Federal Judge Blocks Medicaid Work Requirements in Arkansas, Kentucky

On Wednesday, a U.S. District Court Judge in the District of Columbia issued a dual-ruling, striking down Medicaid work requirements in Arkansas and Kentucky. Judge James Boasberg determined that the U.S. Department of Health and Human Services (HHS) failed to adequately consider impacts of work requirements, writing, “The Court cannot concur that the Medicaid Act leaves the Secretary so unconstrained, nor that the states are so armed to refashion the program Congress designed in any way they choose.”

In this week’s ruling, Judge Boasberg rejected for a second time Kentucky’s proposed work requirements after previously ordering HHS last June to reevaluate its plan. Once again, Boasberg determined that HHS had not adequately considered whether the state’s proposed work requirements would continue to allow beneficiaries adequate access to health coverage. Kentucky’s proposed work requirements were a component of a broader overhaul of the state’s Medicaid program which was projected to decrease enrollment in the program by over 95,000 individuals. Boasberg, in his ruling invalidating the state’s proposed program, indicated the demonstration shall not move forward because HHS officials “did not consider the health benefits of the project relative to its harms to the health of those who might lose their coverage.”

The ruling on Arkansas’ Medicaid work requirements are expected to have a more immediate impact, particularly given that over 18,000 Medicaid beneficiaries lost coverage last year for failing to meet newly-imposed work requirements. Arkansas, as part of its state Medicaid demonstration, required beneficiaries to work or participate in other employment-related activities for at least 80 hours per month to retain their coverage.

This week’s ruling has potential impacts on the six other states that have already received approval, as well as seven other states seeking approval, to implement similar employment-conditional requirements for Medicaid coverage. As legal challenges increasingly mount against those states, U.S. Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma reaffirmed the Trump Administration’s commitment to defending efforts of states to implement such requirements and help people “rise out of poverty and government dependence.” Pending legal challenges are expected to continue to play out over the coming months, leaving in limbo states’ work requirements and beneficiaries’ coverage.