Capitol Correspondence - 07.21.20

Trump Administration Asks Supreme Court to Reinstate Medicaid Work Requirements in Two States

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ANCOR has been following policy discussions surrounding Medicaid work requirements because of our concern that they could affect people with disabilities and the Direct Support Professional workforce on which they rely. As reported by Politico Pro:

“The Trump administration has asked the Supreme Court to reinstate Medicaid work rules in two states, in hopes that the court’s conservative majority will greenlight the administration’s stalled push to overhaul the safety net health care program.

The administration’s request comes after a federal appeals court earlier this year upheld a judge’s ruling striking down the first-ever rules requiring some Medicaid enrollees to work, volunteer or attend school as a condition of coverage.

Trump’s Medicaid overhaul at stake: Tying health coverage for poor adults to work requirements, a longtime goal of conservatives, has been one of the Trump administration’s signature attempts to reshape Medicaid policy. About 20 states, mostly Republican-led, have either received or sought the administration’s approval for work rules since HHS announced the policy over two years ago.

Patient advocates, Democratic lawmakers and other critics of the work rules contend they are designed to shrink coverage and would be especially problematic during a pandemic that’s left millions jobless.

A unanimous three-judge panel of the U.S. Court of Appeals for the D.C. Circuit in February found that HHS’ approval of the Arkansas work rules was “arbitrary and capricious” because the department failed to consider how many Medicaid beneficiaries would lose coverage. The decision applied just to Arkansas, but the case could affect similar rules in other states. The Trump administration has also asked the Supreme Court to weigh a similar challenge to New Hampshire work rules, which were blocked by a federal judge in Washington.

The administration says the work rules would encourage people to find employment and reduce reliance on Medicaid, a program jointly administered by states and the federal government covering about one in five Americans. In its Tuesday filing to the Supreme Court, the Justice Department argued the appellate court’s decision “threatens to impede innovations that may make states’ Medicaid programs more effective and sustainable.”

Critics of the rules point out that most adult Medicaid beneficiaries who can work already do. They also question proponents’ claims the work rules are a cost-saver after an October report from a government watchdog agency found they would add considerable administrative costs for states.

What happened in Arkansas: The state was the first to enforce work rules in June 2018 before a federal judge struck down them seven months later. During that time, more than 18,000 people in the state lost Medicaid coverage, and just a fraction of those found health insurance from other sources, according to state data.

U.S. District Judge James Boasberg, who froze work rules in Arkansas and New Hampshire, also blocked a similar policy in Michigan. Work rules in other states have been put on hold as the Arkansas case moves through the courts. Utah was the only state with work rules in effect earlier this year, but they were paused because of the economic devastation wrought by the coronavirus.

What’s next: The Supreme Court isn’t likely to say whether it will take up the work rules cases before the start of its next term in the fall, when it’s already planning to hear a major challenge to Obamacare. Should the justices hear the cases, a decision would probably come well after the election.”