Judge strikes down Medicaid work requirements in Arkansas, Kentucky

U.S. District Judge James Boasberg on Wednesday struck down programs in Arkansas and Kentucky requiring most Medicaid recipients to work at least 80 hours a month to receive health-care coverage. The Trump administration has approved Medicaid work requirements in eight states and is considering requests by seven more, and Boasberg's ruling potentially affects not just Arkansas and Kentucky but the broader Republican push to reshape the 50-year-old program and limit Medicaid expansion encouraged under the Affordable Care Act.

In his twin rulings, Boasberg blocked Kentucky from enacting its Medicaid work requirement for a second time and ordered a halt to Arkansas' program, saying the Health and Human Services Department's approval of the plan was "arbitrary and capricious" and failed to "consider adequately" whether the work requirement "would in fact help the state furnish medical assistance to its citizens, a central objective of Medicaid."

Arkansas became the first state to impose work requirement for Medicaid recipients last June, and about 18,000 people were denied coverage between September and December because they didn't work, train, or volunteer at least 80 hours a month, or they failed to adequately report their hours. Boasberg first blocked Kentucky's program — approved in January 2018, a day after Centers for Medicare and Medicaid Services head Seema Verma announced HHS would look favorably at Medicaid work requirements for the first time — in June, ordering HHS to reconsider Kentucky's request. Five months later, HHS reapproved Kentucky's near-identical plan.

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Boasberg's ruling sent both programs back to HHS, and Verma said the decisions would not dissuade her from approving Medicaid work requirements in other states. Arkansas Gov. Asa Hutchinson (R) said he was "disappointed in the decision," and Kentucky Gov. Matt Bevin (R) has suggested that if he can't require Medicaid recipients to work, he'll scrap the entire Medicaid expansion enacted under his Democratic predecessor, ending the program's coverage for about 400,000 lower-income people.