A new report officially confirms all suspicions about whether Medicaid work requirements lead to coverage losses. Recently, the state of Arkansas, which began implementing its work requirement program, Arkansas Works, in June, reported that almost 7,500 individuals didn’t comply with the work requirement and are now at risk of losing coverage. Unfortunately, Arkansas Works only allows three months of non-compliance before terminating individuals from coverage until the next calendar year, which could potentially bar someone from health coverage for nine months.
This alarming data confirms what we already know: work requirements don’t work. Not only do they not help individuals connect to or keep a job, but by blocking access to health care, they’ll likely make individuals less healthy and less able to work. It’s hard to see how this type of policy, in essence a “paperwork penalty” that only imposes an administrative barrier between individuals and their health care, will help promote employment or health.
Fortunately, a federal judge agreed and recently invalidated Kentucky’s Medicaid work requirement program in the case of Stewart v. Azar. The case was brought by 15 Kentucky Medicaid enrollees who were concerned the program would cause them to lose coverage for not meeting the paperwork penalty, since they were already working. The judge found that since Medicaid’s primary purpose is to provide health coverage, Secretary Azar has a duty to evaluate how any change a state is looking to make to its Medicaid program impacts care. Because Secretary Azar never addressed Kentucky’s projection that 95,000 individuals would lose coverage when he approved the state’s proposal, the court felt it had “little reason to think that he seriously grappled with the bottom-line impact on health care.” The Secretary also has a duty to consider public comments in response to a state’s Medicaid work requirement application. Many commenters raised concern about the projected coverage losses, and some even noted that 95,000 was likely an underestimate, with the real number between 175,000 and 297,500. The court found there was “a rather stunning lack” of evidence that the Secretary considered the comments received. Therefore, the Secretary’s approval of Kentucky’s Medicaid work requirement program was invalid.
The Kentucky court decision should serve as a warning to other states to reconsider undertaking an unprecedented policy such as Medicaid work requirements. Not only have work requirements been shown to be costly to implement and harmful to individuals and families, but they’ve now been invalidated as not furthering the purpose of Medicaid. If states go forward nonetheless, as many are continuing to do, the decision also shows public comments citing projected coverage losses can help prevent or undo work requirements. Hopefully, as a result of Stewart v. Azar, these types of policies are now on the path towards being struck down in other states. The reasoning is clear – since Medicaid’s purpose is to provide health coverage, policies and costly bureaucracy that causes losses of coverage can in no way promote its purpose.