Public health scholars blast ‘bizarre’ logic of Arkansas’ work requirements

Medicaid on paper and a stethoscope
40 medical scholars said no such research exists to support Medicaid work requirements. (Getty/designer491)

Warning of spiraling Medicaid disenrollment, dozens of researchers and deans at the nation's top public health universities have called on a court to block work requirements in Arkansas.

In an amicus brief filed with the D.C. District Court hearing a legal challenge to halt the state's work requirement policy, 40 public health scholars from Yale, New York University, George Washington, Georgetown University and dozens of other prominent schools said the demonstration project, and others like it, will kick “millions of low-income individuals” off the program.

“To accomplish this aim, CMS fabricated an entirely new Medicaid purpose—to encourage work—in order to shoehorn a blatantly political agenda into its demonstration authority,” the scholars wrote in the court filing (PDF). “In doing so, the agency mischaracterizes crucial research to support its unproven theory and ignores its own record, including comments regarding the health risks its actions create.”

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RELATED: MACPAC urges Azar to pause, re-evaluate Arkansas' Medicaid work requirements

Specifically, the group rebuffed an assertion from the Centers for Medicare & Medicaid Services (CMS) claiming that research supports the idea that community engagement activities are correlated with improved health and wellness, arguing that “no such research exists.” The scholars also challenged a new CMS policy, outlined in a State Medical Directors Letter (SDML), that diverged from the agency’s prior stance that work requirements do not reflect Medicaid’s objectives, and invited states to submit demonstration proposals.

“Arkansas Works Approval reflected the bizarre logic of CMS’ earlier SMDL letter: The purpose of depriving Medicaid beneficiaries of medical assistance is to improve their health,” the scholars wrote.

RELATED: Arkansas could lose up to $340M because of Medicaid work requirements

The amicus brief comes shortly after MACPAC, the independent commission that advises CMS on Medicaid policy issues, urged HHS Secretary Alex Azar to pause the Arkansas waiver until it can resolve issues around reporting.

Arkansas’ work requirements dropped 8,000 people from the program in the first two months, and recent research suggests as many as 48,300 could lose coverage over the course of the year. That could cost the state as much as $340 million in federal funding.

But CMS has shown no signs of backing down. Last month, the agency approved Wisconsin’s waiver request to implement work requirements.

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