PT: US Judge to Rule on Legality of Medicaid Work Requirements


A Monumental Month on Medicaid Work Requirements

Politico  March 18, 2019

When CMS Administrator Seema Verma approved Ohio's work requirements on Friday, it was either a sign of the Trump administration's relentless push to transform Medicaid, or a last effort to put a conservative imprint on the program before the courts force a change in strategy.

Verma has made clear that work requirements are a priority, releasing new guidance to help states apply and already approving waivers in eight states, counting Ohio. (Maine's work requirements were approved, too, but the state withdrew its approval under a new Democratic governor.)

The CMS administrator also used her platform to repeatedly defend the policy last week.

"The Medicaid program was designed to serve our most vulnerable populations like children and people with disabilities," Verma wrote on Thursday. "[I]t's logical that the nature of demonstration projects would change given the unprecedented expansion of [Medicaid] eligibility to childless, working-age adults that occurred under Obamacare."

But new data has patient advocates and health industry officials warning that the policy is disruptive and potentially harmful. The Commonwealth Fund last week released analysis that suggested hospital margins would suffer under Medicaid work requirements, given the likelihood that fewer patients would have health coverage.

Meanwhile, just 1,910 of the roughly 18,000 Arkansas residents dropped from Medicaid coverage under work requirements re-enrolled during the first two months of 2019, according to state data released Friday.

Another 6,472 Arkansas Medicaid beneficiaries also have "two strikes" for not reporting work requirement data in the first two months of 2019; failing to report this month would lead them to be disenrolled starting in April for the rest of the year.

What we're waiting for now: A judge's ruling, which could shake up strategy. U.S. District Judge James Boasberg said on Thursday that he'd rule on the legality of work requirements in Arkansas and Kentucky by the end of March.

Boasberg, an Obama appointee, in 2018 blocked Kentucky's work requirements, leading CMS to rethink its approach and solicit more comments on Kentucky's waiver. A ruling this time would likely be more expansive and, if Boasberg again blocks the work requirements, could force another change in tactics.

A clue toward his thinking? Boasberg was skeptical last week when government lawyers argued that work requirements helped Medicaid beneficiaries find jobs. "That's not the purpose of Medicaid," the judge responded.