Arkansas and the federal government have given different reasons why a judge should throw out a lawsuit that challenges a requirement for some Medicaid recipients to hold jobs or participate in other approved activities.
In a court filing late Friday, attorneys with the U.S. Department of Justice argued that such requirements further the goal of the Medicaid program by allowing states to "experiment with ways to stretch limited Medicaid resources and thus maximize coverage."
In a separate filing, attorneys with Arkansas Attorney General Leslie Rutledge's office wrote that the requirement is meant to encourage recipients to be more financially independent, which the attorneys argued is a goal of Medicaid.
"Just as a school that expels students for violations of a strict honor code offers a service, education, that promotes honesty of its students, and just as an insurer that kicks off its insureds if they smoke offers a service, insurance, that promotes tobacco abstinence, Arkansas offers a service, Medicaid, that promotes the community engagement that is a condition of its receipt," the state's attorneys wrote.
The lawsuit, filed in August in U.S. District Court in Washington, D.C., contends that U.S. Health and Human Services Secretary Alex Azar failed to adequately consider the effect the requirement would have on the Medicaid program's goal of providing health coverage for low-income people.
In Friday's filings, attorneys for both the state and federal government also argued that even if U.S. District Judge James Boasberg finds that President Donald Trump's administration exceeded its authority when it approved the work requirement in March, the judge should allow the requirement to stay in place while the administration addresses any shortcomings he identifies.
Removing the requirement would interrupt the state's effort to gather information on how the rule is working and "cause confusion among beneficiaries, as the obligations with which they are becoming familiar would suddenly change," Justice Department attorneys wrote.
More than 12,200 enrollees have lost coverage as a result of the work requirement since the state began phasing it in in June. The rule requires enrollees to work 80 hours a month or engage in other approved activities, unless exempted, and to report their status using a state website, access.arkansas.gov.
Enrollees who fail to report their status for three months during a year lose their coverage and are barred from re-enrolling for the rest of the year.
The requirement applies to enrollees in Arkansas Works, which covers people who became eligible for Medicaid in 2014 when the state expanded the program to cover adults with incomes of up to 138 percent of the poverty level.
In June, Boasberg stopped a similar requirement from taking effect in Kentucky, ruling that Azar hadn't considered the effect the requirement would have on the Medicaid program's goal of providing medical assistance to needy residents.
He noted that the Social Security Act allows the secretary to grant waivers from certain provisions of federal law only when they are likely to "assist in promoting the objectives" of the Medicaid program, which is funded by the federal government and states.
In response to Boasberg's ruling, the federal Centers for Medicare and Medicaid Services solicited a new round of public comments on the Kentucky requirement. Last month, the agency approved Kentucky's waiver again, saying it will help make recipients more financially independent and that employment "may lead to improved health and wellness."
The Medicaid agency also argued in its Nov. 20 approval letter that the requirement will promote the objective of providing medical assistance by making Medicaid expansion more politically palatable. The requirement is scheduled to start in April.
"Kentucky has repeatedly stated that if it is unable to move forward with its Kentucky HEALTH, it will discontinue coverage under the [Affordable Care Act] expansion population, a choice it is entitled to make," Paul Mango, the federal agency's chief principal administrator, said in the letter.
"The reasoning of that new letter applies equally to Arkansas' demonstration project," Justice Department attorneys wrote in the court filing on Friday.
They noted that the U.S. Supreme Court in 2012 ruled that Congress couldn't require states to expand their Medicaid programs.
"Policies that help these Medicaid recipients become healthier lower the cost of their care for the simple reason that healthy and productive people are less expensive to insure," the attorneys wrote. "Such policies may thus enhance the overall fiscal sustainability of the program and help preserve and expand the health-care safety net for those who need it the most."
In their filing, attorneys for Arkansas argued that providing health coverage isn't the Medicaid program's only goal. The Affordable Care Act created grants for states to reward Medicaid recipients for healthy behavior, they said, and a 2005 law allows states to require some Medicaid recipients to pay monthly premiums and face out-of-pocket charges charges for medical care.
They also noted that the Social Security Act lists providing "rehabilitation and other services" to help Medicaid recipients "attain or retain capability for independence or self-care" as a goal of the program.
Kevin De Liban, an attorney with Jonesboro-based Legal Aid of Arkansas, one of three advocacy groups that filed the lawsuit, said Monday that that part of the law is referring to the ability to physically perform tasks of daily living, such as getting dressed or bathing, not financial independence.
"It's not some broad brush permission to impose work requirements," he said.
A response to the requests to dismiss the lawsuit is due Dec. 21.
A Section on 12/04/2018