August 5, 2020

Voters in Missouri on Tuesday approved a ballot measure expanding Medicaid to roughly 230,000 low-income residents.

With 99 percent of precincts reporting, 53 percent voted "yes" on the measure, while 47 percent voted "no." Missouri is the sixth red state to expand Medicaid, and the second to do so amid the coronavirus pandemic, after Oklahoma. The state is now reporting on average more than 1,200 daily new coronavirus cases, nearly three times more than a month ago, Politico reports.

Missouri has until July 1, 2021, to expand Medicaid under the Affordable Care Act. The measure amends the state's constitution, so lawmakers cannot add requirements to the program. Gov. Mike Parson (R) opposed the expansion, saying it was too expensive and the state doesn't have enough money to pay for it. The federal government gives states up to 90 percent of funding necessary for Medicaid expansion, an improvement over the 65 percent provided to Missouri now under its current program.

"Quite frankly, Missourians are sick and tired of not getting their fair share," Jack Cardetti, a spokesman for the ballot initiative's organizers, told Politico last week "They pay their taxes, they've seen now 37 other states use that money to expand access to health care. Meanwhile, our economy's clearly ailing here." Catherine Garcia

March 28, 2019

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.

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. Peter Weber

January 11, 2018

In a historic first, President Trump issued guidelines Thursday that will allow states to require able-bodied Medicaid recipients to have work of some kind, CNN reports. While work activities have long been a staple of the welfare system, Medicaid has never had such a requirement before. "[C]ritics contend rules that could deny people coverage contradict its objectives," The Washington Post writes.

The first state expected to impose work requirements is Kentucky, where a waiver could be approved as soon as Friday. Kentucky's law would require Medicaid recipients to report income changes within 10 days, a policy that "boggles my mind," in the words of the Kentucky Equal Justice Center's Cara Stewart, who pointed to low-wage workers such as waitresses who have incomes that fluctuate. At least nine other states could soon follow with work requirements for Medicaid, the Post reports.

States are also apparently able to broadly choose their own definition of "able-bodied," "medically frail," and what qualifies as "work." The Trump administration says vaguely that work includes "community service, caregiving, education, job training, and substance use disorder treatment."

In anticipation of challenges in court, the Trump administration is arguing that people who are unemployed have "poorer general health" and that "productive work and community engagement may improve health outcomes," an assertion that has produced pushback by critics. "It's a little like saying that rain causes clouds," said the National Health Law Program's Leonardo Cuello. "It's more that people [with Medicaid] get care, which helps them be healthy and makes them able to work." Read more about the new policy at The Washington Post. Jeva Lange

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