By Renato Rocha

Yesterday, the Federal District Court for the District of Columbia blocked the Trump Administration’s attempt to take away health coverage from people who can’t document new work reporting requirements in Kentucky and Arkansas. The judge concluded that the administration’s approvals of these new requirements were “arbitrary and capricious.” The court’s actions blocked the Department of Health and Human Services’ decision to allow the requirements in these states and asked the department to review the waivers that allowed them. With so many programs to meet basic needs under threat, the judge’s decisions are a victory for the health and wellbeing of people with low-incomes in Arkansas and Kentucky whose access to Medicaid was in jeopardy.

The lawsuits were filed to protect the health coverage of thousands of people in Kentucky and Arkansas who could lose their coverage under the Trump Administration’s efforts to reshape the Medicaid program. While Kentucky has not yet implemented its new requirement, the state estimates that nearly 100,000 residents will lose coverage. Arkansas, which is the first state to implement work reporting requirements, has already experienced a sharp decline in enrollment among those subject to the requirements. In total, over 18,000 individuals have lost coverage since Arkansas implemented its work reporting requirements in June 2018. Many likely didn’t understand the reporting requirements, lacked internet access to complete required forms, or struggled to document their hours in the portal.

One of the many people already harmed by the policy in Arkansas is Adrian McGonigal, who is a plaintiff and was featured in a PBS NewsHour story about the confusion of work reporting requirements. Mr. McGonigal is 40 years old; formerly worked in the shipping department of a food-service company; and suffers from several serious medical conditions. In 2014, Mr. McGonigal received insurance through the state’s expanded Medicaid program. However, his life turned upside down in mid-2018 when he had to comply with Arkansas’ work reporting requirements. Mr. McGonigal knew he’d need to report his work hours online and, despite difficulty working with computers, successfully reported his hours in June. However, he didn’t know he’d need to continue doing so every month. As a result, he lost his health coverage and his severe health conditions worsened, causing him to miss work and ultimately lose his job. This is the cruel reality of work reporting requirements—if people lose their coverage for not submitting the correct paperwork or falling a few hours short of the criteria, their health suffers, and it becomes harder to work.

The court decisions this week cannot restore the harm already caused to thousands of people, but the decisions came right before matters get worse. Kentucky was set to begin implementing its work reporting requirements in just a few months. In Arkansas, thousands of additional people were expected to lose their coverage on April 1 when the first wave of 2019 disenrollments were to take effect.

While the decisions send both Kentucky and Arkansas’ work reporting requirement policies back to the administration for review, they don’t directly impact other states considering implementing work reporting requirements in Medicaid, including the six states that have already received approval from the administration to implement these requirements and seven more states with applications pending.

However, the decisions make clear that the administration doesn’t have unlimited authority. In the Kentucky case, which the judge reviewed and rejected for the second time, the decision states that “the Court cannot concur that the Medicaid Act leaves the Secretary so unconstrained, nor that the states are so armed to refashion the program Congress designed in any way they choose,” and, in the Arkansas case, the judge concludes, “approval of the Arkansas Works Amendments is arbitrary and capricious because it did not address—despite receiving substantial comments on the matter—whether and how the project would implicate the ‘core’ objective of Medicaid: the provision of medical coverage to the needy.”

Another clear takeaway from the court ruling is the importance of submitting comments on waiver applications. As the battle continues in court, CLASP will continue to oppose these harmful proposals through administrative advocacy, including by submitting public comments on Medicaid waiver applications as we did for Kentucky and Arkansas. We’ll use our expertise on income and work supports and low-wage employment to help document the harm these policies would cause for people in low-income households.