A federal judge has blocked Arkansas and Kentucky from requiring Medicaid beneficiaries to work or train for work as a condition of staying enrolled in the program.
The ruling was issued Wednesday by Judge James Boasberg of the U.S. District Court for the District of Columbia, an appointee of former President Barack Obama. The decision may be appealed and eventually make it to the Supreme Court.
At issue were rules the Trump administration approved in the states obligating certain people to work, volunteer, or take classes for 80 hours a month as a condition of being allowed to remain in Medicaid. Plaintiffs said the rules were illegal and did not serve the purpose of Medicaid, a program that is jointly funded by states and the federal government.
Boasberg concluded that the Trump administration should have considered whether the rules “would be likely to cause recipients to lose coverage and whether it would cause others to gain coverage.”
“He did neither,” Boasberg wrote of the secretary for the Department of Health and Human Services, Alex Azar.
“By his own description, the secretary ‘entirely failed to consider’ this question,” Boasberg wrote.
The Trump administration approved the rules because it opposes the changes Obamacare made to Medicaid. Under the law, states are allowed to expand coverage to people under the $17,000 a year income threshold, regardless of other factors such as disability status or whether they are working.
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Officials from the administration have said that coverage should not extend to adults capable of work and instead should be limited to the most vulnerable groups, such as people with disabilities, children, and older adults who need specialized care. Boasberg, however, concluded that Obamacare changed the purpose of Medicaid and that any changes the administration approves need to make sure that they fulfill its new goals.
Wednesday’s ruling marked the second time that Boasberg struck down the rules in Kentucky, which have never gone into effect and weren’t scheduled to begin until this summer. He previously said the commonwealth did not adequately consider what the effects of enacting the requirements would be. After that happened, the rules were re-evaluated then re-approved by the Trump administration, before again being challenged in court.
But the changes that were made were not enough to get Boasberg’s support.
“The court finds its guiding principle in Yogi Berra’s aphorism, ‘It’s deja vu all over again,'” he wrote.
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Arkansas was the first and only state to enact its Medicaid work rules. Last year, 18,000 people either failed to work or failed to report their work for three months and were cut off from Medicaid for the rest of the year. Boasberg said he wanted to rule on the cases before April 1 so that people who had not worked or reported work in January, February, and March wouldn’t lose coverage.
Federal officials argued in court earlier this month that ending the rules in Arkansas would be too disruptive to a program that had already started, but Boasberg wrote he thought it would be more disruptive for people to lose coverage.
In support of the work rules, the administration has argued that Medicaid could go beyond providing healthcare coverage, and instead, through the work requirements, help beneficiaries improve their lives by earning more money and securing private health insurance coverage. They noted that people who work are healthier and that improving health is another goal of Medicaid.
Boasberg concluded these arguments were not persuasive, ruling the policy “arbitrary and capricious.”
