Democratic victories in Kentucky, Virginia deal another blow to Medicaid work requirements

Elections vote voting booth
State elections in Kentucky and Virginia Tuesday could have major ramifications for Medicaid work requirement programs in both states. (Getty/hermosawave)

Medicaid work requirements will likely take a hit after Democrats made gains in Kentucky and Virginia Tuesday night.

Democrat Andy Beshear defeated Kentucky's Republican incumbent Gov. Matt Bevin, and Democrats took control of the state legislature in Virginia. Both states were seeking to install work requirements for Medicaid expansion beneficiaries, but the election night changes could stymie those efforts.

Bevin was a major proponent of work requirements for Medicaid expansion beneficiaries. Kentucky became the first state to get federal approval for the program. But Beshear, who will take office in early December, said Tuesday that during his first week in office, “I am going to rescind this governor’s Medicaid waiver.”

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Bevin has yet to concede the close race, but Beshear is moving ahead with a transition plan.

The election results show that the expansion is entrenched in Kentucky, as even the legislature voted twice to fund the expansion, said Patricia Boozang, senior managing director for Manatt Health. Bevin’s proclamation to end the expansion if the work requirement lawsuit doesn’t go his way also “hasn’t played out to be a very popular position,” she said.

RELATED: Tennessee releases proposal to convert federal Medicaid dollars into block grant

Kentucky’s work requirement program never got off the ground due to a slew of legal challenges. Lawsuits from advocacy groups charged that the Centers for Medicare & Medicaid Services (CMS) exceeded its authority when it approved the work requirements program.

A federal judge ruled the agency didn’t fully estimate the coverage losses from the requirements. The program also went against the meaning of the Medicaid statute that calls for the expansion of coverage.

The same judge also struck down work requirement programs in New Hampshire and Arkansas, the latter of which did implement its program—and 17,000 people lost coverage. A three-judge panel heard oral arguments last month on an appeal from the Trump administration to the decision to strike down Kentucky and Arkansas’ programs.

So far, six other states got CMS approval for work requirements but none have been implemented. Indiana and Arizona both have held off implementation in the face of similar lawsuits.

"New Hampshire even before its approval was vacated also put a pause on its implementation," Boozang said. "Those decisions have to do with not only litigation but also key concerns about the potential implication for coverage."

Another nine states have an application before CMS for approval for work requirements, according to data from the Kaiser Family Foundation.

RELATED: KFF: Medicaid enrollment down in 2019 and expected to be flat in 2020 

Among those nine states is Virginia, where voters gave Democrats control of the entire state legislature. Virginia passed a law to expand Medicaid with the caveat the state would apply for work requirements, a demand from the state’s Republicans who had a majority in the House.

But now that Democrats have complete control of the state legislature, and they could pursue legislation to get rid of the work requirement portion of the expansion. Democratic Gov. Ralph Northam’s office did not return a request for comment as of press time.

However, a Republican did retain the governor’s seat in Mississippi on Tuesday as Lt. Gov. Matt Reeves defeated Democrat Jim Hood. Reeves’ victory likely means that Mississippi will continue to not expand Medicaid under the Affordable Care Act.

Mississippi is one of 14 states to have not expanded Medicaid.

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