HARRIS MEYER February 14, 2020 12:21 PM
A federal appellate court Friday shut down the
CMS' approval of Arkansas' Medicaid work requirement, dealing a major blow to
the Trump administration's Medicaid policy centerpiece of requiring
beneficiaries to work as a condition of receiving benefits.
In a unanimous ruling, a three-judge panel for the U.S. Court of Appeals
for the District of Columbia Circuit upheld a lower court decision that HHS'
approvals of Medicaid work requirements in Arkansas and Kentucky were arbitrary
and capricious and not consistent with the primary objective of the Medicaid
statute. Kentucky ultimately terminated its Medicaid work requirement program
and withdrew from the appeal.
The opinion, written by Republican-appointed
Judge David Sentelle, said the lower court "is indisputably correct that the
principal objective of Medicaid is providing healthcare coverage."
The Trump administration in its approvals of
Section 1115 waiver requests from Arkansas and Kentucky said requiring
beneficiaries to report 80 hours a month of work of "community engagement"
activities would lead to improved health outcomes and wellbeing for
beneficiaries.
But the panel rejected that rationale.
"We agree with the district court that the
alternative objectives of better health outcomes and beneficiary independence
are not consistent with Medicaid," Sentelle wrote.
The CMS did not immediately comment on the
ruling. It's unknown whether the administration or Arkansas officials will
appeal the ruling to the Supreme Court.
CMS Adminstrator Seems Verma has aggressively
promoted the administration's move to expand Medicaid work requirements. Nearly
a dozen conservative-led states are seeking waiver approvals for such
requirements. Michigan and Ohio currently are launching programs requiring
Medicaid expansion beneficiaries to report work or community engagement
activities.
Jane Perkins, legal director of the National
Health Law Program, which spearheaded the legal challenge to the work
requirement waivers, praised the ruling on Friday.
"It means that thousands of low-income
people in Arkansas will maintain their health insurance coverage — coverage
that enables them to live, work, and participate as fully as they can in their
communities," she said.
Arkansas's Republican leaders had hoped to
reinstate the work requirement program, which was blocked by U.S. District
Judge James Boasberg last March after more than 18,000 Arkansas Medicaid
expansion enrollees lost coverage.
Kentucky's new Democratic Gov. Andy Beshear
recently withdrew his state's work requirement waiver program.
Some experts believe this could dramatically
impact other work requirement requests. Nicholas Bagley, a University of
Michigan law professor who has closely followed the work requirements
litigation, said Friday's ruling marks "the end of the road for work
requirements at least until the Supreme Court has an opportunity to weigh
in."
He said the opinion minces no words in saying
the Trump administration can't approve waivers that would result in kicking
tens of thousands of people off program. It might also block variations like
Utah's waiver, which requires Medicaid expansion enrollees to report that they
have applied for employment but does not require them to actually be employed.
"They might try to go ahead with something
different like Utah," Bagley said. "But it's very difficult to see
how any waiver whose adoption would result in loss of coverage could possibly
be approved."
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