The administrations of President Trump and Gov. Matt Bevin argue that Kentucky's proposed Medicaid program, which includes work and other "community engagement" requirements, should be upheld because the new rules would be no different than what is already required of people who receive federally funded food assistance, Darla Carter reports for Insider Louisville.
In briefs filed last week with the U.S. Court of Appeals for the District of Columbia, they maintain that Health and Human Services Secretary Alex Azar used proper judgment to approve the state’s new Medicaid plan, which called for a waiver of the traditional Medicaid rules to require some "able-bodied," non-elderly Medicaid recipients to work or participate in a list of approved community engagement activities 20 hours a week to get their health benefits.
The official name for the state's new Medicaid plan under the Section 1115 waiver is Kentucky HEALTH, for "Helping to Engage and Achieve Long Term Health." The administrations liken the work rules to those already in use by food-aid programs such as the Supplemental Nutrition Assistance Program, formerly food stamps, and Temporary Assistance for Needy Families (TANF), generally known as "welfare."
“There is no reason why a Section 1115 waiver cannot test a community-engagement program in Medicaid, given that SNAP and TANF already have work-oriented programs,” the state argues in its brief. “Surely Section 1115 allows the secretary to test whether long-standing work-oriented programs from other public-assistance programs will work in Medicaid."
Carter reports in detail about the brief, which is part of an appeal from the March decision by District Judge James Boasberg that stopped similar plans proposed by Kentucky and Arkansas. This was the second time that Boasberg had vacated the federally approved plan and sent it back to the Department of Health and Human Services for further review. He said both times that HHS had not sufficiently considered the state's projection that its Medicaid rolls would have 95,000 fewer people in five years with the rules than without them, in large measure for failing to follow the rules.
The state takes issue with Boasberg's criticism that Azar failed to estimate the number of Medicaid recipients who would shift to other coverage because of Kentucky HEALTH, saying Azar is not required to know results in advance because that would defeat the purpose of the demonstration.
The new filing argues that Boasberg "was influenced by portrayals of the food-aid work requirements being counterproductive to low-income people, making him skeptical that a demonstration project like Kentucky HEALTH could lead to employment," but Congress disagrees, Carter reports.
The Kentucky Center for Economic Policy and Kentucky Voices for Health have reported that since last year, about 21,400 people have lost their SNAP benefits because of a work requirement in Kentucky.
Samuel Brooke, a deputy legal director at the Southern Poverty Law Center, which represented the 16 Kentucky Medicaid recipients who filed suit against Bevin's plan, said May 22: “When the waiver briefly went into effect in Arkansas, everyone saw the devastating effect it could have – thousands lost coverage in a matter of months. We are confident the appeals courts will similarly agree with the district court that the Medicaid program is designed to provide access to health care, and efforts to undercut that are contrary to Congress’s intent.”
In addition to arguing that Azar was within the scope of what is allowed and that his rationale was "careful and well-reasoned," the state says he was right in concluding that Kentucky HEALTH is likely to help sustain the state’s Medicaid program. It cites an executive order issued by Bevin last year that ends the expansion of Medicaid to people who earn up to 138% of the federal poverty line six months after any final court decision that blocks his plan.
In briefs filed last week with the U.S. Court of Appeals for the District of Columbia, they maintain that Health and Human Services Secretary Alex Azar used proper judgment to approve the state’s new Medicaid plan, which called for a waiver of the traditional Medicaid rules to require some "able-bodied," non-elderly Medicaid recipients to work or participate in a list of approved community engagement activities 20 hours a week to get their health benefits.
“There is no reason why a Section 1115 waiver cannot test a community-engagement program in Medicaid, given that SNAP and TANF already have work-oriented programs,” the state argues in its brief. “Surely Section 1115 allows the secretary to test whether long-standing work-oriented programs from other public-assistance programs will work in Medicaid."
Carter reports in detail about the brief, which is part of an appeal from the March decision by District Judge James Boasberg that stopped similar plans proposed by Kentucky and Arkansas. This was the second time that Boasberg had vacated the federally approved plan and sent it back to the Department of Health and Human Services for further review. He said both times that HHS had not sufficiently considered the state's projection that its Medicaid rolls would have 95,000 fewer people in five years with the rules than without them, in large measure for failing to follow the rules.
The state takes issue with Boasberg's criticism that Azar failed to estimate the number of Medicaid recipients who would shift to other coverage because of Kentucky HEALTH, saying Azar is not required to know results in advance because that would defeat the purpose of the demonstration.
The new filing argues that Boasberg "was influenced by portrayals of the food-aid work requirements being counterproductive to low-income people, making him skeptical that a demonstration project like Kentucky HEALTH could lead to employment," but Congress disagrees, Carter reports.
The Kentucky Center for Economic Policy and Kentucky Voices for Health have reported that since last year, about 21,400 people have lost their SNAP benefits because of a work requirement in Kentucky.
Samuel Brooke, a deputy legal director at the Southern Poverty Law Center, which represented the 16 Kentucky Medicaid recipients who filed suit against Bevin's plan, said May 22: “When the waiver briefly went into effect in Arkansas, everyone saw the devastating effect it could have – thousands lost coverage in a matter of months. We are confident the appeals courts will similarly agree with the district court that the Medicaid program is designed to provide access to health care, and efforts to undercut that are contrary to Congress’s intent.”
In addition to arguing that Azar was within the scope of what is allowed and that his rationale was "careful and well-reasoned," the state says he was right in concluding that Kentucky HEALTH is likely to help sustain the state’s Medicaid program. It cites an executive order issued by Bevin last year that ends the expansion of Medicaid to people who earn up to 138% of the federal poverty line six months after any final court decision that blocks his plan.
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