April 21, 2019

Federal judge again blocks new Medicaid rules in Kentucky

31 March 2019, 05:41 | Silvia Roy

Federal Judge Tosses Medicaid Work Requirements


A federal judge has said that in Kentucky and Arkansas, the Trump administration can not put certain work requirements on people who receive Medicaid. "We emphatically disagree because a healthcare program like Medicaid, by its very nature, must take into account whether it improves people's health", said Adam Meier, secretary of Kentucky's Cabinet for Health and Family Services.

The ruling on Arkansas' waiver program could negatively affect the decision of that state's Republican-controlled Legislature on whether to renew funding for Medicaid expansion for another year, said Bo Ryall, CEO of the Arkansas Hospital Association, which supports expansion and opposes the work requirement.

The twinned opinions, in a pair of states that have been national leaders in the move towards Medicaid work requirements, cast doubt on the Trump administration's approvals of efforts to re-envision the public insurance program.

The future is less certain in MI, where Democratic Gov. Gretchen Whitmer last month said she would ask the Republican-led Legislature to change newly enacted work or job-related requirements to qualify for Michigan's Medicaid expansion program.

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Kentucky Gov. Matt Bevin has warned that he will stop participating in the Medicaid expansion to save money if the work rules are not approved.

U.S. District Judge James E. Boasberg in Washington, D.C., blocked work requirements for low-income people in two states - Arkansas and Kentucky.

The Trump administration reapproved the rules in November. Boasberg, appointed by President Barack Obama, questioned whether Arkansas' work requirements "would in fact help the state furnish medical assistance to its citizens, a central objective of Medicaid".

HHS and the CMS have approved the waivers on the grounds that they enhance beneficiary health and financial independence and the fiscal sustainability of Medicaid.

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IN officials said they planned to move forward with their work requirements despite the ruling. The state also planned to impose small monthly premiums from those Medicaid recipients to mimic private insurance plans. Bevin, a Republican, has threatened to end Kentucky's Medicaid expansion covering more than 400,000 people if work requirements are ultimately struck down.

Arkansas Gov. Asa Hutchinson said he was disappointed with the decision. "We believe, as have numerous past administrations, that states are the laboratories of democracy and we will vigorously support their innovative, state-driven efforts to develop and test reforms that will advance the objectives of the Medicaid program". Removal of recipients for failed reporting this year will cease.

Medicaid work requirements are a particular passion of Seema Verma, the administrator of the Centers for Medicare and Medicaid services. Last June, Boasberg blocked them from taking effect. The Affordable Care Act originally required states to expand Medicaid, but a Supreme Court ruling allowed states to decide whether they wanted to or not. "Arkansas", he wrote, "might use the time while the program is paused to consider whether and how to better educate persons about the requirements and how to satisfy them". A federal judge on Wednesday threw out the work rules.

A new report from The Commonwealth Fund found that work requirements would leave hospitals with lower revenues, higher levels of uncompensated care and, consequently, even tighter operating margins.

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"I remain fully committed to a work requirement, and we are in this for the long haul because we believe this is the right policy for Arkansans who want to work and need training and more opportunity", the governor said during a news conference at the state Capitol.

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