially dealing a blow to the
Trump administration's effort to scale back the 50-year-old health
insurance program for the poor and disabled.
Kentucky was the first of four states to receive approval from the U.S.
Department of Health and Human Services (HHS) to require that
able-bodied Medicaid recipients work at least 80 hours a month or lose
their benefits. Arkansas began this month to implement its work
requirements, while Kentucky was set to begin its program on Sunday.
The ruling could threaten the Trump administration effort to put a
conservative stamp on Medicaid after the Republican-controlled Congress
last year failed to repeal and replace the Affordable Care Act, commonly
known as Obamacare, which expanded Medicaid in more than 30 states.
Another eight states await federal approval for similar work
requirements. Virginia and Michigan have passed work requirements
through their statehouses.
According to Kentucky state estimates, nearly 100,000 people could be
eliminated from the Medicaid rolls within five years under the
requirements.
U.S. District Judge James Boasberg in Washington, D.C., ruled that the
U.S. Department of Health and Human Services never adequately considered
whether Kentucky's plan will actually help the state furnish medical
assistance to state residents.
"At bottom, the record shows that 95,000 people would lose Medicaid
coverage, and yet the (department) paid no attention to that
deprivation," Boasberg wrote, sending Kentucky's proposal back to HHS
for further review.
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Kentucky said the judge had blocked the program on the "narrow basis"
that HHS failed to consider its impact on Medicaid coverage, and that
the state would work with HHS to address that problem so the program
could take effect.
"We will have no choice but to make significant benefit reductions"
without implementing the work requirements, said Adam Meier, secretary
of Kentucky's health department.
The new rules require many residents to engage in some combination of
work, volunteer, job training or school for 80 hours a month or else
lose their benefits.
"Today’s decision is disappointing," Centers for Medicare and Medicaid
Services administrator Seema Verma said in a statement. "States are the
laboratories of democracy and numerous administrations have looked to
them to develop and test reforms that have advanced the objectives of
the Medicaid program."
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The agency said it was conferring with the U.S. Justice Department
to "chart a path forward." The Justice Department, which represented
the federal government in the case, did not immediately respond to a
request for comment.
OTHER STATES
The ruling could threaten changes in other states where work
requirements have already been approved and those that await
approval, said Timothy Jost, an emeritus professor at Washington and
Lee University School of Law.
The judge ruled that cutting people off of Medicaid because they do
not meet requirements that are "completely extraneous" to receiving
medical assistance were not legitimate grounds for the federal
government to approve changes to Medicaid, Jost said.
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"It seems to me that the other state programs that have been
approved have the same flaw," Jost said.
Kentucky Governor Matt Bevin had threatened to scrap the entire
Medicaid expansion under former President Barack Obama's Affordable
Care Act, which extended insurance to about 400,000 state residents,
if the work requirements were overturned. He earlier signed an
executive order that overturns the expansion in the event that
appeals are exhausted.
The rules, which the state expected to begin implementing on July 1,
cover people 19 to 64 years old, exempting some groups including
pregnant women, the medically frail and former foster care youth.
"There are better – and legal – ways to help people find work," said
Jane Perkins, director of the National Health Law Program, which was
one of three groups to file the Kentucky lawsuit.
The work requirements were approved by Republican President Donald
Trump's administration through a process that allows states to
receive waivers from federal Medicaid law to test new approaches to
the 50-year-old program.
A group of Kentucky residents sued in January, contending that,
rather than testing a new approach, Kentucky had "effectively
rewritten" the federal Medicaid law.
(Reporting by Nate Raymond in Boston and Yasmeen Abutaleb in
Washington; Additional reporting by Brendan Pierson in New York;
Editing by Alistair Bell and Cynthia Osterman)
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