State of Play:  For a second time, on March 27, a federal judge blocked requirements for able-bodied Medicaid beneficiaries to seek work or participate in other qualifying activities (known as work requirements to be eligible for Medicaid beneficiaries).  U.S. District Court Judge James Boasberg ruled that the federal government failed to justify that adding employment conditions and other changes to Medicaid in Arkansas and Kentucky advanced Medicaid’s basic purpose of providing health coverage.  Beneficiary advocates also filed a third lawsuit challenging New Hampshire’s work requirement waiver in March.   Arkansas is the only state to enforce work requirements to date and more than 18,000 residents lost coverage since the waiver program took effect. Department of Health and Human Services (HHS) Secretary Alex Azar said there is “a strong indication” those people got jobs that offered health insurance, but neither the state nor the federal governments tracked those residents.  Centers for Medicare and Medicaid (CMS) Administrator Seema Verma has rejected the Medicaid and CHIP Payment and Access Commission recommendation to pause work requirements in Arkansas. To date, 37 states (including the District of Columbia) have expanded Medicaid under the Affordable Care Act (ACA), and 14 states have not adopted the expansion.

HLC Position:  Medicaid serves as an important and viable safety net for low-income individuals and families without access to either employer-sponsored insurance or the individual insurance market.  Increasing efficiency in the program is important, but such changes should maintain access to the healthcare safety net for our country’s most vulnerable citizens.  Drawing from private-sector progress in moving to pay for value, the Medicaid program should encourage the thoughtful use of federal waivers to encourage actuarially sound Medicaid expansion in those remaining states that have not yet expanded their eligibility requirements.   Waivers should be used to encourage innovation that will emphasize value-based care and care coordination while allowing private sector entities to play an integral role.  HLC also supports streamlining the Medicaid application process and incentivizing healthy behaviors and care management for Medicaid enrollees.  Additionally, the Children’s Health Insurance Program (CHIP) should be funded so that children have access to care. 

HLC Recent Activity:

  • On April 5, HLC staff met with Senate Health, Education, Labor, and Pensions (HELP) Committee staff to discuss the High-Need Beneficiary Playbook. The playbook addresses recommendations to state Medicaid agencies.
  • HLC updated its document on coverage solutions to stabilize the individual healthcare insurance marketplace.