The upshot is that nearly two years after senior Trump health officials said they would allow states to impose work requirements on some of their most vulnerable residents, no Medicaid recipient in the United States is currently at risk of losing coverage for failing to find a job.
Indiana and Arizona — both with Republican governors — are the first states to do voluntarily what a federal judge in Washington has achieved through court orders in three others. The administration has given nine states permission to impose the rules, and nine more are asking for approval.
Indiana was an early state to encourage people on Medicaid to train for work, predating Vice President Pence’s time as governor, as well as the Trump presidency. Seema Verma, the top federal official overseeing Medicaid, was an Indiana-based health-care consultant who says she has refrained from participating in decisions involving the state since she joined the administration.
Kentucky was on the cusp of being the first state to require some people on Medicaid to report that they worked, were training for a job or were volunteering before U.S. District Judge James E. Boasberg blocked the requirements. He ruled in early summer of 2018 that the Department of Health and Human Services had been “arbitrary and capricious” in giving permission, failing to consider the effects on poor people who need health coverage.
Arkansas became the first place to set the rules in motion, causing about 18,000 people on Medicaid to lose their insurance before Boasberg issued a similar opinion last March, forcing the state to stop. In July, the same judge ruled that New Hampshire also could not begin.
Critics of the policy filed a lawsuit in Indiana in late September, and the state announced Thursday that the requirements were being postponed until the case was resolved. There is no such litigation in Arizona, but in notifying federal health officials in mid-October that it was postponing its work rules “until further notice,” the Medicaid director there cited “the evolving national landscape” concerning such requirements and “ongoing litigation.”
Boasberg’s rulings in the Kentucky and Arkansas cases have been appealed to the U.S. Court of Appeals for the D.C. Circuit. During recent oral arguments, all three members of a panel of judges sounded skeptical of the administration’s position. The judges suggested that, in approving the states’ plans, federal health officials had neglected to consider that they would cause some people to lose health insurance.
States generally have sought to place the requirements on able-bodied people covered through states’ expansion of Medicaid under the Affordable Care Act. The idea has been championed by Verma, administrator of HHS’s Centers for Medicare and Medicaid Services.
Indiana adopted a somewhat gentler version of work requirements than several other states. The first people were to have been at risk of losing benefits in January.