Biden asks SCOTUS to drop Medicaid work requirement arguments

Law

Dive Brief:

  • The Biden administration has asked the Supreme Court to cancel upcoming oral arguments around Medicaid work requirements, a controversial Trump-era policy linking coverage eligibility in the safety-net program to work or volunteering hours.
  • Acting Solicitor General Elizabeth Prelogar in a motion filed Monday told the court the administration was currently in the process of reversing the policy, which 12 states received federal approval to test in the past four years. No such programs are currently active, having run into numerous legal and administrative challenges even prior to the pandemic.
  • Prelogar requested the court scrub the scheduled arguments on March 29 around programs adopted by Arkansas and New Hampshire, and consider throwing out the cases altogether. New Hampshire declined to take a position on the pending case, while Arkansas opposes the abeyance and intends to file a response with the court.

Dive Insight:

Tying the coverage for low-income Americans to work hours was a dream for conservatives, who saw it as a way to incentivize work while eventually moving Medicaid beneficiaries to more comprehensive private coverage. 

Trump’s HHS approved the first pilot programs in 2018 for Arkansas and New Hampshire. Arkansas was the only state that began disenrolling beneficiaries for not meeting work requirements before halting the program in March 2019, after about a quarter of beneficiaries subject to the policy lost coverage in its first five months.

After a series of litigation, a federal appeals court unanimously struck down Arkansas’ work requirement in February last year, calling it “arbitrary and capricious” and citing the drastic loss of coverage.

The Supreme Court in December agreed to hear an appeal made by the Trump administration to review the ruling, joining Arkansas’ suit with another brought by New Hampshire.

However, with the inauguration of President Joe Biden on Jan. 20, the case for work requirements has significantly deflated. Earlier this month, Biden’s HHS sent letters to Arkansas, New Hampshire and other states with previously approved demonstration projects, informing them HHS was debating withdrawing approval of the requirements.

Along with COVID-19 complicating implementation of the programs, the Biden administration argues work requirements are inconsistent with the objective of Medicaid — to expand coverage for the poor, Prelogar said, noting HHS holds serious worries about testing policies that could lead to a loss of coverage in the near term.

Liberals generally view work requirements as a strategy to surreptitiously pare down Medicaid rolls, but the programs have also faced severe criticism from policy experts, patient advocates, hospitals and even government watchdogs.

Work requirements could weaken hospital finances, as losing Medicaid enrollees would reduce reimbursement and lead to higher volumes of uncompensated care.

And work requirements also run into big administrative barriers. The Government Accountability Office said in 2019 there was almost no oversight around the high price of implementing work requirements, finding they cost taxpayers nearly $408 million in five states.

Additionally, researchers found millions of low-income Americans could lose Medicaid eligibility under the policies not because they don’t meet hourly requirements, but because they’re unable to report their hours due to a lack of access to technology.

​The Kaiser Family Foundation estimates if work requirements were scaled nationwide, between 1.4 million and 4 million individuals would lose coverage.

Since Biden’s inauguration, the Supreme Court has already canceled some oral arguments defending Trump-era policies, including a suit defending Mexico border wall funding and another on a policy forcing migrants to wait in Mexico while their asylum claims are processed.

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