Analysis: What factors will come into play as stakeholders respond to a recent decision on Medicaid work rules

Politico reported on March 27 that “a federal judge today blocked new work requirements on Medicaid recipients for a second time, dealing another blow to the Trump administration’s efforts to reshape the safety net healthcare program.” 

The ruling found the government failed to identify how adding employment requirements to the program furthered Medicaid’s purpose of providing insurance coverage to low-income individuals. The article states: “Both of the court decisions issued Wednesday remand the Arkansas and Kentucky projects back to HHS. But the ramifications of [U.S. District Judge James} Boasberg’s ruling, issued nine months after he first blocked work requirements in Kentucky last summer, extend beyond those two states.”

For more information, see the HFMA article “Medicaid Work Requirements Impact Hospital Finances: Report.”

Takeaway

Even though the ruling only applies to the Kentucky and Arkansas cases, it’s worth watching to see how the various stakeholders respond. Key things to look for include:

1. How will this impact U.S. Department of Health and Human Services decisions on future waivers that include work requirements? Given that Utah’s partial expansion waiver, which included a work requirement, was approved shortly after the ruling, it looks like the administration is determined to press forward despite setbacks in court.
2. How will Kentucky and Arkansas respond? Gov. Matt Blevin has threatened to overturn coverage expansion. It’s one thing to threaten it, it’s another thing to run the political risk of taking coverage away from 400,000 individuals. On April 2, the Arkansas House of Representatives passed a Senate-approved bill that continued its Medicaid expansion for an additional year. An initial vote the Friday after the ruling had failed to pass by the necessary margin to continue the expansion.
3. How will Virginia respond, given that its coverage expansion was predicated on a work requirement wavier? Like in Kentucky, will members of the Virginia General Assembly risk the political blowback of rolling back a recently started coverage expansion
4. How will states like Georgia that are considering coverage expansion respond? Will the lack of work requirements slow progress, or do those conversations continue forward?