Medicaid Work Requirements at the U.S. Supreme Court - Kaiser Family Foundation

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Though the Trump Administration has left office, the Supreme Court is set to decide whether Medicaid work requirements – a controversial policy advanced by the Trump Administration – are legal. Oral argument is scheduled for March 29th, with a decision expected by the end of the term in June. The Supreme Court agreed to hear the cases after the DC appeals court, in a unanimous opinion written by a judge appointed by President Reagan, affirmed that the HHS Secretary’s approval of Medicaid work requirements in Arkansas was unlawful because the Secretary failed to consider the impact on coverage. The DC appeals court subsequently ruled that its decision in the Arkansas case applies to a New Hampshire case challenging Medicaid work requirements and affirmed that the Secretary’s New Hampshire approval also was unlawful. In addition to work requirements, both cases challenge waivers of Medicaid’s 3-month retroactive coverage requirement. The Arkansas and New Hampshire waivers were sent back to HHS following the lower court decision and are now pending at CMS.

What happens next in the Supreme Court cases?

While the Biden Administration is expected to undo the policy of approving waivers allowing states to condition Medicaid eligibility on meeting a work reporting requirement, the opening brief setting out the federal government’s position in the Supreme Court cases was filed by the Trump Administration on January 19th, the day before President Biden’s Inauguration. Arkansas and New Hampshire were allowed to intervene in the cases challenging the approvals of their respective waivers, and both states joined the Trump Administration in urging the Supreme Court to reverse the appeals court decisions. A group of 17 states, led by Indiana, filed an amicus brief arguing in support of work requirements, and Nebraska filed a separate amicus brief making a similar argument. The answering brief setting out the arguments of the Medicaid enrollees who challenged the Arkansas and New Hampshire approvals is due on February 18th, and amicus briefs in support of the enrollees’ position are due the following week.

What actions can the Biden Administration take that could affect the cases?

A January 28th executive order from President Biden to “protect and strengthen Medicaid” sets the stage for the Biden Administration’s next steps in the pending litigation, with the federal government’s reply brief due shortly before the March 29th argument date. The Biden executive order directs HHS to consider whether to suspend, revise, or rescind any policies or waivers that “may reduce coverage under or otherwise undermine Medicaid” as well as policies or practices that “may present unnecessary barriers” to people attempting to access Medicaid. Data from Arkansas show that over 18,000 people lost coverage while work reporting requirements were in place, with major barriers related to disability and technology. Across states, other data show that most Medicaid adults were working prior to the coronavirus pandemic, albeit primarily in low-wage jobs in industries likely affected by the recent economic downturn. Among those not working, many face barriers such as caregiving responsibilities, illness or disability, and school attendance.

Because the Trump Administration’s approvals of the Arkansas and New Hampshire work requirements were vacated by the lower courts, the states’ original waiver amendment requests technically remain pending decision at HHS. Rejecting the Arkansas and New Hampshire work requirement requests could moot out the Supreme Court appeal. In addition, the Biden HHS could rescind the Trump Administration guidance that invited states to apply for work requirement waivers and determine that work requirements do not further Medicaid program objectives. Though the Trump Administration approved work requirement waivers in other states, none is currently in effect, either due to litigation or the pandemic. Since the president’s executive order requires a review by HHS but does not detail specific policy actions, Court observers and policymakers will be closely watching Biden Administration’s actions on these waivers in the coming weeks.

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Medicaid Work Requirements at the U.S. Supreme Court - Kaiser Family Foundation
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