Judge strikes down Kentucky’s Medicaid work requirement

WASHINGTON — A federal judge Friday blocked Kentucky’s closely watched plan to require many Medicaid recipients to work, volunteer or train for a job as a condition of coverage.

Judge James E. Boasberg of U.S. District Court for the District of Columbia, an Obama appointee, ruled the Trump administration’s approval of the plan had been “arbitrary and capricious” because it had not adequately considered whether the plan would “help the state furnish medical assistance to its citizens, a central objective of Medicaid.”

The ruling in the Kentucky case is the first on this issue, but it will almost certainly not be the last; the question might wind up before a more conservative Supreme Court with two Trump appointees. Three other states have gotten permission from the Trump administration to impose work requirements, and seven more have asked for clearance to do so.

The debate over requiring poor people to work to keep their health insurance encapsules fundamentally different visions of the role of Medicaid, a program jointly funded by federal and state governments that covers 1 in 5 Americans. Many Republicans see it as a welfare program that should be conditioned on participants working if they are able; Democrats consider it a crucial piece of the government safety net for the poor.

Requiring Medicaid recipients to work — and to pay monthly premiums, which is also part of Kentucky’s plan — will significantly reduce the number of people with coverage, many experts predict, either because they will be deemed able to work or volunteer but will not, or because they do not keep up with premium payments or provide the documentation every month to prove they worked the required 80 hours.