Last Friday, a federal judge decided he didn’t like the Medicaid work requirements that had been imposed by the Kentucky state government on Medicaid recipients despite the fact that the work requirements had been approved by the Department of Health and Human Services.

[The judge] writes that in approving Kentucky’s work requirement proposal, Health and Human Services Secretary Alex Azar “never adequately considered whether Kentucky HEALTH would in fact help the state furnish medical assistance to its citizens, a central objective of Medicaid.”

The judge pointed out that Azar did not mention that 95,000 people could lose coverage under the plan — an oversight that he called “glaring.”

A number of health policy experts praised the ruling, which they’ve described as “scathing” and “savage.”

…

HHS approved Bevin’s request to change Kentucky’s Medicaid program in January. It requires “able bodied” Medicaid recipients to either find work, do job training or do volunteer work to be eligible for medical benefits. It was the first state to get such approval, after Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, said she would look favorably on such proposals.

…

Instead, he wrote, HHS failed to consider whether the work requirements would do anything to further the program’s core mission, which is to provide medical care to the poor.

“While plaintiffs and their amici assert that these proclaimed health benefits are unsupported by substantial evidence, the Court need not enter that thicket. The Secretary’s analysis, instead, fails for a more basic reason; it is little more than sleight of hand,” the judge wrote.

“The message here? Anybody who wants to add work requirements, the bar is very high to now show that there is a connection to health,” says Rodney Whitlock, a health policy analyst at Mintz Levin, a law firm with expertise in health care regulations.

There was a message here alright, just not the one that Rodney Whitlock anticipated.

Gov. Matt Bevin’s administration has abruptly cut Medicaid dental and vision benefits to nearly half a million Kentuckians, prompting an outcry from Democrats who called the Republican governor’s decision “rash.”
…
“This is an unfortunate consequence of the judge’s ruling,” said an email Sunday from Doug Hogan, communications director for the Cabinet for Health and Family Services.

…

Hogan’s email said that under Bevin’s overhaul, known as Kentucky HEALTH, about 460,000 Medicaid members affected by the changes already had been notified that effective July 1, basic dental and vision benefits would end.

Instead, they could earn points toward paying for services through a “My Rewards” account by completing activities such as online classes or volunteer work.

“When Kentucky HEALTH was struck down by the court, the ‘My Rewards Account’ program was invalidated, meaning there is no longer a legal mechanism in place to pay for dental and vision coverage for about 460,000 beneficiaries who have been placed in the Alternative Benefit Plan,” the email said. “As such, they no longer have access to dental and vision coverage as a result of the court’s ruling.”

So Kentucky had come up with an innovative way of subsidizing a Medicaid expansion that was otherwise unaffordable. Unfortunately for Kentucky, they assumed that people should be doing something productive in return for medical coverage. A federal judge intervened to make the point that working was unconstitutional and cruel and now there has been a cut in medical coverage.

I hope Bevin has the stones to make this stick. The idea that able-bodied adults should get a government benefit and not be required to work or volunteer or go to school is simply insane. This is another case of a federal judge imposing his personal policy preferences upon an elected government. And, not for the last time, the people paying the price are the people he thought he was trying to help.

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