Kentucky recently received approval for a Medicaid Section 1115 waiver from the Center for Medicare and Medicaid Services (CMS). The Kentucky 1115 imposes work or volunteer requirements on Medicaid recipients. I am not a lawyer but I knew that there would be lawyers involved.
A lawsuit was filed today challenging the approval of Kentucky's 1115 waiver, which includes (among other things) work requirements. https://t.co/wdqjEDJb66
— Nicholas Bagley (@nicholas_bagley) January 24, 2018
The 1115 waiver process allows states to experiment and modify the basic Medicaid program as long as the experiment furthers the objectives of the Medicaid program. Medicaid’s objective has always been perceived to be “Get people health care!” Some states will experiment with money follows the individual programs, other states may want to allow for more substance abuse providers to be eligible, most states use some managed care components.
Work requirements have never been part of the mission of “Get people health care”. The justification in the CMS guidance is either acontextual or flips correlation and causation on its head. So there will be lawyers running up billable hours for a very long time.
Now Governor Bevin (R-KY) has threaten that if any part of the waiver is ruled illegal by the federal courts, he will shut down the entire Kentucky Medicaid expansion project. Rachel Sachs notes that this is a threat with a long and variable lag.
Bevin needs 1) "final judgment" against one or more parts of the waiver and 2) "all appeals … having been exhausted or waived." Then, 3) the Secretary has 6 months or "otherwise as soon as legally practicable" to end the expansion. Could take years. 2/2
— Rachel Sachs (@RESachs) January 16, 2018
And if that happens, I imagine that there will be lawyers as well.