Bad News for Medicaid Work Requirements

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Appeals court hands Trump administration a big defeat
WASHINGTON -- A federal appeals court on Friday struck down a waiver program that allowed states to enforce work requirements on Medicaid beneficiaries, calling the decision to allow such requirements "arbitrary and capricious" because it failed to take into account "whether the demonstrations would promote the primary objective of Medicaid -- to furnish medical assistance."

The lawsuit, known as Gresham v. Azar, addressed Arkansas' implementation of a federally approved work requirement in June 2018 that required beneficiaries ages 30 to 49 (later expanded to include those ages 20 to 29 as well) to show that they were "working or engaging in specified educational, job training, or job search activities for at least 80 hours per month," and to document such activities. A federal district court issued an injunction that halted the program at the end of March 2019; by then, more than 18,000 Arkansans had been removed from the Medicaid rolls when they failed to meet the new requirement. (Kentucky was also originally included in the lawsuit, since it too had instituted a Medicaid work requirement, but successfully removed itself from the case after terminating its program.)

In the three-judge panel's unanimous decision issued Friday by the U.S. Court of Appeals for the District of Columbia, Judge David Sentelle wrote that the district court "noted that the [Health and Human Services, or HHS] secretary identified three objectives that Arkansas Works would promote: "(1) 'whether the demonstration as amended was likely to assist in improving health outcomes'; (2) 'whether it would address behavioral and social factors that influence health outcomes'; and (3) 'whether it would incentivize beneficiaries to engage in their own health care and achieve better health outcomes.'" But "[t]he Secretary's approval letter did not consider whether [Arkansas Works] would reduce Medicaid coverage. Despite acknowledging at several points that commenters had predicted coverage loss,…
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