Oral arguments to begin this week in Medicaid work requirements cases

Medicaid work requirements will again go before a judge this week.

Oral arguments in lawsuits against such requirements in Kentucky and in Arkansas will begin on Thursday. Kentucky’s waiver for work requirements was the first approved by the Centers for Medicare & Medicaid Services, while Arkansas’ program was the first to formally roll out.

Kentucky’s plan, called Kentucky HEALTH, was previously blocked by a federal judge, but the state refiled its waiver, which CMS approved a second time.

If the program is approved, at least 90,000 people will be culled from the rolls, patient advocates warned on a call with reporters Monday morning. More than 18,000 people lost coverage in the first four months of Arkansas’ program, they said.

Those figures undergird a significant political pushback, which has led to even Republican-led state legislatures spiking work requirements, said Eliot Fishman, senior director of health policy at Families USA.

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“There’s a growing political dynamic against these,” Fishman said. “This week’s hearings are important on their own terms, but they pay into that changing political dynamic.”

CMS first issued guidance on work requirements in January 2018, paving the way for states to apply for Section 1115 waivers to implement such a program. Since then, waivers have been approved in eight states.

The Trump administration and supporters of the work requirements say they promote health by promoting employment, as having a job can lift people out of poverty. The requirements also take direct aim at the expansion population, which added childless adults to the rolls.

The White House took the plan a step further in the president’s annual budget proposal Monday morning, suggesting that the requirements should be place nationwide.

Following the legal setback in Kentucky late last year, CMS Administrator Seema Verma said it was important for the agency to give states the power to test different approaches.

“These are demonstration waivers, so we think it’s important to put out as many as they can so we can learn from different states and see what approaches work,” Verma said.

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The policy’s opponents, however, say that the work requirements go against the central goal of Medicaid: to provide healthcare coverage. Fishman said CMS “does not have great legal options here” because Medicaid statute clearly lays out the program’s goals—which doesn’t include promoting health or helping people secure employment.

“HHS has not provided any new or cogent explanation that show these policies promote coverage, hence these approvals are still arbitrary and capricious,” Leonardo Cuello, director of health policy for the National Health Law Program, said on the call.

Attorneys for Cuello’s organization are among those spearheading the case against the work requirements.

The Medicaid and CHIP Payment and Access Commission has also expressed concern about the requirements.