Medicaid work requirement ruling could affect Ohio

July 05--Ohio's effort to attach work requirements to Medicaid expansion could be affected by a federal judge's ruling against similar requirements in Kentucky.

U.S. District Judge James Boasberg said last week that Kentucky can't require poor people to get a job to keep their Medicaid benefits, chastising the President Donald Trump's administration for rubber-stamping the new rules without considering how many people would lose their health coverage.

States were previously not allowed to tie Medicaid eligibility to work requirements, but the Trump administration opened the door to let states add such requirements. The Republican-majority Ohio General Assembly asked Ohio Medicaid to seek federal approval for similar rules.

The health insurance program for low income Ohioans -- jointly funded by the state and federal government -- covers about 3 million residents, with about 700,000 covered through Medicaid expansion.

The decision could be a setback for the Ohio Department of Medicaid, which is waiting on federal permission to add job requirements for those covered through the expansion of Medicaid through the Affordable Care Act.

"We are currently reviewing the court decision regarding Kentucky's work requirement program and will continue to work with the federal government throughout the process regarding our proposal," stated Melissa Ayers, spokeswoman for Ohio Medicaid.

"We believe that the peoples' elected representatives, not the judiciary, are responsible for setting health care policy and determining how tax dollars are spent. We hope the Kentucky decision is appealed, and we expect that it will be. In the meantime, we urge the Administration to consider Ohio's waiver," said Ohio Senate President Larry Obhof, R-Medina.

Kentucky was the first state in the country to get that permission, and the new rules were scheduled to take effect Sunday in a northern Kentucky suburb of Cincinnati.

Boasberg blocked the rules because it said the Trump administration never adequately considered whether the changes would comply with the central tenet of Medicaid: Providing health care for its citizens.

"The Secretary never provided a bottom-line estimate of how many people would lose Medicaid with (the new rules) in place. This oversight is glaring," wrote Boasberg, an appointee of former President Barack Obama. "For starters, the Secretary never once mentions the estimated 95,000 people who would lose coverage, which gives the Court little reason to think that he seriously grappled with the bottom-line impact on healthcare."

Boasberg ordered that Kentucky's approval of the project be vacated and sent it back to the U.S. Department of Health and Human Services so the process could be restarted.

Rep. Emilia Sykes, D-Akron, said that Ohio will be challenged in court on its new Medicaid rules if it gets federal approval and the Kentucky case shows the legal challenge won't go in the state government's favor. The state should abandon its effort to create work requirements, she said.

"We certainly do not have the resources and the funds to fight a legal battle that we will lose," Sykes said.

The process for getting approval for work requirements likely will be slowed by the ruling, according to Rea S. Hederman, vice president of policy for The Buckeye Institute, an Ohio free-market think tank. The Buckeye Institute voiced support for the requirements during the public comment phase of the approval process.

"This ruling is not on the merits of the waivers but a ruling on the approval process. The judge wants more detailed information from the Administration on how these waivers meet the goals of the Medicaid program. The Administration can either appeal the ruling or give a more detailed explanation for how the waiver works," Hederman said via email.

In addition, Ohio's request is different than Kentucky's, according to Hederman, adding that it is smaller in scope and affects fewer people than the Kentucky rules.

Loren Anthes, Medicaid researcher with Cleveland-based Centers for Community Solutions, has said the changes would add costly red tape to oversee the requirements and would also create uncessesary barriers to health care.

He said health law experts have labeled work requirements as problematic because they don't fit in to Medicaid's mission as it was originally set up under federal law, which is to provide medical assistance.

"A lot of questions are centered around 'Is this even what Medicaid is supposed to be? And I think the judge very clearly said 'No. This proposal is not only incomplete, it's arbitrary and capricious', meaning it is not consistent with the way Medicaid is supposed to be," Anthes said.

Associated Press contributed to this report.

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