The major administrative policy goal of the Trump Administration’s HHS was to erect significant barriers to accessing and using Medicaid by erecting work and paperwork requirement barriers via a series of waiver solicitations. Many states applied for work requirements. Only Arkansas implemented work requirements before litigation stopped the measures as not being conducive to the fundamental purpose of Medicaid — paying for health care. Research led by Dr. Ben Sommers (now part of the Biden Administration’s HHS) found that the Arkansas work requirements did not lead to any changes in employment and led to the disenrollent of 18,000 eligible adults.
Beneficiaries sued the states and they won big at both the trial court and the court of appeals level. The states appealed the decision to the Supreme Court. The Court will be hearing the case at the end of March.
The Biden Administration has decided to try to render the Supreme Court case moot and pocket the appeals court as a win and precedent. They announced late last week that the work requirements were no longer to be approved (NY Times):
In separate actions Friday, officials notified states with approved work requirements that the administration planned to withdraw the approvals, and it rescinded a Trump-era online guidance document inviting states to pursue new work requirement plans.
There will be lawyers!
Under regular procedure, a state or the federal government can fairly readily get out of a waiver and return to the pre-waiver status-quo. The process involves a single hearing and a short waiting period. HOWEVER, the outgoing CMS Administrator, Seema Verma, sent a letter to the waiver states offering to extend the withdrawal period to nine months in return for no consideration from the states. There will be lawyers.
We know that work requirements increase administrative burden and opportunities for otherwise eligible people to fall through paperwork cracks.
We know that work requirements don’t lead to increased work.
We know there will be lawyers and lots of them, but this is a move towards increasing access and coverage of care.