Judge in Medicaid work-requirements case seems skeptical that state and feds have come up with a plan that fits the law

The judge who kept Kentucky from adding work requirements to Medicaid remained dubious of the plan in a hearing on the state's latest attempt Thursday.

District Judge James Boasberg of Washington, D.C., "cast a seemingly skeptical eye Thursday as Kentucky and Trump administration officials sought to defend requiring some recipients to find jobs, volunteer or lose their benefits," Lesley Clark reports for McClatchy Newspapers. Boasberg asked the lawyers "why he shouldn’t again strike down the initiative, and whether it meets Medicaid’s objective to provide medical care."

The latter point was key to Boasberg's ruling last June, which struck down the Department for Health and Human Services' approval of the plan that was to take effect days later. The latest one is scheduled to take effect April 1, and Boasberg said he would rule by then.

"He also heard a challenge to work requirements imposed by Arkansas that have led to an estimated 17,000 losing coverage," Clark reports. That case crossed paths with the Kentucky case when Justice Department lawyer James Burnham "said that Kentucky wouldn’t know how many people would lose coverage until they started the program, Boasberg pointed to the loss of coverage in Arkansas.

Kentucky officials have estimated that under their plan, state Medicaid rolls would have 95,000 fewer people in five years than without the plan, called Kentucky HEALTH, for "Helping to Engage and Achieve Long Term Health." (Frequent references to that many people losing coverage are not precise, because tens of thousands of people go on and off the program each month.)

In his ruling last June, Boasberg, and appointee of Barack Obama, ruled that HHS Secretary Alex Azar “never adequately considered whether Kentucky HEALTH would in fact help the state furnish medical assistance to its citizens, a central objective of Medicaid.”

Clark notes, "Kentucky was the first of four states to win federal approval to impose a work requirement for Medicaid enrollees, and the case has national implications with other states moving quickly to impose similar restrictions."

Lawyers for Gov. Matt Bevin and the Trump administration "argued that any flaws he identified were addressed and the state is ready to roll out" the plan, Clark reports.

The state and Azar have “worked exhaustively to minimize coverage loss,” argued Deputy General Counsel Matthew Kuhn, who "sported a bright red pin scissors pin, a symbol of Bevin’s signature Red Tape Reduction Initiative, as he argued his case in federal court," Clark reports. "He said the changes would exempt thousands from the work requirements."

An attorney for the National Health Law Program, representing 16 Kentucky Medicaid beneficiaries, "dismissed the changes and said they’d still result in an unacceptable loss of coverage," Clark writes.