Healthcare

Federal judge strikes New Hampshire's Medicaid work requirements

Federal judge strikes New Hampshire's Medicaid work requirements

A federal judge on Monday struck down Medicaid work requirements that had been approved by the Trump administration in a state.

U.S. District Judge James Boasberg, an Obama appointee, struck down New Hampshire’s work requirements less than a week after hearing oral arguments.

Boasberg is the same judge who has twice rejected the administration’s approval of similar requirements in Kentucky, and also blocked Arkansas from implementing its Medicaid work requirements. 

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“In short, we have all seen this movie before,” Boasberg wrote in his opinion.

Just as in Kentucky and Arkansas, Boasberg ruled that the Department of Health and Human Services (HHS) failed to take into account how many people subject to the work requirements would lose Medicaid coverage.

HHS did not offer its own estimates of coverage loss, nor did it address the many comments projecting that the proposal would lead to a substantial number of residents being taken off the Medicaid rolls, Boasberg ruled.

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“For the fourth time, HHS has fallen short of this fundamental administrative law requirement,” Boasberg wrote.

While not surprising, the ruling is a blow to the Trump administration and to red states that want to implement work requirements. Centers for Medicare and Medicaid Services Administrator Seema Verma has long touted state flexibility and has made approving work requirements a priority.

The ruling also comes on the heels of the administration’s decision not to approve Utah’s request for full federal funding of a partial Medicaid expansion. 

Work requirements have now been struck down or blocked in three states. The administration, though, hasn't been slowed by the litigation, and has approved Medicaid work requirements in eight other states. 

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The Trump administration was sued in March by four low-income New Hampshire residents. The state had originally proposed that Medicaid beneficiaries need to work or volunteer 100 hours a month to maintain coverage.

The state required beneficiaries to begin tracking their hours June 1, but GOP Gov. Chris Sununu recently pushed back implementation of the program’s penalties until the end of September amid fears of massive coverage losses. 

State officials found nearly 17,000 people failed to provide proof to the state that they met the new Medicaid work rules, despite months of outreach by state officials, including mailings, and TV and radio ads.

Nearly everyone who gained coverage through the state’s Medicaid expansion would have been required to meet the work requirements, with some exemptions for pregnant women, caretakers and people with serious illnesses.

“On their face, these work requirements are more exacting than Kentucky’s and Arkansas’s,” Boasberg wrote. “Yet the agency has still not contended with the possibility that the project would cause a substantial number of persons to lose their health-care coverage.”

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Boasberg also noted the similarities between New Hampshire’s proposal and the work requirements that he struck down in Arkansas and Kentucky. 

“CMS’s [Centers for Medicare and Medicaid Services] approval letter mirrors the one in [Kentucky], with numerous key paragraphs matching it word for word,” Boasberg wrote. “And New Hampshire’s proposed project presents, if anything, greater coverage-loss concerns than Kentucky’s and Arkansas’s, given the hours requirement and the age range to whom it applies.”

The administration argues that “able-bodied” adults should instead be working, and that Medicaid should be reserved for children, women who are pregnant, adults who are disabled and residents with very low incomes.