Capitol Correspondence - 11.26.18

Trump Administration Oks Kentucky Work Requirements for Second Time

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We are sharing this story based on ANCOR’s concerns that work requirements impact people with disabilities and the workforce that support them.

According to Politico Pro:

“For a second time, the Trump administration has approved Kentucky’s controversial Medicaid waiver which imposed work requirements on some enrollees. The program had been blocked in court.

In its reapproval, CMS said it determined the Kentucky project still advanced Medicaid’s purpose of providing coverage in part because it promotes enrollee health and financial independence.

The waiver, which takes effect April 1 and will be rolled out gradually, is part of a strategy to surmount a federal court decision in June that blocked the Kentucky program from taking effect, a major blow to the Trump administration’s efforts to overhaul the health coverage program for the poor.

In that decision, Judge James Boasberg of the U.S. District Court for the District of Columbia said the Trump administration failed to consider how the Kentucky plan would affect coverage, and specifically criticized HHS Secretary Alex Azar for disregarding public comments that were overwhelmingly against the plan.

In a statement this evening, CMS said that it had “worked diligently to analyze and reconsider the comments received. … CMS believes the Kentucky HEALTH program is likely to promote the objectives of Medicaid.” Kentucky didn’t actually change its work requirement proposal for this second round; CMS approached the approval in a different way in an effort to satisfy the court. More legal challenges are possible.

Kentucky had been planning to require certain adult Medicaid enrollees — mostly those who gained coverage under Obamacare’s expansion of the program — to work or participate in a job-related activity for at least 80 hours per month or lose their health coverage. Vulnerable populations traditionally covered by Medicaid before the Obamacare expansion would have been exempt, including pregnant women, children and individuals with disabilities. Yet the work rules and other components of Republican Gov. Matt Bevin’s plan would have resulted in 95,000 fewer people being covered by the program.

Bevin has threatened to end the entire Obamacare Medicaid expansion, which provided coverage to more than 400,000 people in his state, if any part of his plan is blocked in court. His state originally expanded Medicaid under his Democratic predecessor.

After the court decision, CMS redoubled its efforts to move the Kentucky plan ahead and opened a new 30-day federal comment period on the proposal, a move that would allow the administration to potentially show that it’s addressing the court’s concerns.

Kentucky is one of two states where advocacy groups have sued to block work rules from Medicaid — the other being Arkansas. In total the Trump administration has approved work requirements in five states, but Arkansas’ are the only ones that have gone into effect. More than 12,000 people have been removed from Arkansas’ program since the state began culling enrollment in September.

Consumer groups in Kentucky criticized CMS’ decision on Tuesday, with Kentucky Voices for Health Executive Director Emily Beauregard saying the Trump administration and CMS “have once again ignored the voices of their constituents.”

“During the 2018 federal comment period, thousands of Kentuckians spoke up to share why access to health care is critical to their ability to be good parents and caregivers, productive employees, successful entrepreneurs, and contributing members of their communities. Reapproving a waiver that makes hardworking Kentuckians jump through hoops to keep their coverage will no doubt have the opposite effect,” she said in a statement.