Judge Strikes Down Kentucky’s Medicaid Work Rules


More than 400,000 Kentuckians have joined Medicaid since 2014 as a result of the expansion, and the state estimated that some 350,000 of them — about a quarter of its overall Medicaid population — would be subject to the new work rule. But many recipients already have jobs or otherwise would meet the requirement. The state had planned to grant exemptions to people it deemed medically frail or who were pregnant, in school, or the primary caregiver of a dependent child or disabled family member.

Advocates for the poor say that even many working Medicaid recipients would have lost coverage because of the new documentation requirements. Kentucky itself has estimated that 95,000 fewer residents would have been enrolled in Medicaid within five years, although its lawyers said many of those people would have found jobs that offered insurance. Regardless, the plaintiffs used Kentucky’s estimate to argue that work requirements would have thwarted the purpose of Medicaid.

The Trump administration approved Kentucky’s plan in January, shortly after Ms. Verma announced a major policy shift letting states require many adults to work or participate in other “community engagement activities” as a condition of eligibility for Medicaid.

Weeks later, the National Health Law Program, the Kentucky Equal Justice Center and the Southern Poverty Law Center filed the suit on behalf of 16 Medicaid beneficiaries in the state.

The work requirement has drawn the most interest. Arkansas, Indiana and New Hampshire have won permission to follow in Kentucky’s footsteps, and seven other states are waiting for the Trump administration to decide whether they can, too. Those states are Arizona and Ohio, which have expanded Medicaid, and Kansas, Maine, Mississippi, North Carolina, Utah and Wisconsin, which have not and would direct their work requirement at the small number of adults who were not disabled, mostly mothers of dependent children.

Michigan, Virginia and several other states were also planning to pursue work requirements but had not yet submitted applications.

“The Trump administration’s attempt to transform the Medicaid program through executive action has been restrained,” said Jane Perkins, the legal director for the National Health Law Program, which provides legal services for the poor. “The purpose of the Medicaid Act is to furnish medical assistance, and this approval could not stand because it was doing just the opposite — restricting coverage.”


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