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Arkansas, Kentucky, New Hampshire Fight to Protect Medicaid Work Rule

May 6, 2019

It took two attempts, but the Arkansas House of Representatives passed a Medicaid funding bill after rejecting it days after U.S. District Judge James Boasberg blocked the state, along with Kentucky, from implementing a work requirement for able-bodied Me

The funding rejection came despite an appeal by Arkansas Governor Asa Hutchinson and leaders of the state Senate and House expressing confidence the Trump administration would defend the work requirement in litigation. The Senate voted on and passed the $8 billion Medicaid budget bill before Boasberg’s decision. Budget bills requires a super-majority in both chambers. Initially, the Medicaid budget bill in the house fell short by 10 votes.  On April 9, it passed by 3 votes, with 7 members not voting.

Kentucky had planned to launch its work requirement on April 1. Boasberg initially ruled against the Kentucky waiver in 2018, but after minor changes to the Kentucky HEALTH initiative, the U.S Department of Health and Human Services approved the waiver a second time in March. Boasberg once again said no and ruled against it, along with Arkansas’s rule, in a  March 27 decision.

Meanwhile, New Hampshire’s Medicaid work requirement is under attack. In March, several Medicaid advocacy groups announced they are suing the federal government for approving the state’s work requirements request under a Section 1115 waiver. The National Center for Law and Economic Justice, one of the plaintiffs, said in a press release the waivers violate Medicaid’s stated purpose and cited the decline in participation in Arkansas when its work requirements went into effect June 2018.

Bridge to the Workplace

Opponents of Medicaid work requirements fail to recognize the importance of work, says Grace-Marie Turner, president of the Galen Institute and a policy advisor to The Heartland Institute, which publishes Health Care News.

“According to advisors to former President Obama, 40 percent of the people initially eligible for coverage under Medicaid expansion had an offer of private coverage, primarily through the workplace,” said Turner. “What a tragedy it would be if states were to lure them with free coverage through Medicaid but discourage them from working and having an incentive to find their right place in the workforce.”

In the current system, fear of losing government benefits discourages low-income individuals from increasing their income. A study by The Buckeye Institute, Healthy and Working: Benefits of Work Requirements for Medicaid Recipients, found Medicaid can cost individuals hundreds of thousands of dollars in lifetime earnings.

“By keeping enrollees connected to the workforce, Medicaid work requirements will help people gain experience and learn news skills,” said Rea Hederman, executive director and vice president at The Buckeye Institute. “Our study shows [working] will result in higher lifetime earnings—up to $300,000 for many, and even more for those who transition off Medicaid.”

Helping Hand, Not Handout

“Work requirements actually are a helping hand,” said Turner. “People can continue on Medicaid while they are getting their feet on the ladder of economic independence by getting a job, searching for work, and volunteering. States implementing work requirements are actually using the program to make it a helping hand rather than a handout.

“Giving people incentives to search for work is the right thing to do,” Turner said. “Courts that are striking down work requirements are actually harming people by taking away their incentive to work and succeed.”

Nicole Staley(nicole.staley24@gmail.com)writes from Pensacola, Florida.