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Parties Await Ruling on N.H. Medicaid Work Requirements

By Steven Porter  
   July 24, 2019

This week's hearing came after state officials delayed their rollout of the new requirements and as federal officials continue to defend work requirements in other states on appeal.

U.S. District Judge James Boasberg, who previously blocked Medicaid work requirements in Kentucky and Arkansas, heard arguments Tuesday on whether he should similarly toss out the federal government's approval of such requirements in New Hampshire.

Since the current case is practically identical to the prior two, the plaintiffs are "hopeful" that Boasberg will again issue a decision in their favor, National Health Law Program legal director Jane Perkins told HealthLeaders in an email after Tuesday's hearing.

Perkins and her organization are working with New Hampshire Legal Assistance and the National Center for Law and Economic Justice to represent the four Granite State plaintiffs. They accuse Health and Human Services of shoehorning the administration's own objectives into a Medicaid program that was established for the limited purpose of providing healthcare to people in poverty or living with disabilities.

Court records indicate that Boasberg took the matter under advisement Tuesday. It's unclear whether a decision could come quickly or be delayed.

The hearing came two weeks after New Hampshire officials delayed their rollout of the new work requirements. Two-thirds of the beneficiaries to whom the work requirements apply—that's nearly 16,900 people—had failed to demonstrate compliance by the deadline, so state officials have launched a ramped-up campaign to raise public awareness.

Perkins said her team's legal arguments are unaffected by the state's recent actions because the plaintiffs are challenging the HHS secretary's approval of the requirements.

"The state actions are directed at implementation of that approval and do nothing to fix the errors in what the secretary did," she wrote in her email.

But it's possible the state's work requirements will go back to the federal government for another review after state lawmakers and Gov. Chris Sununu expanded the Medicaid work requirement exemptions and authorized a delay.

Supporters of these work requirements have said the policies help beneficiaries climb out of poverty by giving them stronger incentives to work. Opponents have expressed concerns, however, that the added hurdles will simply result in more poor people being barred from Medicaid coverage over technicalities.

Boasberg blocking work requirements in New Hampshire would almost certainly prompt an appeal, as federal officials are continuing to defend their actions on the Kentucky and Arkansas programs before the U.S. Circuit Court of Appeals for the District of Columbia.

In a brief filed in the appellate case last week, attorneys for the federal defendants argued that the states' demonstration projects are reasonable and modeled after similar requirements that have been part of the Temporary Assistance for Needy Families (TANF) program and Supplemental Nutrition Assistance Program (SNAP) for more than 20 years.

The brief argued, furthermore, that the federal government's approval of the work requirements under Section 1115 of the Affordable Care Act were made appropriately, based on the HHS secretary's determination that the added requirements were "likely to assist" in promoting the program's objectives.

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


The plaintiffs' attorney says the New Hampshire case is nearly identical to Kentucky and Arkansas cases.

The federal government continues to argue that its approval of the added requirements was appropriate.

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