Once Again, Medicaid Work Requirements are Found Impermissible

Yesterday, a federal judge blocked efforts by two states to impose onerous paperwork and employment requirements on Medicaid recipients as a condition of maintaining coverage. For the second time, the judge found that Kentucky’s plan was not permissible under the Medicaid statute, and that similar rules in Arkansas — that have already led to thousands of Arkansans losing coverage — could not stand. The rulings are a set back for the Trump Administration, which has sought to reshape the Medicaid program by allowing states to implement such restrictions.

At issue in these rulings was whether or not the states’ plans to modify their Medicaid programs aligned with the statutory goals of the Medicaid program. For both Kentucky and Arkansas, the judge found their waivers did not, and that the Trump Administration did not do its due diligence in approving the plans, because it failed to account for the thousands of people in each state who would lose health coverage. The judge determined that the federal government’s approval of the waivers was therefore “arbitrary and capricious,” echoing his previous criticism of the Arkansas waiver.

While a victory for the advocates and legal teams who brought these cases, the judge’s decisions are limited and do not mean that states cannot condition Medicaid eligibility on employment. Rather, they mean that the Kentucky and Arkansas plans cannot be implemented in their current forms. The waivers must be re-worked to address the judge’s concerns and then reapproved by the federal government before they could take effect. More litigation is likely in this space, as several other states are pursuing similar efforts to restrict Medicaid coverage.

Medicare Rights continues to oppose work requirements in Medicaid. We are particularly concerned that such requirements disproportionately harm people who are nearing Medicare eligibility and find it difficult to find or maintain work. The Medicaid program was designed to provide health coverage to people who are struggling to afford care. Conditioning their coverage on compliance with punitive work requirements and unnecessary bureaucratic tasks does nothing to advance these goals.

Read our response to the earlier decision on Kentucky’s waiver.

Read about the risks of work requirements for older adults.

Read the Arkansas decision and the Kentucky decision.