A three-judge panel of the U.S. Court of Appeals for the District of Columbia ruled unanimously Friday against the Trump administration's efforts to attach work requirements to Medicaid in a case brought against Arkansas' efforts to do so. It's a pretty decisive blow, with the decision written by very conservative Reagan appointee Judge David B. Sentelle, who in upholding a decision by a lower court wrote, "The district court is indisputably correct that the principal objective of Medicaid is providing health care coverage."
He goes on to cite the Medicaid statute and the program’s purpose of providing medical assistance to families with dependent children and to senior and disabled individuals. Medicaid expansion under the Affordable Care Act added to that cohort, and Sentelle agreed with the lower courts that the "expansion of health care coverage to a larger group of Americans is consistent with Medicaid's general purpose of furnishing health care coverage." Furthermore, he quotes the 1st and 6th Circuits’ conclusion that "[the] primary purpose of Medicaid is to enable states to provide medical services to those whose 'income and resources are insufficient to meet the costs of necessary medical services.'" He returns again to the fundamental fact that "statute and case law demonstrate that the primary objective of Medicaid is to provide access to medical care."
Sentelle, writing for the court, rejects outright the administration's claimed alternative objectives in approving work requirement waivers of influencing or incentivizing beneficiaries to "achieve better health outcomes." Medicaid, statute and case law say, is intended for different aims—the one objective of the law is to ensure access to medical care. He concludes: "Because the Secretary's approval of Arkansas Works was arbitrary and capricious, we affirm the district court's judgment vacating the Secretary's approval."
The case was originally consolidated with a challenge to Kentucky's work requirements, which has since been removed because there's a Democratic governor in Kentucky now, and he axed the requirements. Arkansas had removed more 18,000 people from the program based on work requirements reporting before it was invalidated by a federal judge. The Trump work requirements waiver requests are pending in eight states, and have been approved but not implemented in Arizona, Ohio, South Carolina, Utah, and Wisconsin. This decision will likely keep those states from moving forward. It has been implemented in Indiana and Michigan, and both states have been sued.
This decision could create another thorny issue for the Supreme Court and the Trump administration in this election year. Arkansas' Republican Gov. Asa Hutchinson is itching for a fight in the Supreme Court, and so will pressure the administration to appeal the decision to the Supreme Court. Whether the administration or the Supreme Court wants to have another high-profile fight over health care—the 5th Circuit ruling essentially striking down the whole of the ACA is still out there—is a very big question.