March to Medicaid work requirements slowed by courts, 2018 elections

The federal court rulings striking down Medicaid work requirements in Arkansas and Kentucky have deterred some states that were rushing full steam ahead on it previously. That and the 2018 election results which demonstrated just how attached to their health care most voters are have dampened enthusiasm in some states.

“It’s not surprising that a state would not want to spend a lot of money setting up a program that may be struck down by a court,” said Leonardo Cuello, director of national health policy at the National Health Law Program. “You would think any rational state would not engage in this type of legislation at this point.” His group was among those that sued Arkansas and Kentucky over work requirements. Legislatures in West Virginia, Wyoming, and Iowa all ended up dropping efforts to impose the requirements, being among some of the more rational states.

Arizona, Michigan, Ohio, and Utah have had their programs approved by the Trump administration, which by law must allow waivers to states wishing to make changes to Medicaid, and are moving ahead. Utah is one of the states that voters decided in 2018 should have Medicaid expansion, and where the legislature thwarted the people’s will by shackling the program with work requirements. That happened in Idaho as well, where the state legislature could very rarely be called rational. Idaho moved forward with the work requirement legislation just days after a federal judge struck them down, but did change the legislation to force Medicaid expansion enrollees to pay co-payments if the work requirements are ultimately declared unlawful at the end of the judicial appeals process.

There are states, however, where new Democratic governors are still stymied by Republican lawmakers. In Wisconsin, the legislature in a lame-duck session last year tied Gov. Tony Evers’ hands by declaring that the work requirements could only be lifted by state law. In Michigan, Gov. Gretchen Whitmer is still trying to figure out how to either repeal the requirements or change them to minimize loss of coverage.

Any movement to alter Medicaid at the federal level is thankfully dead now, with a Democratic House and it doesn’t seem likely that new states that have expanded Medicaid will try to jump on board the work requirement train, not with litigation and the political pitfalls. The Medicaid expansion program as a whole, though, remains under the threat of the Fifth Circuit Court of Appeals and the Trump administration’s efforts to throw the whole of the Affordable Care Act out.


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