Photo: Jabin Botsford
The Trump administration is reviving its efforts to let Kentucky compel hundreds of thousands of poor residents to work or prepare for jobs to qualify for Medicaid, after a recent federal court order struck down the plan.
Federal health officials have decided to consider for a second time the same application that Kentucky submitted last year. In an unorthodox maneuver, the Centers for Medicare and Medicaid Services has decided to open a fresh period for public comment on Kentucky’s proposal to transform its Medicaid program, an agency spokesperson confirmed Wednesday.
The 30-day comment period is intended “to better inform any future decision” on whether CMS will reapprove the plan, said the spokesperson, who spoke on the condition of anonymity because the maneuver had not been publicly announced.
The move by federal health officials comes nearly three weeks after Judge James Boasberg, of the U.S. District Court for the District of Columbia, blocked Kentucky’s plan as it was about to become the nation’s first to require many low-income residents who want Medicaid to work or perform other types of “community engagement,” such as job-training or volunteering.
The court case and Kentucky’s timing have placed the state at the forefront of an ideological war over the future of Medicaid, a vast public health insurance program that is a main outgrowth of the War on Poverty of the 1960s and now a target for conservatives eager to shrink the government’s social safety net.
In January, CMS Administrator Seema Verma announced that the agency had rewritten the rules of the Medicaid program, a shared responsibility between the federal government and states, to permit states to create work requirements – an idea that the Obama administration had consistently rejected. Verma contends that such requirements can lift people out of poverty by instilling an ethic of personal responsibility. Critics contend that most poor people who can work already do, and that they need health insurance to look for or hold a job.
The day after the policy change, CMS approved Kentucky’s plan – a victory for that state’s Republican governor, Matt Bevin, who had campaigned for office in 2015 on a pledge to reverse his Democratic predecessor’s embrace of the Affordable Care Act. During the first years of the health-care law, the number of uninsured Kentuckians plunged more than in almost any other state, in large part because of the state’s expansion of Medicaid.
The state was to begin its work requirements on July 1, in a single county at first and statewide by the fall.
But in his June 29 ruling, Boasberg, an Obama appointee, said that the Department of Health and Human Services, which oversees CMS, had been “arbitrary and capricious” in approving Kentucky’s plan, because it had “never adequately considered” whether Kentucky’s plan “would, in fact, help the state furnish medical assistance to its citizens, a central objective of Medicaid.”
The state’s documents had estimated that 95,000 people might lose Medicaid benefits over several years, and Boasberg scolded HHS for having “paid no attention to that deprivation.”
The judge overruled the federal government’s approval of Kentucky’s plan and sent the proposal back to HHS. Since then, it has been unclear whether the Trump administration would appeal the ruling or reconsider the state’s application.
A Kentucky official involved in the development of the state’s Medicaid proposal said late Wednesday afternoon that federal officials had told the state that the CMS planned to create a new comment period but had not said exactly when it would begin or what would happen afterward.
The official, Catherine Easley, said: “Based on recent conversations with CMS, we are confident that we are on the path towards implementing our innovative, transformative program that will strengthen Medicaid. . .We will continue to target our preparations for re-approval on the earliest possible date.”