Nearly five months after Kentucky saw its work requirements program blocked by a federal judge, the Centers for Medicare and Medicaid Services approved a revised waiver that would allow the state to enforce work requirements beginning in April 2019.
The decision was met with criticism by Kentucky healthcare organizations, which said the CMS reapproved the waiver "despite the state having maintained the harsh penalties and onerous reporting requirements that will lead to more than 95,000 Kentuckians losing access to healthcare coverage."
Kentucky was the first state to have a work requirement approved by the CMS, but the program has been on hold since a federal judge blocked it from implementation. Work requirements have been a controversial issue since the CMS began allowing states to apply to add them as a condition of receiving Medicaid in January.
Kentucky Gov. Matt Bevin, however, supported the Nov. 20 decision by the CMS. In a statement, Bevin said the state's program is "an innovative approach that will put Kentuckians on a path to better health, and is key to ensuring the long-term viability of the Medicaid program."
The newly approved waiver would require people to work or participate in community engagement activities such as going to school or volunteering for 80 hours a month, or they will be suspended from Medicaid. Individuals would not be eligible to reapply for coverage until the first day of the month following proof that they worked 80 hours in a 30-day period.
In June, Judge James Boasberg of the U.S. District Court for the District of Columbia blocked Kentucky's program on the grounds that the state and the U.S. Department of Health and Human Services failed to take into account the 95,000 people who were projected by the state to lose coverage if work requirements were implemented.
The CMS reopened a public comment period after the judge's ruling and made revisions to the program. However, a spokesperson for the agency said in an emailed statement that "very little was changed between the two waiver versions."
Samuel Brooke, the deputy legal director for the Southern Poverty Law Center, an organization attached to the lawsuit, said in a Nov. 20 statement that no "meaningful changes" were made and that the group will pursue legal action.
"We intend to pursue the next legal challenge as vigorously as we have before when we won," Brooke said. "We have no reason to believe that the results will be any different this time."
12,000 Arkansans lost coverage
Work requirements have not traditionally been a part of Medicaid, but the CMS told state Medicaid directors in January that the agency will work with states that want to implement them.
Since then, five states have had programs approved, and nine currently have waivers pending with the CMS, according to the Kaiser Family Foundation. Arkansas is the only state that has actually implemented a program, which has been under fire by critics since it began in June due to the 12,277 people who have lost Medicaid coverage. Another 6,002 are at risk of losing coverage at the end of November, according to data from the Arkansas Department of Human Services.
CMS Administrator Seema Verma and state officials, including Arkansas Gov. Asa Hutchinson, have defended the program as a way to help people get work. However, critics have pushed back against this claim, saying the number of people getting jobs is significantly lower than those losing Medicaid eligibility.
According to data released by the Arkansas DHS on Nov. 15, 1,525 people met the work requirement in October. However, 968 people were already meeting the state's work requirements under the Supplemental Nutrition Assistance Program. A total of 557 new people fulfilled the work requirement for last month, while 3,815 lost Medicaid eligibility.
Verma has maintained her defense of the program even as the number of Arkansans losing coverage climbs, saying the agency will "not draw rash conclusions after only a few months of data and information."
The CMS declined to confirm whether Arkansas' data was considered in approving the Kentucky waiver and stated that each waiver is evaluated independently.