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Judge rejects Medicaid work requirement in Kentucky and Arkansas

HHS failed to show work rules would improve access to healthcare

On March 27, a federal judge ruled the Department of Health and Human Services (HHS) violated federal law by approving work requirements and other barriers to eligibility for Medicaid recipients in Kentucky and Arkansas. 

U.S. District Judge James E. Boasbergsent ruled Arkansas’ work requirement program—the first to be implemented around the country—cannot stand, and prevents Kentucky from moving forward with similar requirements slated to begin in July.

Both state’s 1115 Research and Demonstration waivers require Medicaid recipients to work, volunteer, or otherwise engage in community activities for 80 hours a month as a condition of eligibility for the program, as well as include barriers to eligibility, such as waiving retroactive eligibility requirements. 

Since being implemented in June 2018, more than 18,000 Arkansans have lost Medicaid coverage.

Fifteen states have applied to the federal government to implement similar work requirements.

A statement from Lisa Lacasse, president of the American Cancer Society Cancer Action Network (ACS CAN) follows: 

“Today’s ruling is a positive step towards preserving access to health care for the millions of cancer patients, survivors and individuals at risk of developing the disease who rely on Medicaid for health care coverage. The program is essential for enrollees to get timely access to screenings, diagnostic tests, and for cancer patients to receive treatment and long-term follow up care.

“Cancer patients and survivors often become so sick from treatment and its long-term effects that they are unable or told not to work by their doctors. Having to meet and report arbitrary work requirements to keep their Medicaid coverage could be especially challenging for these patients. Such requirements could result in delayed, interrupted or incomplete care with worse outcomes.

“Preserving access to Medicaid without additional obstacles, like work requirements, is essential to ensuring cancer patients, survivors and those with other serious diseases can get the uninterrupted care they need.

“We will continue to work with states across the country to expand access to quality health care.” 


Judge Boasbergsent said Kentucky again had failed to prove its changes would advance a central goal of Medicaid – to ensure health coverage to its most vulnerable citizens. Rather, he said, it appears at least 100,000 Kentuckians stood to lose health coverage under the work rules.

As he did last year, the judge sent Kentucky's plan back to HHS for further review. But he indicated he was doubtful the federal agency could justify approving it a third time "given a second failure to adequately consider one of Medicaid's central objectives."

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