The Trump Administration Doubles Down on Medicaid Work Requirements as Lawsuits Mount
Despite multiple lawsuits, the Trump administration's push for implementation of Medicaid work requirements continues to move forward. In Arkansas, a lawsuit was filed earlier this week against the Trump administration claiming that their approval of the state's Medicaid work requirement is unconstitutional, as it violates and actively undermines the central tenets of Medicaid program -- namely, to provide health care to those unable to procure it on their own. The lawsuit is a near carbon copy of the one that was filed in Kentucky earlier this year, which resulted in U.S. District Judge James Boasberg halting the implementation of the state's work requirements, describing the Department of Health and Human Services' (HHS) approval of the program as "arbitrary and capricious", and accusing both HHS and the Medicare and Medicaid Services (CMS) of failing to consider how the work requirements would impact Medicaid's primary mission of providing health care to the poor.
Unlike in Kentucky, where the lawsuit was brought and won by the plaintiffs before the work requirements had taken effect, Arkansas's Medicaid work requirements had already been up and running for two months by the time the National Health Law Program and Southern Poverty Law Center brought their suit on Tuesday. As a result, whoever the Judge winds up being in the case (the plaintiffs argue it should be Boasberg again) and the public at large will have a chance to see the real world impacts of the work requirements instead of relying on theory and conjecture.
After two months of implementation, 7,500 Arkansans receiving Medicaid who were mandated to report in June that they had participated in at least 80 hours of work or work training, or were otherwise exempt from the reporting requirements, failed to do so. In July, the number of residents failing to report had increased by 60%, with 12,700 Arkansans failing to meet the work requirements. Of the 43,000 individuals who were mandated to report in July, only 844 satisfied the state's work requirements.
Under Arkansas's Medicaid work requirement program, any Medicaid recipient who does not prove that they have worked at least 80 hours or were otherwise exempt from the requirements for 3 months before the end of the calendar year loses their Medicaid coverage, meaning that as many as 7,500 Arkansas Medicaid recipients could be without healthcare by the end of August.
This week also marks the end of the second public comment period for Kentucky's Medicaid work requirement program, which the Trump administration hopes will enable them to address the issues raised by Judge Boasberg in his decision earlier this summer. Should Kentucky's Medicaid work requirement program be approved at the second time of asking, the damage to the health of the state's residents could be considerably greater than in Arkansas. According to a recent report from the Urban Institute projects that 55,000 Kentuckians could lose their Medicaid coverage during the 1st year of work requirement implementation due to a failure to find adequate work, while thousands more stand to lose coverage because failure to report or properly document the hours they worked.
For their part, the Trump administration has responded to the lawsuits in Arkansas and Kentucky by doubling down on their support for Medicaid work requirements. A recent story from Politico detailed the wide array of ways in which CMS Administrator Seema Verma and others in the administration are aiming to undermine Medicaid's primary pursuit of providing health care for low income Americans and some of them are jarring.
In Wisconsin, the Trump administration is reportedly planning to authorize a Section 1115 Medicaid waiver submitted by embattled GOP Governor Scott Walker that would, among other things, ask applicants to disclose whether or not they are currently using drugs or in recovery from a substance use disorder. While this is not nearly as severe as the mandatory Medicaid drug testing that Governor Walker had been pushing for, it still is an unnecessary invasion of the privacy of Medicaid applicants and could be a deterrent to people who use drugs enrolling in the program.
Out in Arizona, Trump administration officials are expected to give the green light to the state's Medicaid waiver, but to deny their request to exempt Arizona's sizable Native American population from being subject to work requirements. If made, this denial by the Trump administration would fly in the face of centuries of constitutional and treaty-based protections for the health and wellbeing of Native Americans and would constitute an egregious attack on tribal sovereignty. The Trump administration's contention that Native American tribes are members of race and not separate governments is a profoundly cynical and disingenuous one and has the potential to decimate the rights to public assistance that Native communities often so desperately need.
This is an outrageous and continuing assault on the Affordable Care Act and must not continue. AIDS United will continue to work with partner organizations as well as Congress and health staff within the administration to oppose any changes to Medicaid that would cause people, especially people living with HIV and other long-term health needs, to lose the health coverage they require and deserve.
[Note from TheBody: This article was originally published by AIDS United on Aug. 17, 2018. We have cross-posted it with their permission.]