The CMS has approved work requirement waivers in eight states, and requests are pending from seven others. And as of now, about 15 states have been working on adding work requirements to their Medicaid programs. Some 100,000 people could be dropped from the rolls because of the new rules.
Boasberg ordered an immediate halt to Arkansas' work requirement program, which went into effect a year ago and has already resulted in more than 18,000 Medicaid expansion enrollees being dropped from the program for non-compliance with the work and reporting requirements.
Administration officials, and a growing cadre of Republican governors, contend that such rules motivate low-income people to find work that will help them climb the economic ladder and eventually become self-sufficient. Officials in GOP-led states have argued that work requirements and other measures such as modest premiums are needed to ensure political acceptance for the expansion.
Kentucky Gov. Matt Bevin has warned that he will stop participating in the Medicaid expansion to save money if the work rules are not approved. That could strip 450,000 people of coverage.
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. In the Kentucky opinion, Boasberg states that the Azar made no finding that Kentucky's changes would promote fiscal sustainability to Medicaid, such as by achieving savings, even though budget contraints were among Kentucky's stated reasons for the requirements. They should have to work for them. A 2017 HHS Office of the Actuary report estimated Medicaid expenditures will grow at 5.7% every year - a faster rate than the gross domestic product is predicted to grow over the next decade.
But Cara Stewart, chief of staff for the Kentucky House Democratic Caucus, said state law bars Bevin from ending the expansion through executive order, and his action would be immediately challenged in court if he tried to do that.
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DeWine has described the OH rules as a possible model for other states. Arkansans must reapply if they want coverage. The desire to connect Medicaid health benefits to work requirements has always been a goal of conservatives, but the language of Boasberg's opinions relays the reasons why advocates for the poor have been predicting this decision; they have insisted that health benefits and work should not be linked. Arizona's work requirements are scheduled to begin no sooner than next January, she said.
Kentucky had been the first state to win permission to impose "community engagement" requirements in January, 2018, a day after Verma announced the government would for the first time allow states to require low-income people to work, prepare for jobs, or volunteer as a condition of coverage.
In Kentucky, expansion supporters fear Bevin will react to the ruling by either trying to end the expansion or by cutting benefits, which he did temporarily after Judge Boasberg first blocked the waiver past year.
"The judge illogically concluded that Medicaid is all about paying for healthcare for as many people as possible without regard to whether this coverage actually makes people healthier", Meier said in a news release from the agency.
Only recipients who gained coverage through the expansion - and not the regular Medicaid population - were subject to the requirement.
State Department of Human Services officials said Thursday they were taking down the website used for reporting hours worked and planned to notify people that the requirement had been halted.
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