by Anita Schnee, Attorney at Law
UPDATE: On February 14, 2020, the D.C. Circuit Court of Appeals affirmed this ruling. For a report on that opinion, go here.
Last week a federal judge invalidated requirements in Arkansas and Kentucky that those who receive Medicaid benefits through the Affordable Care Act (ACA) must work to be eligible for those benefits.
In 2010, ACA extended Medicaid health-care coverage to a population of low-income adults under 65 who would not otherwise qualify. Arkansas plaintiff Adrian McGonigle is an example. He is a 40-year old whose job, pre-ACA, provided no health insurance. After ACA, he enjoyed coverage under Arkansas’s adoption of ACA Medicaid expansion.
In 2018, however, with the approval of the U.S. Department of Health and Human Services (HHS), Arkansas imposed its version of work rules. As a condition to receive expanded Medicaid coverage, most able-bodied recipients must work at least eighty hours a month, and they must report their work history or lose benefits.
Only around twelve percent of those required to report in Arkansas actually did so, however. Consequently, more than 16,900 Arkansans lost Medicaid coverage after the state rolled out the work-rule program in 2018 and early 2019. Plaintiff McGonigle was one such person. Without Medicaid, he was unable to afford $800.00 of medication, he became unable to work due to his untreated medical conditions, and he was fired as a result.
He and two other Arkansas plaintiffs sued, contending that in approving the Arkansas work rules, HHS had failed to consider whether the rules were consistent with the central purpose of ACA, that being to furnish medical assistance to persons who cannot afford it.
The results of McGonigle’s and others’ suits were announced March 27, 2019. The federal district judge invalidated the work rules in both Arkansas and Kentucky, on grounds that HHS had not furnished sufficient justification for its approval of the rules. The judge ruled that imposing a work requirement was not, in and of itself, a bad thing, but HHS was wrong to approve programs that unreasonably prioritized savings to the states over the consequences of lost coverage for the needy. The judge further rejected HHS’s other arguments, on grounds that the HHS Secretary had impermissibly written in to the statute goals that were not, in fact, there.
Thirteen other states seeking to impose similar restrictions will likely be affected by the rulings. The rulings are Gresham v. Azar II, No. 18-1900 (D. D.C. March 27, 2019), available here, and Stewart v. Azar II, No. 18-152 (D. D.C. March 27, 2019), available here, following 313 F. Supp.3d 237 (D. D.C. 2018), available here.
