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August 2, 2019

A federal judge just struck down Medicaid work requirements. (Again.)

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    A federal judge on Monday blocked New Hampshire's Medicaid work requirements, noting that the measure could cause thousands of people to lose health care coverage.

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    Background on New Hampshire's work requirements

    HHS approved New Hampshire's work requirements in November 2018.

    New Hampshire's work requirements mandate that certain Medicaid beneficiaries 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 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 do 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 required affected beneficiaries to submit proof that they are fulfilling the requirements each month and said it would suspend Medicaid coverage for affected beneficiaries who do not meet the requirements until they fulfill the 100-hour work requirement. In addition, New Hampshire eliminated retroactive coverage under the state's Medicaid program.

    Gov. Chris Sununu (R) also signed into law a bill (SB 290) that would halt the work requirements if 500 or more beneficiaries became disenrollled in Medicaid because of noncompliance or if health care providers in the state saw an increase in uncompensated care due to Medicaid beneficiaries losing their coverage because of the work requirements.

    New Hampshire recently delayed implementing the work requirement until Sept. 30, after officials learned that about 17,000 people could lose coverage for not providing proof of compliance.

    Lawsuit details

    The National Health Law Program (NHeLP), New Hampshire Legal Assistance, and the National Center for Law and Economic Justice in March filed a lawsuit in the U.S. District Court for the District of Columbia against HHS and CMS for approving New Hampshire's Medicaid work requirements.

    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.

    The groups in the lawsuit also alleged HHS did not follow proper procedures in approving the work rules.

    Ruling details

    U.S. District Judge James Boasberg in Washington, D.C. on Monday blocked New Hampshire's Medicaid work requirements, ruling in favor of the four Medicaid beneficiaries.

    Boasberg in the ruling wrote that HHS failed to take into account that the proposal could cause a substantial number of people to lose health care coverage. Boasberg added HHS did not offer estimates of how many people would lose coverage, nor did it address comments that the rules could lead to coverage loss.

    The ruling comes after Boasberg earlier this year blocked similar work requirements in Arkansas and Kentucky.

    "In short, we have all seen this movie before," Boasberg said. "For the fourth time, HHS has fallen short of this fundamental administrative law requirement … 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 Trump administration, which appealed Boasberg's rulings on the Arkansas and Kentucky cases, is expected to appeal Boasberg's New Hampshire ruling.


    The state's attorney general plans to appeal the ruling.

    Sununu called the ruling "disappointing but not surprising given this judge's past rulings." He added that he was "confident that New Hampshire's work requirement will ultimately be upheld … a ruling from one federal trial court judge in Washington D.C. is only the first step in the process."

    Johnathan Monroe, a spokesperson for CMS said the agency after the ruling "will continue to defend our efforts to give states greater flexibility to help low income Americans rise out of poverty."

    Dawn McKinney of New Hampshire Legal Assistance, praised the ruling. "We are really pleased with the decision and happy for our clients and thousands of Granite Staters who are going to sleep better tonight knowing they don't have to worry about their health coverage," he said (Raymond, Reuters, 7/29; Weixel, The Hill, 7/29; Goldstein, Washington Post, 7/29; Luthi, Modern Healthcare, 7/29; Ramer, AP/WMUR, 7/29; Moon, NHPR, 8/1).

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