Appeals Court Shoots Down Arkansas’ Medicaid Work Requirements In Latest Legal Blow For Trump Administration

The New York Times: Appeals Court Rejects Trump Medicaid Work Requirements In Arkansas
A federal appeals court panel on Friday unanimously upheld a lower court’s ruling striking down work rules for Medicaid recipients in Arkansas, casting more doubt over broader Trump administration efforts to require poor people to work, volunteer or train for a job as a condition of getting government health coverage. A three-judge panel of the United States Court of Appeals for the District of Columbia Circuit found that approval of the Arkansas work requirement by the health and human services secretary, Alex M. Azar, was “arbitrary and capricious” because it did not address how the program would promote the objective of Medicaid as defined under federal law: providing health coverage to the poor. (Goodnough, 2/14)

The Associated Press: Appeals Court Deals Blow To Trump's Medicaid Work Rules
The court found that it is “indisputably correct that the principal objective of Medicaid is providing health care coverage” and that work requirements for “able-bodied” people lack specific legal authorization. Moreover, the court ruled that administration officials failed to thoroughly examine the risk that some Medicaid recipients would lose coverage in approving Arkansas' experiment with work requirements. The state later reported more than 18,000 people dropped from the rolls, but it wasn't clear how many obtained other coverage. (Alonso-Zaldivar and Bleed, 2/14)

The Hill: Appeals Court Strikes Down Trump Approval Of Medicaid Work Requirements
The court found that the Trump administration disregarded the statutory purpose of Medicaid — to provide health coverage — and did not adequately account for the coverage losses that would result from the work requirements. "Failure to consider whether the project will result in coverage loss is arbitrary and capricious," Judge David Sentelle, an appointee of President Reagan, wrote in the opinion. (Sullivan, 2/14)

NBC News: Federal Court Strikes Down Trump Administration's Medicaid Work Requirements
The appeals court opinion criticized Azar for only considering positive secondary outcomes that did not deal with the central objective of the law and for ignoring Congress's direction within the law itself, noting that "when Congress wants to pursue additional objectives within a social welfare program, it says so in the text." In his original approval letter to Arkansas, Azar said that the program would "encourage beneficiaries to obtain and maintain employment or undertake other community engagement activities that research has shown to be correlated with improved health and wellness." (McCausland, 2/14)

The Washington Post: Appeals Court Unanimously Strikes Down Medicaid Work Requirements
The ruling marks the first time that an appellate court has weighed in on what has been one of the Trump administration’s signature attempts to push health policy in a more conservative direction. The D.C. Circuit is considered the nation’s top appeals court below the U.S. Supreme Court, and the 19-page opinion was written by a jurist appointed by Ronald Reagan, David Sentelle. The panel’s other judges are Cornelia Pillard, an appointee of Barack Obama, and Harry Edwards, appointed by Jimmy Carter. (Goldstein, 2/14)

The Wall Street Journal: Appeals Court Rejects Trump Administration’s Approval Of Work Requirements For Medicaid
The decision could have far-reaching implications for Medicaid, a health program for the poor and disabled. Other states have shown mounting interest in adopting work requirements. Ten of them, including Kentucky, Arkansas, New Hampshire, Arizona and Michigan, have received approval to adopt work requirements, according to George Washington University’s Milken Institute of Public Health. Michigan is the only state now implementing work requirements, and a lawsuit was filed last year challenging federal approval for the mandate. (Armour and Kendall, 2/14)

Modern Healthcare: Appeals Court Nixes Arkansas Medicaid Work Requirement
The CMS said it's reviewing and evaluating the opinion and determining its next steps. "The CMS remains steadfast in our commitment to considering proposals that would allow states to leverage innovative ideas," the agency said in a written statement. Jane Perkins, legal director of the National Health Law Program, which spearheaded the legal challenge to the work requirement waivers, praised the ruling on Friday. "It means that thousands of low-income people in Arkansas will maintain their health insurance coverage—coverage that enables them to live, work, and participate as fully as they can in their communities," she said. (Meyer, 2/14)

NPR: U.S. Appeals Court Upholds Ruling Blocking States' Medicaid Work Requirements
Trump administration officials have promoted work requirements, arguing that working can cause people to live healthier lives. The D.C. Circuit is regarded as the top appeals court below the Supreme Court. HHS' Centers for Medicare and Medicaid Services, which oversees Medicaid, hasn't said whether it will appeal the latest ruling to the Supreme Court. (Wamsley, 2/14)

Bloomberg: Trump-Backed Work-For-Medicaid Plan Is Rejected On Appeal
Friday’s ruling may serve as a warning for future approvals. “I think it sends a very clear signal to the Trump administration that this policy is unlawful and that they should stop approving these waivers,” said Joan Alker, a research professor at Georgetown University’s Health Policy Institute. “But they probably won’t.” (Wheeler and Harris, 2/14)

CNN: Medicaid: Appellate Judges Nix Trump's Work Requirements 
In another controversial move last month, the administration announced it would allow states to apply for so-called block grants to cover certain low-income adults, particularly those who gained benefits under the Affordable Care Act's Medicaid expansion provision. That effort is also expected to be challenged in court since consumer advocates say it will lead to people losing benefits and coverage. (Luhby, 2/14)

In other Medicaid news —

The Wall Street Journal: Medicaid Standoff: Trump Plan To Tighten Oversight Of States Draws Objections
Many governors, insurers and hospitals are denouncing a Trump administration plan to tighten oversight over how states pay for their share of Medicaid, saying it would deprive them of billions of dollars in funding, jeopardize health coverage and strain state budgets. The proposal would impose new reporting requirements and restrictions on financial practices used by states to pay for Medicaid. The Medicaid Fiscal Accountability Regulation, as the proposal is known, also would apply to extra payments states give to some doctors and providers. (Armour, 2/15)

NBC News: 'On The Brink': Trump's Push For Medicaid Transparency Could Worsen Rural Hospital Crisis
The Trump administration is in the final stages of proposing a change to Medicaid that it says will increase financial transparency by hospitals, but health care advocates say will cause vulnerable hospitals to close and hurt Medicaid beneficiaries. In an effort to increase transparency, the administration’s rule will require hospitals and states to share more data about the funds they receive through Medicaid, but at the same time it will lead to a decrease in Medicaid’s federal matching dollars by redefining what is considered to be public funds... Ultimately, the shift could reduce national Medicaid funding by between $37 billion to $49 billion annually and cause hospitals to lose $23 billion to $31 billion in annual Medicaid payments, according to the American Hospital Association. (McCausland, 2/15)