Must Medicaid Recipients Have a Job? No, ACP Says in Court Filing

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College joins health care groups in opposing work requirements that could harm patients and providers alike

Feb. 8, 2019 (ACP) – The American College of Physicians has joined other leading health care groups in supporting a lawsuit aimed at overturning one state's requirement that Medicaid applicants have a job.

In early 2018, the Trump administration reversed long-standing policy and decided to allow states to include work requirements as a condition of eligibility for Medicaid health benefits. To date, 15 states have applied for Medicaid waivers that include work requirements, and seven have been approved.

In Kentucky, one of those states, Medicaid beneficiaries filed suit challenging their state's work requirement. Initially, the court sided with the plaintiffs in the case (Stewart v. Azar). However, after a second round of public comments, the U.S. Department of Health and Human Services (HHS) re-approved Kentucky's plan for Medicaid, called Kentucky HEALTH, including nearly identical work requirements.

Firing back at that decision, ACP signed on to an amicus brief to the court that details the reasons such Medicaid work requirements would harm patients and increase the number of uninsured residents. Amicus briefs are filed by those who have a strong interest in the subject matter and aim to advise the court of relevant information that they believe should be considered when making a decision.

“The brief argues that health outcomes will worsen as people lose coverage due to the work requirement, high premiums and other changes,” explained Ryan Crowley, ACP's senior associate for health policy. “Providers will also be affected, especially rural hospitals and health centers that see a lot of Medicaid patients.”

Specifically, the amicus brief points out that work requirements “will lead to mass disenrollment and health outcomes that dramatically worsen over time … because most of Kentucky's unemployed beneficiaries are not merely jobless – they are unable to work.” In addition, the brief notes that beneficiaries would be mandated to report their work status monthly, and any reporting mistake could result in disenrollment. Taking back benefits would expose former beneficiaries to medical bills they cannot afford and could bankrupt them, according to the brief, which notes that this also would affect health care providers, who would lose an income stream, and could potentially force rural providers to shut their doors for good.

In addition to ACP, organizations who signed onto the amicus brief include the American Academy of Pediatrics, the American Medical Association, the American Psychiatric Association, the Catholic Health Association of the United States, the March of Dimes, and the National Alliance on Mental Illness.

If the court sides with the plaintiffs, Crowley said, the HHS-granted waiver to Kentucky HEALTH would be voided, and the work requirements and other changes could no longer go into effect.

“Doing so would likely prevent thousands of people from going uninsured,” he said. A decision in the case should be made before the waiver takes effect in July, he said.

Besides Kentucky, Medicaid enrollees in Arkansas also have sued HHS over these waivers. “It's possible that if other waivers are approved, enrollees in other states will file suit as well,” Crowley said.

ACP has long been vocal about its opposition to requirements that Medicaid beneficiaries get a job.

“Work requirements will take coverage away from sick, vulnerable patients who are unable to work,” Crowley explained. “Workers who are covered by Medicaid may also lose their coverage if they fail to report their work status, [and] states aren't really investing in job training, child care and other services that may help Medicaid enrollees find work.”

ACP does favor assistance in obtaining employment via voluntary skills-training and interview-training programs, as long as this is not a requirement for Medicaid eligibility.

Instituting work requirements “seems like more of a way to remove people from the program as a way to save money,” Crowley said. For example, he said, Arkansas has implemented a work requirement waiver, and 18,000 people have already been kicked out of its Medicaid program.

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Back to the February 8, 2019 issue of ACP Advocate