Federal court nixes Arkansas Medicaid work requirements

In a unanimous ruling Feb. 14, a three-judge panel for the U.S. Court of Appeals for the District of Columbia Circuit upheld a lower court decision that HHS’ approvals of Medicaid work requirements in Arkansas and Kentucky were arbitrary and capricious and not consistent with the primary objective of the Medicaid statute.

Kentucky ultimately terminated its Medicaid work requirement program and withdrew from the appeal.

The opinion, written by Republicanappointed Judge David Sentelle, said the lower court “is indisputably correct that the principal objective of Medicaid is providing healthcare coverage.”

The Trump administration in its approvals of Section 1115 waiver requests from Arkansas and Kentucky said requiring beneficiaries to report 80 hours a month of work or “community engagement” activities would lead to improved health outcomes and well-being for beneficiaries.

But the panel rejected that rationale. “We agree with the district court that the alternative objectives of better health outcomes and beneficiary independence are not consistent with Medicaid,” Sentelle wrote.

The CMS did not immediately comment on the ruling. It’s unknown whether the administration or Arkansas officials will appeal to the Supreme Court.

Jane Perkins, legal director of the National Health Law Program, which spearheaded the legal challenge to the work requirement waivers, praised the ruling.

“It means that thousands of lowincome people in Arkansas will maintain their health insurance coverage—coverage that enables them to live, work, and participate as fully as they can in their communities,” she said.

Arkansas’ Republican leaders had hoped to reinstate the work requirement program, which was blocked by U.S. District Judge James Boasberg last March after more than 18,000 Arkansas Medicaid expansion enrollees lost coverage.