Kentucky officials, meanwhile, had made the case that the work requirements could save money for the state and thus make its expansion of Medicaid “fiscally sustainable.” Gov. Matt Bevin, a Republican whose Democratic predecessor expanded the program, has warned repeatedly that he will end the expansion for financial reasons if the work rules don’t survive in court.
But Judge Boasberg rejected the financial argument. Federal officials, he said, “made no finding” that the waiver would save any amount of money or make the program more sustainable.
In seeking federal permission to introduce work requirements, Kentucky had estimated that 95,000 fewer residents would have been enrolled in Medicaid within five years, although its lawyers said many of those people would have found jobs that offered insurance. Lawyers for the plaintiffs predicted the number would be much greater, and the early results in Arkansas — thousands losing coverage for either failing to meet the 80-hours-per-month requirement or failing to correctly report their compliance — bolstered their case.
Adam Meier, the secretary of Kentucky’s Cabinet for Health and Family Services, said in a statement, “Although a setback to our implementation schedule, we believe that we have an excellent record for appeal and are currently considering next steps.”
He added, “The judge illogically concluded that Medicaid is all about paying for health care for as many people as possible without regard to whether this coverage actually makes people healthier. We emphatically disagree because a health care program like Medicaid, by its very nature, must take into account whether it improves people’s health.”
Gov. Asa Hutchinson of Arkansas, a Republican, said that he was “disappointed” in the ruling and would discuss it further in a news conference on Thursday.
The other states that have won federal approval for Medicaid work requirements are Arizona, Indiana, Michigan, New Hampshire, Ohio and Wisconsin. New Hampshire’s requirement, the next to take effect, is the subject of a third lawsuit, filed last week.