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March 21, 2019

Trump admin faces third legal challenge over Medicaid work requirements

Daily Briefing

    Three advocacy groups on Wednesday filed a lawsuit against the Trump administration for approving a Medicaid waiver in New Hampshire that allows the state to eliminate retroactive Medicaid coverage and impose work requirements on certain beneficiaries.

    Just updated: Your cheat sheets for understanding health care's legal landscape

    The lawsuit is the third filed against the administration for approving Medicaid work requirements. U.S. District Judge James Boasberg has said he intends to issue rulings in the other two cases, which concern work requirements in Arkansas and Kentucky, by the end of the month.

    Background on New Hampshire’s Medicaid waiver

    Under New Hampshire's Medicaid waiver, the state will require certain Medicaid beneficiaries to attend school, engage in community service, work, or participate in other activities—such as substance use disorder treatment or caregiving outside of the home—for at least 100 hours each month to qualify for coverage. The requirements will apply to beneficiaries ages 19 to 64 with annual incomes between 100% and 138% of the federal poverty level who are enrolled in Medicaid under the state's expansion of the program. The requirements will not apply to beneficiaries who are:

    • Disabled
    • Caring for a dependent child with a disability;
    • Medically frail;
    • Participating in certain drug court programs; or
    • Pregnant.

    The state will require affected beneficiaries to submit proof that they are fulfilling the requirements each month. The state will suspend Medicaid coverage for affected beneficiaries who do not meet the requirements until the beneficiaries fulfill the 100-hour work requirement.

    The state under the waiver also will launch a workforce program to provide qualifying Medicaid beneficiaries with financial assistance to cover tuition and other job training.

    The requirements are scheduled to take effect as early as April 2019 for beneficiaries currently enrolled in coverage under the state's Medicaid expansion. Beneficiaries who newly sign up for coverage under the expansion will be subject to the requirements 75 days after enrollment. There currently are about 50,000 people enrolled in Medicaid coverage under New Hampshire's expanded program.

    Advocacy groups file suit

    The National Health Law Program (NHeLP), New Hampshire Legal Assistance, and the National Center for Law and Economic Justice on Wednesday filed a lawsuit in the U.S. District Court for the District of Columbia against HHS and CMS for approving New Hampshire's Medicaid waiver request. The groups filed the lawsuit on behalf of four Medicaid beneficiaries. The groups argued that the administration did not have the authority to approve the state's request because eliminating retroactive coverage and imposing work requirement do not align with Medicaid's purpose of "furnishing medical assistance." The groups argued that the requirements will result in tens of thousands of Medicaid beneficiaries losing their health coverage.


    Jane Perkins, NHeLP's legal director, said the administration's decision to approve New Hampshire's Medicaid waiver "will not promote coverage, but it will result in significant coverage losses."

    A CMS spokesperson declined to comment on the lawsuit, but said the administration is committed "to considering proposals that would give states more flexibility to engage with their working-age, able-bodied citizens," the Wall Street Journal reports  (Hackman, Wall Street Journal, 3/20; Hellmann, The Hill, 3/20; Diamond, "Pulse," Politico, 3/21; NHeLP release, 3/20).

    Where the states stand on Medicaid expansion

    The Supreme Court ruling on the Affordable Care Act (ACA) allowed states to opt of the law's Medicaid expansion, leaving each state's decision to participate in the hands of the nation's governors and state leaders.

    The Daily Briefing editorial teams have been tracking where each state stands on the issue since the ruling, combing through lawmakers' statements, press releases, and media coverage. In this latest iteration of our Medicaid map, we've determined each state's position based on legislative or executive actions to expand coverage to low-income residents using ACA funding.

    Get the Map

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