State set to defend Medicaid work rules

A judge on Thursday granted Arkansas’ request to be named alongside federal agencies and officials as a defendant in a lawsuit challenging the work requirement for Arkansas Works enrollees.

Arkansas Solicitor General Nicholas Bronni said in a filing a day earlier that the state should be represented in the case because it will affect whether the state “will be permitted to design its state Medicaid plan in the way it has seen fit.”

Also on Thursday, attorneys for the plaintiffs asked U.S. District Judge James Boasberg to reject a request by attorneys for President Donald Trump’s administration for the case to be assigned to a different judge.

The case has been assigned to Boasberg at the request of the plaintiffs, who say it is related to one he decided involving a Medicaid work requirement in Kentucky.

In that case, Boasberg on June 29 blocked Kentucky from implementing its requirement, saying U.S. Health and Human Services Secretary Alex Azar didn’t adequately consider the effect it would have on residents’ health coverage.

In a filing last week, U.S. Department of Justice attorneys argued that the cases should not be considered related because they stem from “two separate approvals of two distinct projects in two different States.”

Attorneys for the plaintiffs countered in a filing Thursday that both lawsuits challenge work requirement guidelines that were outlined in a Jan. 11 letter from the federal Centers for Medicare and Medicaid Services

to state Medicaid directors.

“Without question, the Plaintiffs in both cases are raising claims targeting the

same underlying agency actions: the Defendants’ issuance and use of the [Jan. 11] Letter and Section 1115 of the Social Security Act to terminate benefits and condition Medicaid coverage on work requirements and other eligibility restrictions” in violation of federal rulemaking and Medicaid laws, the attorneys wrote.

They also said Boasberg’s experience with the Kentucky case would help him reach a speedy decision on Arkansas’ requirement.

Both lawsuits were filed in Washington, D.C., by the National Health Law Program and the Southern Poverty Law Center. Jonesboro-based Legal Aid of Arkansas is also helping with the Arkansas case.

Arkansas in June became the first and only state in the country to implement a work requirement for some of its Medicaid recipients, though other states plan similar rules.

On Saturday the state terminated coverage for more than 4,500 enrollees who had failed to report on their compliance with the work requirement in June, July and August. The requirement is being phased in this year for enrollees age 30-49 and next year for those age 19-29.

In an email, Terri Parker West, a spokesman for Little Rock-based QualChoice Health Insurance, said 826 of

the company’s customers lost their coverage because of the requirement. As of Wednesday, about 10 had called the company in an attempt to restore their coverage, she said.

Representatives with Arkansas Blue Cross and Blue Shield and St. Louis-based Centene, which also offer Arkansas Works plans, didn’t respond to inquiries on Wednesday about how many of their customers lost coverage.

When fully implemented, the requirement is expected to apply to more than half of the 265,000 people on Arkansas Works, which covers people who became eligible for Medicaid under the state’s expansion of the program in 2014.

The expansion extended eligibility to adults with incomes of up to 138 percent of the poverty level. Currently that income cutoff is $16,753 for an individual or $34,638 for a family of four. Most enrollees receive the coverage through private insurance plans, with the Medicaid program paying the premiums.

To comply with the requirement, enrollees must spend 80 hours a month on work or other approved activities unless they qualify for an exemption. Those who are not automatically exempted based on information in state records must visit a state website, access.arkansas.gov, to report on their compliance.

Those who fail to comply for three months during a year will lose their coverage for the rest of the year.

The potential for enrollees to be locked out of coverage for noncompliance for up to nine months makes Arkansas’ work requirement different from others that the Trump administration has approved.

In Indiana and New Hampshire, which have been approved to implement requirements next year, enrollees who lose their coverage for failing to comply will be able to restore it by coming back into compliance.

Arkansas enrollees whose coverage was terminated on Saturday originally had until 9 p.m. Wednesday to report work hours or an exemption and get reinstated, but the state Department of Human Services late that evening extended the deadline to Oct. 5 for enrollees who had problems accessing the website because of a computer problem it said affected several state agencies.

The enrollees can submit a request for a “good cause exemption,” containing the information on the work hours or exemption they attempted to report, to the Human Services Department at a county office or by emailing the request to AW good cause request@dhs.arkansas.gov/.