Appeal options considered for Medicaid work rules

A judge on Thursday entered orders clearing the way for President Donald Trump's administration to appeal rulings that last week struck down Medicaid work requirements in Arkansas and Kentucky.

Granting joint requests in court filings by the administration and plaintiffs in the two cases, Thursday's orders by U.S. District Judge James Boasberg formally entered judgments in favor of the plaintiffs on their claims that the administration was "arbitrary and capricious" and abused its discretion in approving the requirements.

The orders in Washington, D.C., also stayed future proceedings in the cases pending any appeals by the administration and canceled status hearings that had been set for Wednesday of next week.

Attorneys for the administration and plaintiffs said in the court filings that such a "final judgment" in the two cases would allow the administration to appeal.

In footnotes in each filing, the attorneys said the administration "does not intend to take further action" on the two states' requests to impose the requirements "unless and until any appellate review has concluded."

Boasberg agreed with the plaintiffs in his rulings last week that the Trump administration violated the law governing Medicaid by failing to adequately consider the effect work requirements would have on the program's goal of providing health coverage to needy people.

The ruling preserved coverage for 5,492 Arkansas Works enrollees who did not meet the requirement for January and February and had not yet met it for March when the ruling was issued.

Gov. Asa Hutchinson has urged the Trump administration to appeal the ruling in Arkansas' case. He hadn't received word Thursday on whether that will happen, spokesman J.R. Davis said.

"We're still keeping those communications open and having those discussions," Davis said, adding that Hutchinson has "been very clear that that's what he'd like to see."

In a statement last week, Adam Meier, secretary of Kentucky's Cabinet for Health and Family Services, said his state "has an excellent record for appeal" and is "currently considering next steps."

"The judge illogically concluded that Medicaid is all about paying for healthcare for as many people as possible without regard to whether this coverage actually makes people healthier," Meier said in the statement. "We emphatically disagree because a healthcare program like Medicaid, by its very nature, must take into account whether it improves people's health."

Federal court rules require the Trump administration to file a notice within 60 days if it does plan to appeal.

A spokesman for the U.S. Department of Health and Human Services' Centers for Medicare and Medicaid Services said a decision on whether to appeal is up to the Department of Justice, which represented the administration in the cases.

A Justice Department spokesman declined to comment on Thursday.

Kevin De Liban, an attorney for Legal Aid of Arkansas, said Boasberg was "thoughtful and cautious in his reasoning."

The Jonesboro-based group was one of three organizations that filed the lawsuit in August challenging Arkansas' requirement on behalf of several enrollees.

"If the federal government chooses to appeal, we'll be standing by our clients," he said.

Arkansas' was the first work requirement that had been added to a state Medicaid program.

It was phased in last year and in January for Arkansas Works enrollees ages 30-49 and was being added this year for those ages 19-29.

The program covers adults with incomes of up to 138 percent of the poverty level who became eligible for Medicaid under the state's expansion of the program in 2014 under the 2010 Patient Protection and Affordable Care Act.

To stay in compliance, enrollees had to spend 80 hours a month on work or other approved activities, unless they qualified for an exemption, and report what they did using a state website or over the phone.

Those who failed to meet their requirement for three months during a year were kicked off the program and barred from re-enrolling for the rest of the year.

Last year and in January, the state terminated coverage for 18,164 enrollees who accumulated three months of noncompliance in 2018.

Kentucky's requirement had been set to take effect this week.

The court filings this week indicate the Trump administration plans a different response to Boasberg's rulings than the one it took the first time Boasberg threw out Kentucky's requirement, in June.

Rather than appeal that ruling, which prevented the requirement from going into effect in July, the administration solicited a new round of public comments on the plan and issued a new approval letter in November.

According to the San Francisco-based Kaiser Family Foundation, a health policy research organization, seven other states have also received approval to add work requirements to their Medicaid programs. That includes Utah, which was granted approval two days after Boasberg's rulings last week.

Six other states have applied for approval to add similar requirements to their programs.

Metro on 04/05/2019

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