A federal judge's decision to strike down a work requirement for Arkansas' Medicaid program was based on a "fundamental misinterpretation" of the law governing Medicaid, attorneys for the state argue in an appeal brief.
Urging the U.S. Court of Appeals for the District of Columbia Circuit to overturn the March 27 ruling by U.S. District Judge James Boasberg, the attorneys argued that President Donald Trump's administration acted within its authority when it approved the requirement last year.
Boasberg ruled that, in approving the requirement, the Trump administration violated the law governing Medicaid by failing to adequately consider the effect the rule would have on the program's goal of providing health coverage to needy people.
Attorneys with the Arkansas attorney general's office said in the appeal brief, filed late Tuesday, that improving recipients' health is also one of the program's goals.
The Trump administration predicted that the requirement would improve the health of Medicaid recipients by prodding them to find jobs, which research has shown to be correlated with improved health, the attorneys contend.
Boasberg's "ultimate conclusion that Medicaid's 'core purpose' is the mere perpetuation of coverage with no specific goal in mind conflicts with commonsense, text, and precedent," the attorneys argue in the brief.
The brief was one of three filed Tuesday seeking to overturn Boasberg's rulings that struck down work requirements in Arkansas and Kentucky.
The Trump administration has approved work requirements for seven other states' Medicaid programs, according to the San Francisco-based Kaiser Family Foundation. New Hampshire's requirement, which took effect in March, is also being challenged in a lawsuit in Boasberg's court.
In a brief filed earlier Tuesday in the Arkansas and Kentucky cases, Trump administration attorneys focused on their argument that the work requirement would strengthen the financial sustainability of Medicaid by encouraging recipients to move off of public assistance.
Kentucky raised the same point in its brief, noting that its governor, Matt Bevin, has threatened to end the state's Medicaid expansion if the work requirement is not implemented.
Kevin De Liban, an attorney with Legal Aid of Arkansas, said Arkansas' attorneys are "recycling losing arguments" that Boasberg rejected.
The Jonesboro organization was among three groups that filed the lawsuit challenging Arkansas' requirement on behalf of several Arkansas Works enrollees.
Even if improving health were an objective of Medicaid, "there's nothing about the work requirement that's going to improve health in any way" because poor people are already doing the best they can and don't need an additional incentive to find jobs, De Liban said.
"If you want to have a healthy population, you start by making sure they have health coverage," he said.
Section 1115 of the Social Security Act allows the U.S. Health and Human Services secretary to issue a waiver from the laws governing Medicaid for an "experimental, pilot, or demonstration project" that is "likely to assist in promoting the objectives" of the Medicaid program.
Boasberg's rulings in Washington, D.C., overturning the approval of such waivers allowing work requirements, found that Medicaid's chief goal is to provide health coverage to needy people.
Even if promoting health could also be considered a goal of the program, Boasberg wrote in the Arkansas case, the Trump administration was "arbitrary and capricious" in approving the requirements by failing to consider the effect they would have recipients' coverage.
Arkansas' requirement, which went into effect in June, resulted in 18,164 enrollees losing coverage for noncompliance.
Boasberg's rulings prevented as many as 5,492 more enrollees who had failed to meet the requirement during the first three months of the year from losing coverage in April and stopped Kentucky's requirement from going into effect.
Arkansas' attorneys said in their appeal brief that federal officials predicted that the harm to recipients who lost coverage due to noncompliance would be outweighed by the improvement in the health of those who did comply.
They added that federal officials weren't required to consider the effect the requirement would have on recipients' coverage.
"To the contrary, so long as the Secretary reasonably identified at least one Medicaid objective and reasonably predicted a demonstration project would advance that objective -- as he did -- the Secretary did not act arbitrarily and capriciously, and the approval must stand," Arkansas' attorneys wrote in the brief.
Plaintiffs' responses to the briefs filed in the two cases Tuesday are due June 20.
Arkansas' work requirement was the first ever implemented for a Medicaid program. It applied to enrollees in Arkansas Works, which covers people who became eligible for Medicaid when the state expanded it in 2014 to cover people with incomes of up to 138% of the poverty level.
This year the income cutoff is $17,236 for an individual or $35,535 for a family of four. More than 240,000 Arkansans were covered by the program as of April 1.
Arkansas required enrollees to spend 80 hours a month on work or other approved activities, unless they qualified for an exemption, and report what they did using a state website or over the phone.
Those who failed to meet the requirement for three months during a year were kicked off the program and barred from re-enrolling for the rest of the year.
Metro on 05/16/2019