Lawsuit challenges New Hampshire's Medicaid work requirements

New Hampshire residents have filed suit against the Trump administration over work requirements in the state’s Medicaid program. 

Several advocacy groups, including the National Health Law Program, are suing (PDF) the Department of Health and Human Services on the residents’ behalf, warning that the work requirements do not comply with the core goals of Medicaid and are thus illegal. 

The lawsuit is the third state where there has been a legal challenge to the work requirements. The Centers for Medicare & Medicaid Services approved waiver requests for such requirements in eight states so far, with Ohio being the most recent

“Congress has defined the scope of the secretary’s power to waive portions of the Medicaid Act, and those waivers must further Medicaid’s stated objective of furnishing medical assistance,” Jane Perkins, NHeLP legal director, said in a statement

“We filed this case because the federal government ignored these limits in its effort to fundamentally transform Medicaid and ‘explode’ the Affordable Care Act’s expansion of health coverage,” Perkins said. 

RELATED: The 4 biggest Medicaid controversies in 2018 

NHeLP is also involved in the two other suits against the Trump administration over work requirements in Arkansas and Kentucky. A federal judge heard oral arguments in both cases last week and is expected to issue a joint ruling by the end of the month. 

At the heart of the debate is whether work requirements satisfy the requirements of Medicaid statute as they could lead to people losing coverage. Trump administration officials argue that the goal of the requirements is to ensure eligible people are working, as being employed improves health, which means they’re legal. 

Kentucky’s work requirements were previously struck down because CMS did not consider the impacts of the requirements on coverage in its approval. Kentucky submitted a nearly-identical request, which was approved by the agency a second time

Arkansas is the only state where work requirements have been put in place following approval. More than 18,000 people were booted from Medicaid in the first four months of the requirements, mostly for administrative reasons, and just 8% of those who lost coverage have since re-enrolled. 

RELATED: National Health Law Program—Medicaid work requirements are bad policy disguised as flexibility 

Amid the legal proceedings, CMS went on the defensive last week, issuing guidance that would establish greater oversight and monitoring for the effectiveness of these requirements

In an accompanying blog post, Administrator Seema Verma said that offering states greater flexibility in Medicaid has been one of the Trump administration’s key goals, and under previous administrations states were frequently “rebuffed” when seeking more options for their programs. 

Waivers are a crucial tool for managing expanded Medicaid programs, Verma said. 

“Effectively serving the needs of this population will require new and different strategies, and 1115 demonstrations provide a critical vehicle for these efforts—particularly given the statutory requirement for these projects to be effectively evaluated,” she wrote.