Arkansas Case re Breadth of Intention of 1115A Demonstrations (Medicaid)

 States of Medicaid Work Requirement Policy Reversals

Reporting this week suggests that President Biden will notify the states that have been approved to implement conditions for Medicaid eligibility tied to employment or similar requirements that basis for this flexibility is no longer in effect. To further implement the policy change, CMS is expected to withdraw 2018 guidance that encouraged states to experiment with work requirements to advance a purpose not expressed in the Medicaid statute: to improve beneficiaries’ health and well-being. The actions will not have a practical impact to state programs as no state currently operates such work requirements, due to a combination of court injunctions setting aside the programs or state voluntary actions stemming from litigation threats as well as the COVID-19 public health emergency (preventing terminations). 

The actions may affect the course of the pending U.S. Supreme Court case regarding the approvals of the Arkansas and New Hampshire work requirement demonstrations if the Court determines the case is now moot. 

If the case moves forward, the Court may ultimately decide a larger question underpinning this policy as to whether CMS has discretion to create purposes not expressed in the statute and in turn, approve demonstration projects that advance such agency-created purposes

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https://www.washingtonpost.com/health/biden-ends-medicaid-work-requirements/2021/02/11/74b51d78-6cc3-11eb-9f80-3d7646ce1bc0_story.html?utm_campaign=wp_the_health_202&utm_medium=email&utm_source=newsletter&wpisrc=nl_health202

Biden administration to move Friday to rescind Medicaid work requirements

In its planned announcement, the Biden administration said the requirements were especially unwise during the coronavirus pandemic, which has sickened millions of Americans and forced many out of work. The agency overseeing Medicaid “has serious concerns that now is not the appropriate time to test policies that risk a substantial loss of health care coverage or benefits,” according to the draft plan.

According to the 15-page document, the Trump administration approved work programs in 13 states, and 10 others were still seeking approval. A few withdrew when GOP governors were replaced by Democrats. Arkansas was the only state that actually implemented its requirements, and 18,000 poor residents there were removed from Medicaid rolls over several months before the program was blocked by a judge on the U.S. District Court for the District of Columbia.

Accompanying the steps to reverse the Trump policy, HHS also plans to release an analysis Friday assessing how the Trump policy limited low-income Americans’ access to health coverage, according to the two individuals familiar with the plans.

The analysis was overseen by Ben Sommers, a longtime Harvard researcher who joined HHS last month as a deputy assistant secretary for strategy and planning and had previously written about the drawbacks of Medicaid work requirements, the officials said. “[W]e found no evidence that the policy succeeded in its stated goal of promoting work and instead found substantial evidence of harm to health care coverage and access,” Sommers and colleagues wrote in a September 2020 analysis in the journal Health Affairs.

Sommers did not respond Thursday night to a request for comment

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The MFN Most Favored Nation legal cases also deal with breadth of intention of 1115A.

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