Appellate judges nix Trump's Medicaid work requirements

A panel of federal appellate court judges on Friday struck down the administration's approval of work requirements in Medicaid, the federal health insurance program for low-income Americans.

The unanimous decision, written by Judge David Sentelle, a Reagan appointee, upheld a district court ruling that found the administration failed to analyze whether such programs would "promote the primary objective of Medicaid -- to furnish medical assistance."

The ruling puts another roadblock in President Donald Trump's efforts to inject conservative ideals into the Medicaid program, which provides coverage to nearly one in five Americans.

In another controversial move last month, the administration announced it would allow states to apply for so-called block grants to cover certain low-income adults, particularly those who gained benefits under the Affordable Care Act's Medicaid expansion provision. That effort is also expected to be challenged in court since consumer advocates say it will lead to people losing benefits and coverage.

The Trump administration, in a historic step, began granting state requests to mandate that certain Medicaid beneficiaries work in order to receive benefits in 2018. Ten states received waivers, though three were set aside by the same district court judge. Work requirements are currently only in effect in Michigan since several other states pulled back on their efforts after the legal rulings. Another 10 state requests are awaiting federal approval.

Friday's ruling applies specifically to Arkansas, where more than 18,000 people lost coverage in 2018 before the court stepped in. The district court had also voided Kentucky's approval, which blocked work requirements from being implemented there. However, Kentucky terminated its waiver request after a Democratic governor won election last November and dismissed its appeal.

The Centers for Medicare & Medicaid Services, which grants the requests, "is reviewing and evaluating the opinion and determining next steps," a spokesman said. "CMS remains steadfast in our commitment to considering proposals that would allow states to leverage innovative ideas."

The administration contends that requiring people to work, volunteer or participate in job training will better their health and is therefore in keeping with Medicaid's mission.

The appellate court ruling, however, said that "the primary objective of Medicaid is to provide access to medical care." The Medicaid statue makes no mention of alternative objectives, such as "improving health outcomes," as the administration cited in its approvals.

"The text of the statute includes one primary purpose, which is providing health care coverage without any restriction geared to healthy outcomes, financial independence or transition to commercial coverage," Sentelle wrote.

The lawsuit was brought by the National Health Law Program, along with Legal Aid of Arkansas, the Southern Poverty Law Center and Jenner & Block.

"This is a victory for thousands of Americans who can now continue to have access to health coverage and health care," said Ian Heath Gershengorn, a Jenner & Block partner and National Health Law Program board member who argued the case.