The Biden administration asked the Supreme Court to drop a hearing to defend Medicaid work requirement programs in Arkansas and New Hampshire.
In a Department of Justice filing last month, the administration argued the hearing is unnecessary because the U.S. Department of Health and Human Services (HHS) is reviewing the waivers that the Trump administration granted to the states that allowed them to set up the programs.
Work requirement programs placed new restrictions on Medicaid eligibility, such as requiring healthy beneficiaries to look for work or enroll as a student. With the support of former President Donald Trump, the state-level policies aimed to put more people on standard health insurance coverage and to solve the problem of the Medicaid “poverty trap.”
In traditional Medicaid, beneficiaries who earn money, can lose health coverage which creates an incentive to stay out of the workforce and, ultimately, reducing lifetime earnings, says Rea Hederman, the executive director of the Economic Research Center at The Buckeye Institute.
“The Buckeye Institute’s research indicates that the lifetime earnings of some Medicaid recipients could increase by almost a million dollars if, through working, they transition from Medicaid to private insurance,” Hederman told Health Care News.
The Attack on Medicaid Work Requirements
Hederman claims that opponents of the policies misrepresent them.
“These are work and community engagement requirements,” Hederman said. “So volunteer work, skills training, schooling, job training all count towards the requirements.”
Work requirements were not designed to apply to the traditional Medicaid population, including pregnant women and disabled people but to single, able-bodied Medicaid recipients.
Lower courts have blocked attempts to institute Medicaid work requirements in four states, including the Arkansas and New Hampshire programs, according to Kaiser Family Foundation statistics. Another eight states had waivers approved by the Centers for Medicare & Medicaid Services (CMS). Seven states still have CMS approval pending.
Arkansas is the only state to have fully implemented work requirement rules before court interference. In both Arkansas and New Hampshire, the administration failed to show that the eligibility requirements promote Medicaid’s objectives.
Trump v. Biden
The Trump administration filed a brief defending the requirements one day before Trump left office.
Biden’s HHS told states less than one month later that it was considering withdrawing their waivers, citing a potential decrease in health insurance in the midst of the pandemic. The Biden administration cited this “preliminary determination” as a cause for dropping the scheduled hearing.
Work requirement policies have safeguards for times of economic distress, however. The requirements can be suspended during a downturn, Hederman says.
“Again, opponents often scare people by implying when a community is in recession and there are no jobs that work requirements will still be imposed,” Hederman said. “This is false; state governments have flexibility on when to suspend requirements.”
The Biden administration asked the Supreme Court to vacate the appeals court judgments and remand the cases back to HHS to allow it to finish deciding whether to withdraw the waivers. The high court is scheduled to hold a hearing on the merits of the work rules on March 29.
“By ending Medicaid work and community engagement requirement rules, the Biden administration is making it harder for some Medicaid recipients to achieve a better life,” Hederman said. “As a result of this rule change, it is likely that people and families will remain trapped on Medicaid rolls.”
Harry Painter (firstname.lastname@example.org), (@TheHarryPainter) writes from Brooklyn, New York.