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story.lead_photo.caption In this Sept. 12, 2018, file photo, Arkansas Gov. Asa Hutchinson, center, talks at a news conference at the State Capitol in Little Rock, Ark., about the state's work requirement for its expanded Medicaid program. Federal judge James Boasberg is blocking Medicaid work requirements in Arkansas and Kentucky, dealing a blow to the Trump administration's efforts to push the poor toward self-sufficiency.

President Donald Trump's administration had "ample reason" to believe that work requirements would strengthen the Medicaid programs in Arkansas and Kentucky by encouraging recipients to get jobs and move off of public assistance, government attorneys argued in an appeal brief on Tuesday.

Reducing the Medicaid rolls in the two states would "conserve finite resources for other persons in need," the attorneys with the U.S. departments of Justice and Health and Human Services said in the brief.

The brief urges the U.S. Court of Appeals for the District of Columbia Circuit to overturn a pair of March 27 rulings by a federal judge in Washington, D.C., that struck down the work requirements in the two states.

The judge, James Boasberg, said the administration's approval of the requirements was "arbitrary and capricious" because it failed to take into account the effect the measures would have on the program's goal of providing health coverage to needy people.

Arkansas' requirement, which went into effect in June, resulted in 18,164 enrollees losing coverage for noncompliance.

Boasberg's rulings prevented as many as 5,492 more enrollees who had failed to meet the requirement during the first three months of the year from losing coverage in April and stopped Kentucky's requirement from going into effect.


Government’s brief in support of appeal


In Tuesday's appeal filing, Trump administration attorneys said Health and Human Services Department officials acknowledged that the requirements would cause some recipients to lose coverage.

But, they said, the requirements were "carefully tailored to allow those adults who are subject to the requirements to succeed in fulfilling them."

The attorneys also argued that Section 1115 of the Social Security Act "does not require HHS to provide an explanation for its decisions" to grant waivers such as the ones allowing the work requirements.

Section 1115 allows the Health and Human Services Secretary to issue such waivers to allow an "experimental, pilot, or demonstration project" that is "likely to assist in promoting the objectives" of the Medicaid program.

"In approving these experiments, the Secretary does not know in advance whether they will succeed, and is not required to have substantial evidence that they will attain their goals," the attorneys wrote.

The attorneys also noted that most of the recipients subject to the work requirement in Kentucky, and all of the recipients subject to Arkansas' requirement, were covered through the states' expansions of Medicaid under the 2010 Patient Protection and Affordable Care Act.

Such expansions are optional, the attorneys noted, and "a number of states are participating in the expansion with the expectation that they may test work and work-related requirements."

In an interview, Kevin De Liban, an attorney with Legal Aid of Arkansas, called it "preposterous" to argue that the Health and Human Services Department doesn't have to explain its reasons for granting waivers.

The Jonesboro-based organization was among three groups that filed the lawsuit challenging Arkansas' requirement on behalf of several Arkansas Works enrollees.

"Decision-making can't be arbitrary and capricious, and remaking the Medicaid program based on ideological beliefs of the bureaucrat who happens to occupy the relevant office in [the Centers for Medicare and Medicaid Services] or in Health and Human Services is not a rational decision," De Liban said.

He added that the appeal brief is "just rehashing the same unsuccessful arguments that didn't persuade Judge Boasberg."

To meet Arkansas' work requirement, the first ever implemented for a state Medicaid program, 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 the requirement for three months during a year were kicked off the program and barred from re-enrolling for the rest of the year.

The requirement applied to enrollees in Arkansas Works, which covers people who became eligible for Medicaid when the state expanded it in 2014 to cover people with incomes of up to 138% of the poverty level.

This year the income cutoff is $17,236 for an individual or $35,535 for a family of four. More than 240,000 Arkansans were covered by the program as of April 1.

Boasberg's ruling in Arkansas' case noted that federal Centers for Medicare and Medicaid Services Administrator Seema Verma didn't mention a goal to improve the financial sustainability of Medicaid in her March 5, 2018, letter approving the state's requirement.

Instead, Verma wrote that the requirement is designed to "encourage beneficiaries to obtain and maintain employment or undertake other community engagement activities that research has shown to be correlated with improved health and wellness."

In Kentucky's case, Boasberg said that an agency official, in a Nov. 20 approval letter, did list fiscal sustainability as a goal, but didn't give any estimate of how much money the requirement was expected to save.

The official also didn't weigh the potential savings against the harm that would be caused to enrollees who would lose coverage for noncompliance, Boasberg said in the ruling.

A response by the plaintiffs to the appeal brief is due June 20.

A Section on 05/15/2019

Print Headline: Filing in appeal backs Medicaid work rule

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