Federal Appeals Court Strikes Down Trump's 'Work-or-Die' Medicaid Requirements in Arkansas

Healthcare advocates on Friday applauded a federal appeals court decision striking down the Trump administration's Medicaid work requirements in Arkansas after a three-judge panel unanimously ruled that the proposed rule fundamentally disregarded the purpose of the safety net program.

Judge David Sentelle, a conservative Reagan appointee, handed down the ruling on behalf of the U.S. Court of Appeals for the D.C. Circuit, vehemently rejecting the administration's argument that requiring Medicaid recipients to work would make poor Arkansas residents more self-sufficient and reduce the need for the program.

"The Court recognized the tragic harm that these work requirements have caused people in Arkansas doing their best to get ahead."
--Kevin De Liban, Legal Aid of Arkansas

Medicaid, Sentelle wrote, "includes one primary purpose, which is providing healthcare coverage without any restriction geared to healthy outcomes, financial independence, or transition to commercial coverage."

Critics of the temporarily-imposed restrictions, which the Trump administration has adopted in 10 states but which have faced legal challenges and have been halted across the country, applauded the challenge to what disability rights advocate and attorney Matthew Cortland called "work-or-die requirements."

The ruling could portend similar challenges to other items on the healthcare agenda of President Donald Trump and Seema Verma, the administrator of the Centers for Medicare and Medicaid Services. Last month, Verma urged state Medicaid officials to reduce spending for the program by converting its funding into block grants.

"The appeals court decision makes clear that the [administration] cannot make up new objectives for the program and that the text of the law is clear that the central purpose of Medicaid is to provide coverage," wrote Joan Alker, executive director of the Center for Children and Families at Georgetown University. "This suggests that other harmful waiver policies which have the effect of limiting coverage (such as lockouts, limiting retroactive eligibility, premiums, etc.) may suffer a similar fate."

Under the rules, Medicaid recipients would be required to work or attend job training courses for at least 20 hours per week in order to qualify for health coverage.

A study by researchers at Harvard University last year showed that when the requirements were temporarily in effect in Arkansas before a lower court ruling halted them, nearly 20,000 residents lost their health coverage--while the employment rate also went down by 4%.

"Medicaid work requirements don't cause anybody to get work; they just lose their insurance," wrote political science professor Scott Lemieux at the time.

The federal appeals court slammed the Trump administration in its ruling for not considering the number of Arkansans who lost coverage under the requirements before they were struck down last year.

"The Court recognized the tragic harm that these work requirements have caused people in Arkansas doing their best to get ahead," Kevin De Liban, an attorney at Legal Aid of Arkansas, which challenged the requirements, told The Hill. "Now, more than two hundred thousand Arkansans on the program can rest easier knowing that they'll have healthcare when they need it."

The work requirements are currently only in effect in Michigan. The Arkansas decision makes it likely that the Trump administration may ask the U.S. Supreme Court to hear its case.

"We hope the federal government and the states will return to focusing on expanding coverage and access, so that everyone--regardless of economic status--can be healthy," said Sam Brooke, deputy legal director at the Southern Poverty Law Project.