Supreme Court agrees to consider Medicaid work requirements

The Supreme Court agreed Friday to review whether the Trump administration can allow states to impose work requirements in their Medicaid programs.

The administration had asked the justices in July to reinstate its historic approvals of state work requirements waivers, which it argues may assist certain beneficiaries in transitioning to private policies and may lead to improved health, as well as help states conserve financial resources to provide coverage to others in need.

Lower courts have voided the Department of Health and Human Services’ approvals, saying Medicaid’s main purpose is to provide health care coverage.

Regardless of the Supreme Court’s ultimate decision, work requirements are not expected to last long in the incoming Biden administration, which supports expanding access to coverage, not throwing up roadblocks to Medicaid enrollment.

The National Health Law Program, one of the consumer advocacy groups that brought the original lawsuits, said it expects to prevail in the nation’s highest court.

“HHS’s action was properly vacated because Secretary [Alex] Azar failed to account for the significant loss in health coverage that these approvals would produce,” said Jane Perkins, legal director at the National Health Law Program. “Tens of thousands of people would lose their Medicaid coverage and become uninsured.”

The justices’ decision to hear the cases comes after a panel of federal appellate judges struck down the Trump administration’s approval of work requirements in Arkansas in February. The unanimous decision, written by Judge David Sentelle, a Reagan appointee, upheld a district court ruling that found the administration had failed to analyze whether such programs would “promote the primary objective of Medicaid — to furnish medical assistance.”

New Hampshire halted its implementation of work requirements last year after the same district judge, James Boasberg in the District of Columbia, set aside the administration’s approval in the Granite State.

The Trump administration, in an unprecedented step, in 2018 began granting state requests to mandate that certain Medicaid beneficiaries work in order to receive benefits. Republicans have long wanted to add such a requirement to Medicaid, which insures more than 75 million low-income Americans.

Twelve states received waivers, though four were set aside in court, according to the Kaiser Family Foundation. Another seven state requests are awaiting federal approval. Work requirements are not in effect anywhere after states pulled back their efforts in the wake of the legal rulings and the coronavirus pandemic.

In Arkansas, more than 18,000 people lost coverage in 2018 before the court stepped in.

Boasberg had also voided Kentucky’s approval, which blocked work requirements from being implemented there. However, Kentucky terminated its waiver request after a Democratic governor won election in 2019 and dismissed its appeal.

In March, the judge blocked work requirements in Michigan.