Court Strikes Down KY Medicaid Work Requirements, Governor RespondsJuly 6, 2018
By Brandon Toth
We know that access to Medicaid promotes well-being by helping families stay healthy and equipped to learn, work, engage with others, and contribute to thriving communities. On Friday, June 29, a federal district court concluded that Kentucky’s plan to impose work requirements on Medicaid recipients throughout the state would undermine this access. Judge James Boasberg found that the Kentucky HEALTH plan, which would have imposed “community-engagement” requirements on many of the state’s Medicaid participants, was not adequately reviewed by the Secretary of Health and Human Services (HHS). Adequate review is required to determine whether the plan would actually serve Medicaid’s core purpose to “increase the number of Americans covered by health insurance.” While the ruling initially seemed like a win for Medicaid’s ability to build well-being in the state, Kentucky’s governor, Matt Bevin, quickly cut vision and dental coverage for nearly 500,000 Medicaid participants. Many have questioned the motive and legality of this maneuver, as the court battle will now likely move on to appeal.
A potential unintended consequence of the court’s decision could be that states simply refuse to accept the federal Medicaid expansion if there is concern that the state won’t be able to afford the cost of increased enrollment. Policymakers, like Gov. Bevin, have asserted that work requirements will save states money because once current participants are employed, they will either earn too much to qualify for, or will not need, Medicaid to obtain health care. If states are, therefore, no longer free to impose work requirements to help limit enrollment, the remaining states submitting expansion plans that include potentially invalid work requirements may claim they can no longer bear the cost. The actual savings from work requirements due to the high implementation cost is dubious, and experts have shown that work requirements are likely to reduce access to care, make it more difficult to find jobs, and worsen health outcomes.
As proposed requirements in other states are considered by HHS and potentially challenged in court, judges who are willing to take a “hard look” at an agency’s justification for its actions may well play a pivotal role in determining how low-income families can access the health services that build and maintain well-being.