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Medicaid Work Requirements Blocked in Kentucky and Arkansas

Analysis  |  By Steven Porter  
   March 27, 2019

The HHS secretary keeps trying to advance Medicaid objectives that aren't rooted in the law itself, the judge ruled.

The same federal judge who blocked Medicaid work requirements from taking effect in Kentucky nine months ago did so again on Wednesday, and he struck down similar requirements for Arkansas as well.

D.C. District Court Judge James E. Boasberg granted summary judgment in favor of the Medicaid beneficiaries who sued to block each state's Medicaid waiver, which the Trump administration approved as part of a push to embrace what it describes as "community engagement" requirements.

A central objective of the Medicaid program is to provide healthcare to needy populations, but the Health and Human Services secretary "continues to press his contention that the program promotes his alternative proposed objectives of beneficiary health, financial independence, and fiscal sustainability of Medicaid," Boasberg wrote, determining that the first two of those three goals are not rooted in the Medicaid Act.

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Boasberg found that HHS failed to adequately consider what effect the policy would have on coverage, so he vacated HHS' approval of each state's Medicaid waiver, sent the matter back to HHS for further proceedings, and ordered the parties to appear for an April 10 status hearing.

The lawsuits challenging each state's new requirements—Stewart v. Azar in Kentucky and Gresham v. Azar in Arkansas—were brought with help from the National Health Law Program and other organizations. A similar lawsuit involving some of the same groups, Philbrick v. Azar, was filed just last week to challenge Medicaid work requirements in New Hampshire as well. (No decision has been issued in the Philbrick case, which is also before Boasberg.)

Those who support imposing work requirements on Medicaid beneficiaries have argued that they help people climb out of poverty and improve their financial independence. Those who oppose such requirements have argued that they are designed to reduce the Medicaid-eligible population.

In addition to Kentucky, Arkansas, and New Hampshire, there are five other states with Medicaid waiver approvals that include work requirements: Arizona, Indiana, Michigan, Ohio, and Wisconsin. At least nine more have requests for such waivers pending.

Between 1.4 million and 4 millioin people could lose coverage if work requirements were imposed nationwide, according to estimates by the Kaiser Family Foundation.

Steven Porter is an associate content manager and Strategy editor for HealthLeaders, a Simplify Compliance brand.

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