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A Judge Blocked a Medicaid Work Requirement. The White House Is Undeterred.

WASHINGTON — Trump administration officials, whose push to impose work requirements on Medicaid beneficiaries was dealt a blow by a federal judge in June, say they have found a way around the ruling and will continue to allow states to put the restrictions in place.

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Robert Pear
, New York Times

WASHINGTON — Trump administration officials, whose push to impose work requirements on Medicaid beneficiaries was dealt a blow by a federal judge in June, say they have found a way around the ruling and will continue to allow states to put the restrictions in place.

The judge, James E. Boasberg of U.S. District Court in Washington, stopped a Kentucky plan to introduce the work requirements after finding that the secretary of health and human services had failed to consider the state’s estimate that the new rules would cause 95,000 low-income people to lose Medicaid coverage. Limiting access to medical assistance does not promote the objectives of the Medicaid program, he said.

But administration officials said they could sidestep the ruling by providing a better explanation of the rationale for work requirements. The officials have a narrow reading of Boasberg’s decision, saying he faulted them for failing to follow proper procedure. They can satisfy his concerns, they say, by compiling a fuller record and showing they have thoroughly reviewed the evidence.

The Trump administration said it was “inviting additional comments” on Kentucky’s proposal, to hear what people had to say in the wake of the court decision. The deadline for public comments is next Saturday.

Opponents of work requirements say they unfairly punish people who face barriers to employment, and they can block access to programs that help enable people to hold a job. But administration officials say they are committed to work requirements because they believe they not only reduce reliance on government programs, but also improve a person’s physical and mental health.

“We suffered one blow in a district court in litigation,” said Alex Azar, the secretary of health and human services. “We are undeterred. We are proceeding forward. We are fully committed to work requirements and community participation requirements in the Medicaid program. We will continue to litigate. We will continue to approve plans.”

Asked whether the court decision had changed her mind, Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, said, “It doesn’t change our commitment to giving states flexibility and our commitment to helping people rise out of poverty.”

The administration approved the Kentucky plan as a demonstration project, but it clearly embodies President Donald Trump’s vision for the future of the social safety net.

Federal officials have allowed states to impose work requirements on Medicaid beneficiaries in Arkansas, Indiana and New Hampshire, as well as Kentucky. Seven other states — Arizona, Kansas, Maine, Mississippi, Ohio, Utah and Wisconsin — are seeking federal permission, in the form of waivers, and other states are expected to do so.

Arkansas is already putting a work requirement into effect. More than 7,000 people in Arkansas failed to meet the requirement in June and are at risk of losing coverage if they fail to comply before the end of the year.

“You are noncompliant with the work requirement,” says a letter sent to families by the Arkansas Department of Human Services. “You must complete 80 hours of work activities each month and make on-time reports to DHS to keep your Arkansas Works insurance.”

The Kentucky lawsuit was filed by 15 residents who said the work requirement put them in danger of losing health insurance. Ian H. Gershengorn, a lawyer for the plaintiffs, said a better explanation of the decision to approve Kentucky’s waiver would not be enough.

“We continue to believe that the imposition of work requirements is for Congress, acting through its legislative authority, not for the executive branch, seeking to change the law on its own,” Gershengorn said.

Since Kentucky expanded Medicaid in 2014, enrollment in the state’s Medicaid program has more than doubled, to 1.4 million, according to the state Medicaid agency. Nearly one-third of Kentucky’s 4.45 million residents are now covered by Medicaid.

In approving a Medicaid waiver for Kentucky, Boasberg said, Azar, the health secretary, “never once mentions the estimated 95,000 people who would lose coverage.” Indeed, the judge said, Azar ignored the overarching purpose of the Medicaid program, which is to provide medical assistance to needy people.

Boasberg found that the Trump administration’s action approving work requirements in Kentucky was “arbitrary and capricious” and therefore violated the Administrative Procedure Act.

Under that law, the Supreme Court has said, an agency must engage in “reasoned decision-making” and must “articulate a satisfactory explanation for its action.” Agencies must also solicit comments from the public, and hundreds of people have responded to the Trump administration’s latest request for comments on the Kentucky plan.

Some express a strong animus against government health insurance programs. Others testify to the importance of Medicaid.

A 60-year-old Kentucky woman who is taking six prescription medicines wrote, “Without Medicaid, I would have absolutely no way to pay for my doctors and prescriptions, which would leave me completely crippled and would quickly prove fatal, if not by my thyroid condition then by my own hand.”

“I hope that you can find it in your hearts and budgets to keep me and others alive for a few more years,” she added. “I promise we will NOT live forever!”

But others supported work requirements.

“I have to work to pay for my extremely expensive health care,” a Kentucky health care provider wrote. “I can’t find a reason that an able-bodied person should not have to show some effort for their free health care.”

Statements by Trump administration officials indicating that they still intend to allow states to enforce work requirements could create legal complications for the government.

Lawyers for Medicaid beneficiaries in Kentucky said the statements showed that Trump administration officials had prejudged the issue and knew what they would conclude even before considering public comments.

More than 30 states have expanded Medicaid under the Affordable Care Act to cover millions of adults without dependent children. The Trump administration has supported efforts to roll back the expansion, saying states should focus on groups that were eligible for Medicaid before passage of the Affordable Care Act.

“The thought that a program designed for our most vulnerable citizens should be used as a vehicle to serve working-age, able-bodied adults does not make sense,” Verma said.

Boasberg rejected that distinction, saying the 2010 health law placed new beneficiaries “on equal footing” with those who were already eligible, like poor children, pregnant women and people with disabilities. He found no justification in the law for “prioritizing certain groups over others.”

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