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Providers, others file court briefs against work rule in Medicaid; KY Hospital Association supports it


Kentucky Health News

Dozens of provider groups, advocates and academics are urging a federal appeals court to rule against” Gov. Matt Bevin’s plan to require work or other “community engagement” from “able-bodied” Medicaid beneficiaries in Kentucky, James Romoser reports for Inside Health Policy.

In five friend-of-the-court briefs, “a diverse array of organizations and prominent health-care scholars weighed in on the side of beneficiaries who are challenging the legality” of the plan and a similar one in Arkansas, Romoser writes.

U.S. District Judge James Boasberg

U.S. District Judge James Boasberg of Washington, D.C., has blocked the plans, saying they are not allowed by the 1965 law that created Medicaid as a national program also funded by the states. The Trump administration has appealed to the U.S. Court of Appeals for the District of Columbia Circuit.

The briefs agree with Boasberg, and argue that work rules “undermine the purpose of Medicaid, make people sicker, and disproportionately harm beneficiaries in vulnerable populations,” Romoser reports. “Several of the briefs rely on a recently released Harvard study finding that Arkansas’ work requirements failed to boost employment during the initial months when they were in effect.”

The Arkansas Hospital Association joined with nine other organizations in a brief criticizing the plan in that state, contrary to the Kentucky Hospital Association, which filed a brief in May, urging the court to uphold the Kentucky plan, Romoser notes. He adds that KHA “is the only entity that filed an amicus brief in support of work requirements — a marked contrast with the roughly 80 individuals and organizations that have signed one of the amicus briefs opposing work requirements.”

The KHA brief called the plan a “reasonable experiment” to test whether “linking Medicaid benefits to work-sponsored commercial insurance, may encourage beneficiaries to maintain — and use — health care coverage even while healthy,” Andy Davis reports in a long story for the Arkansas Democrat & Gazette.

The Arkansas hospitals joined a brief with the American Medical Association, the American Academy of Pediatrics, the National Alliance on Mental Illness and other national groups. “It argues that the Arkansas waiver, if upheld, will cause mass disenrollment from the state’s Medicaid rolls, will make beneficiaries sicker and will possibly lead to premature deaths,” Romoser reports. “The AMA and other national provider groups also filed a similar brief arguing that the Kentucky waiver will have the same negative health consequences.”

Another brief, by organizations that represent seniors and people with disabilities or chronic conditions, argues that Kentucky’s work requirements would “devastate older adults and people with disabilities or chronic conditions.” Kentucky’s plan would apply to beneficiaries up to age 64; the one in Arkansas goes to age 49.

“The organizations take issue with CMS’ contention that work requirements apply only to beneficiaries who are capable of working,” Romoser reports. “Many beneficiaries who are deemed able-bodied may have chronic conditions and need significant care, the brief says.” CMS is the Centers for Medicare and Medicaid Services.

A date for oral arguments in the case has not been set, “but likely will occur in the fall,” Romoser writes. Bevin is up for re-election on Nov. 5, but has said he expects the issue to go to the U.S. Supreme Court.


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