U.S. District Court Judge James Boasberg has struck down the Trump administration's Medicaid work requirement waivers in Kentucky (for the second time) and Arkansas, saying the rules requiring low-income people to prove they are employed "cannot stand."
"The Court cannot concur that the Medicaid Act leaves the [HHS] Secretary so unconstrained, nor that the states are so armed to refashion the program Congress designed in any way they choose," Boasberg wrote in the Kentucky case. "The Court rejected the Secretary’s contention that 'he could properly focus on' ... three alternative criteria—health and well-being, cost considerations, and beneficiary self-sufficiency—in approving the demonstration project." Addressing the fact that states argue that the programs are more cost-effective than Medicaid without the requirements, he writes that the resulting "loss of coverage" of enrollees "appears, from the record in this case, to be how the Commonwealth would save money. That is precisely what the Ninth Circuit said states cannot do with a § 1115 waiver."
The rulings were handed down in the middle of a hearing in the Idaho legislature trying to impose work requirements on the citizens' initiative-passed Medicaid expansion. One witness, David Lehman, speaking for Bingham Memorial Hospital, broke the news to legislators. "We were just informed that the federal judge in D.C. has struck down the work requirements in Arkansas and Kentucky. The issues that have been present in both of those states exist in [Idaho legislation] HB 277. […] I think now the new calculus has to be what is legal in Idaho. […] I think it's important that the committee know that before they make this […] decision."