Skip to main content


Latest Lawsuit Targets New Hampshire's Medicaid Work Requirements

By Steven Porter  
   March 20, 2019

The National Health Law Program, which helped plaintiffs challenge similar requirements in Arkansas and Kentucky, have added New Hampshire's so-called 'community engagement' requirements to their hit list.

While they wait for a federal judge to decide whether Medicaid work requirements in Arkansas and Kentucky are legal, some of the same people involved in those two cases filed a third action Wednesday to challenge Medicaid work requirements in New Hampshire.

The National Health Law Program, which is involved in all three suits, partnered with New Hampshire Legal Assistance and the National Center for Law and Economic Justice to represent the four Granite State plaintiffs. They argue that the U.S. Department of Health and Human Services overstepped its legal authority when it approved a waiver to allow the added requirements in their state.

Jane Perkins, legal director for the National Health Law Program, said Congress gave the HHS secretary authority to waive some provisions of the law when such waivers would advance the Medicaid program's objective: to furnish medical assistance.

"We filed this case because the federal government ignored these limits in its effort to fundamentally transform Medicaid and 'explode' the Affordable Care Act's expansion of health coverage for medically necessary services that low-income adults need," Perkins said in a statement. "This approval will not promote coverage, but it will result in significant coverage losses, and that is the administration's goalโ€”to weaken the Medicaid program and cull people whom it deems unworthy from it."

A spokesperson for the Centers for Medicare & Medicaid Services declined to comment on matters of pending litigation, but CMS Administrator Seema Verma has said in the past that Medicaid work requirements are a tool to help beneficiaries rise out of poverty. In a blog post last week, Verma said such requirements may "help families break cycles of generational poverty and improve their health and financial independence more than just handing out a Medicaid card."

A spokesperson for HHS did not immediately respond Wednesday to HealthLeaders' request for comment.

When an attorney for the federal government argued last week that the work requirements would provide an incentive for people to improve their lives and find work, U.S. District Judge James Boasberg in the D.C. District Court reportedly interjected, "That is not the purpose of Medicaid."

Boasberg said he planned to rule by the end of the month on the Arkansas and Kentucky suits. The new challenge to New Hampshire's requirements was also filed in his court.

A spokesperson for New Hampshire Gov. Chris Sununu said the lawsuit is an attempt by "a partisan national organization" to "undo a bipartisan agreement by New Hampshire lawmakers," as The Concord Monitor's Ethan DeWitt reported. The state, which wasn't named as a defendant, is mulling whether to intervene in the case, the spokesperson reportedly added.

The lawsuit comes as the Trump administration has continued approving similar requirements in other states, most recently in Ohio. Waivers for Medicaid work requirements have been granted to eight states: Arizona, Arkansas, Indiana, Kentucky, Michigan, New Hampshire, Ohio, and Wisconsin. Waiver requests are pending for at least nine others: Alabama, Kansas, Mississippi, Oklahoma, South Carolina, South Dakota, Tennessee, Utah, and Virginia.

Related: Judge Vows to Rule on Medicaid Work Requirements by End of March

Related: New Guidance on Medicaid Demonstrations Released as Judge Mulls Legality of Work Requirements

HHS Secretary Alex Azar drew scrutiny for suggesting in a congressional hearing last week that the 18,000 beneficiaries booted from the Arkansas Medicaid program under that state's newly implemented work requirements had likely found jobs.

Analysis released Tuesday by the Center on Budget and Policy Priorities contradicted Azar's suggestion. Only 1,981 of the Arkansans who lost coverage for not meeting the work requirement had matches in the state's New Hire Database, which indicates that they had found employment.

"That means that for the more than 16,000 others who lost coverage, there is no evidence that they found new work," CBPP Senior Policy Analyst Jennifer Wagner wrote, adding that finding employment doesn't necessarily mean finding health insurance.

Dawn McKinney, policy director for New Hampshire Legal Assistance, said in the statement announcing the latest lawsuit that New Hampshire beneficiaries are worried their state, too, will soon see drops in enrollment like those documented in Arkansas and anticipated in Kentucky.

"This new policy, which includes ending retroactive health coverage, adds more confusing and burdensome requirements for families struggling to make ends meet," McKinney said.

New Hampshire's work requirements, which were approved last May, apply to adults who gained coverage from Medicaid expansion under the Affordable Care Act, with some exceptions.

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


The lawsuit claims HHS went too far when it approved New Hampshire's waiver for Medicaid work requirements last May.

Proponents of the work requirements argue they will help Medicaid beneficiaries climb out of poverty.

Get the latest on healthcare leadership in your inbox.