Medicaid: appellate judges nix Trump’s job requirements

The unanimous decision, written by Judge David Sentelle, in charge of Reagan, confirmed a district court ruling that the administration failed to analyze whether such programs would “promote Medicaid’s primary goal – to provide medical care”.

The ruling inserts another block President Donald Trump efforts to inject conservative ideals into the Medicaid program, which provides coverage to nearly one in five Americans.
In another controversial move last month, the administration announced that it would allow states to apply so-called block subsidies to cover some low-income adults, especially those who have benefited under the Medicaid expansion provision of the Affordable Care Act. It is also expected that this effort will be contested in court as consumer advocates say this will lead to the loss of benefits and coverage from people.
The Trump administration, in a historical phase, began granting of state requests require certain Medicaid beneficiaries to work to receive benefits in 2018. Ten states have received exemptions, although three have been set aside by the same district court judge. Job requirements are currently in effect only in Michigan since many other states have withdrawn their efforts after legal sentences. Another 10 state requests are pending federal approval.

Friday’s ruling specifically applies to Arkansas, where more than 18,000 people lost coverage in 2018 before the court intervened. The district court had also canceled the Kentucky approval, which blocked the implementation of the job requirements there. However, Kentucky closed its waiver after a Democratic governor won the election last November and rejected his appeal.

The Centers for Medicare and Medicaid services, which respond to requests, “are reviewing and evaluating the opinion and determining the next steps,” said a spokesman. “The CMS remains firm in our commitment to consider proposals that allow states to exploit innovative ideas.”

The administration claims that requiring people to work, volunteer or participate in professional training will improve their health and is therefore in line with Medicaid’s mission.

The appellate court ruling, however, said that “Medicaid’s main objective is to provide access to medical care.” The Medicaid statue does not mention alternative goals, such as “improving health outcomes,” as the administration cited in its endorsements.

“The text of the statute includes a primary purpose, which is to provide health coverage without any limitation geared to healthy outcomes, financial independence or a switch to commercial coverage,” Sentelle wrote.

The lawsuit was filed by the National Health Law Program, along with Legal Aid of Arkansas, Southern Poverty Law Center and Jenner & Block.

“This is a victory for thousands of Americans who can now continue to have access to health coverage and healthcare,” said Ian Heath Gershengorn, partner of Jenner & Block and board member of the National Health Law Program who supported the case.


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