Capitol Correspondence - 02.18.20

Appeals Court Rejects Medicaid Work Requirements, Setting Up Potential for Supreme Court Case

Share this page

ANCOR has been following news of efforts by states and the Centers for Medicare and Medicaid Services (CMS) to institute work requirements for the Medicaid program because of its potential to affect people with disabilities and the workforce who supports them. As reported by Health Law:

“A three-judge panel of the U.S. Court of Appeals for the District of Columbia ruled in favor of the plaintiffs in Gresham v. Azar, concerning the Trump administration’s approval of a restrictive Medicaid waiver project, which among other things, conditioned Medicaid coverage on compliance with work requirements. Judge David Sentelle issued the unanimous opinion. The panel found that in approving the project without considering its effect on Medicaid coverage, the U.S. Department of Health and Human Services violated the Administrative Procedure Act.”

Politico Pro further elaborates on the significance of this ruling: “The decision, which upheld a lower court ruling against the work requirements, brings the Trump administration’s Medicaid overhaul closer to possible review from the Supreme Court. For the first time in Medicaid’s history, the administration has allowed states to condition coverage for some enrollees on whether they work or participate in a similar activity, like job training, volunteering or attending school.

Critics of the rules say they are a thinly veiled effort to allow states, which jointly finance the program with the federal government, to pare down program enrollment.

The Trump administration has approved work requirements in 10 states, largely in those that adopted Obamacare’s Medicaid expansion to low-income adults. Another nine states have sought similar rules, including some that have not expanded Medicaid.

Friday’s decision does not effect rules in other states. Some states have paused their work requirements, citing ongoing litigation.


In Arkansas, more than 18,000 people lost Medicaid coverage last year as a result of the work rules before they were invalidated by U.S. District Judge James Boasberg. Just a fraction of those enrollees rejoined the program while the rules were in effect, state data showed.

The Arkansas lawsuit was originally consolidated with a similar case involving Kentucky’s work requirements. However, Kentucky was removed from the lawsuit after recently elected Democratic Gov. Andy Beshear dropped the work requirements.

Work requirements are currently only in effect in Indiana, though legal aid groups have sued to block the state’s rules. Boasberg earlier this year overturned rules in New Hampshire. The Justice Department hasn’t said if it would appeal that decision.”