Kentucky's Medicaid Work Requirements Reapproved After Judge Tossed Them

The state revised its proposal, and the Trump administration collected additional comments on the policy before granting the reapproval.

The Centers for Medicare & Medicaid Services reapproved Kentucky's work requirements for certain Medicaid beneficiaries on Tuesday, five months after a judge blocked their prior approval as arbitrary and capricious.

The judge had reasoned that CMS failed to assess whether Kentucky's plan for the program would further Medicaid's central purpose, which is to provide for medical services. So CMS collected additional comments, and the state revised its plan.

The 136-page approval released Tuesday evening is 54 pages longer than the approval CMS released last January. It notes several differences between the two versions, including the following four changes:

1. An additional waiver regarding retroactive eligibility;
    
2. A revision to the premium requirement for those deemed eligible for transitional medical assistance;
    
3. Updated special terms and conditions (STCs) for monitoring and evaluation; and
    
4. A requirement for Kentucky to submit an implementation plan and a monitoring protocol, each of which must address the work requirements.
    

The implementation plan is due to CMS within 90 days, and the monitoring protocol is due to CMS within 150 days, according to the approval—which means the latter of the two deadlines falls after the approval's effective date of April 1, 2019.

A spokesperson for CMS could not immediately be reached Wednesday morning to answer HealthLeaders' questions about these deadlines and this timeline.

In Arkansas, where work requirements took effect in June, policymakers are still revising their evaluation frameworks for the program, with feedback CMS released earlier this month. More than 12,000 people have reportedly lost Medicaid coverage as a result of the policy change in Arkansas.

Critics contend that the underlying goal of these policies is to cull Medicaid rolls. Some of the same groups that successfully challenged the original approval of Kentucky's work requirements are similarly challenging the program in Arkansas, and they argued Tuesday that the reapproval is illegal.

"Kentucky HEALTH runs directly counter to the purpose of the Medicaid Act, which is to furnish health care coverage to low-income individuals and families. Medicaid is a health care program, not a jobs-training program," Ben Carter, senior litigation and advocacy counsel for the Kentucky Equal Justice Center, which participated in representing Medicaid beneficiaries in a class action suit to block Kentucky's work requirements, said in a statement.

Southern Poverty Law Center Deputy Legal Director Samuel Brooke added in the statement that the plaintiffs "intend to pursue the next court challenge as vigorously as we have before when we won."

In addition to Kentucky and Arkansas, three other states have secured federal approvals to impose work requirements, though the details of their plans differ significantly: Indiana, New Hampshire, and Wisconsin.

Editor's note: This story has been updated to include information about a response from the organizations that sued to block the prior approval of Kentucky's work requirements.