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New Hampshire's Medicaid work rules challenged in federal court

A lawsuit challenging New Hampshire's Medicaid work requirements was filed in federal court, claiming that the policy hurts Medicaid recipients and its approval was an "abuse" of authority by the Trump Administration.

New Hampshire is the third state facing legal action for attaching the controversial requirements to Medicaid, the dual state and federally run health insurance program for low-income Americans. The lawsuit was filed March 20 in the U.S. District Court for the District of Columbia.

The lawsuit argues that work requirements violate the principles of Medicaid by limiting access to care and making it harder to obtain eligibility. Therefore, the document claims that the Trump Administration does not have the authority to approve the states' waivers.

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Because Medicaid operates at both the state and federal level, states can adapt their programs through experimental or demonstration projects. However, the projects must uphold principles of Medicaid like increasing access to coverage and expanding eligibility.

Rather than upholding Medicaid's principles, the lawsuit claims that "the Executive Branch has instead effectively rewritten the statute, ignoring congressional restrictions, overturning a half-century of administrative practice, and threatening irreparable harm to the health and welfare of the poorest and most vulnerable in our country."

The National Health Law Program, a healthcare law and policy organization, is representing four plaintiffs in the New Hampshire case. The organization is also attached to two cases challenging work requirements in Kentucky and Arkansas.

Jane Perkins, legal director for the National Health Law Program, said in a March 20 statement that the federal government has ignored Medicaid requirements set by Congress by approving work requirement waivers.

"This approval will not promote coverage, but it will result in significant coverage losses, and that is the administration's goal – to weaken the Medicaid program and cull people whom it deems unworthy from it," Perkins said.

The National Center for Law and Economic Justice and the New Hampshire Legal Assistance are also attached to the New Hampshire lawsuit.

New Hampshire's waiver was approved by the Centers for Medicare and Medicaid Services in 2018. Under the state's policy, Medicaid recipients are required to work for 100 hours per month to maintain eligibility — the highest number of hours required by any state that has had a work requirements waiver approved.

Gov. Chris Sununu, R-NH, had not responded to S&P Global Market Intelligence's request for comment at the time of publication.

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Work requirement policies in Kentucky and Arkansas are also being challenged in federal court. Judge James Boasberg, who blocked Kentucky's policy from taking effect June 2018, heard both cases March 14 and said that his ruling will come by the end of March.

During oral arguments, the plaintiffs pointed to Arkansas' policy as an example of the failure of work requirements. In 2018, more than 18,000 people in Arkansas lost their Medicaid eligibility due to work requirements. Nearly 6,500 are at risk of losing their eligibility at the end of March, according to data from the Arkansas Department of Human Services.

The defense argued that CMS and the U.S. Department of Health and Human Services have the authority to approve experimental waivers that may lead to coverage loss.

Despite the criticism surrounding work requirements, CMS Administrator Seema Verma has continually defended the policy.

CMS has approved nine work requirements waivers; however, Maine's Democratic Gov. Janet Mills rejected the agency's approval shortly after taking office. Seven states currently have work requirement waivers pending with CMS.