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Stephanie Pellitt

, National Council for Behavioral Health

Court Blocks Medicaid Work Requirements in Arkansas, Kentucky

March 28, 2019 | Waivers/SPAs | Comments
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On Wednesday, a district court judge issued a pair of decisions blocking Medicaid work requirements in Kentucky and Arkansas. Consistent with an earlier ruling, the court found that the federal government had failed to justify how adding employment requirements advanced Medicaid’s central statutory objective to provide medical assistance to the state’s citizens. The impact of the ruling is likely to extend beyond these two states and complicate Trump Administration plans to expand Medicaid work requirements more broadly.


While Judge James Boasberg’s ruling applies only to Kentucky and Arkansas’ programs, his reasoning for overturning the Centers for Medicare and Medicaid’s (CMS) decision to approve these initiatives could extend to the other seven states that CMS has approved for work requirements in addition to the seven other states whose waiver applications are currently being reviewed by the federal government. Joan Alker, head of Georgetown’s Center for Children & Families, told Politico, “The judge’s ruling is a wake-up call for states considering work requirements or other barriers to coverage in Medicaid.”

Although the decision did not outlaw Medicaid work requirements outright, it makes clear that the Department of Health and Human Services (HHS) Secretary does not have unlimited authority to approve waivers or “refashion the program Congress designed in any way they choose.” In other words, as Joan Alker explains “Medicaid was designed by Congress to be a health insurance program for low income people and the Trump Administration can not arbitrarily change that.”


HHS must now reevaluate Kentucky and Arkansas’ waiver approvals and decide whether they will seek an appeal. As a result, HHS may hold off on announcing any additional work requirement approvals — and states may wait to submit their requests — until this legal battle reaches its conclusion.

Kentucky Gov. Matt Bevin (R) has threatened to reverse the state’s Medicaid expansion if his Medicaid reforms do not survive legal challenges.