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A federal judge has blocked the requirements for work, volunteering or job training by "able-bodied" Kentucky Medicaid members, rules that were to go into effect in one county Sunday, July 1, and almost all the rest of the state by Dec. 1.
U.S. District Judge James Boasberg of Washington, D.C., vacated the U.S. Department of Health and Human Services' approval the new rules, saying federal officials "never adequately considered whether" the plan "would in fact help the state furnish medical assistance to its citizens, a central objective of Medicaid." Calling that a "signal omission," Boasberg declared the waiver of normal Medicaid rules "arbitrary and capricious," key points for overturning an administrative decision.
Lawyers for the 16 Kentucky Medicaid members who filed the suit argued that the plan was not likely to promote the objectives of the program, and that Health and Human Services Secretary Alex Azar "entirely failed to consider" or alter the state's projection that in five years, Kentucky Medicaid would have 95,000 fewer members than it would without the waiver. Academic health experts said in a friend-of-the-court brief that a more likely range was 175,000 to 297,500.
Medicaid covers 1.4 million Kentuckians, almost half a million of them under the state's 2014 expansion of eligibility to people with incomes up to 138 percent of the federal poverty level, as provided by the 2010 Patient Protection and Affordable Care Act. Most on the expansion work.
"The record shows that 95,000 people would lose Medicaid coverage, and yet the secretary paid no attention to that deprivation," wrote Boasberg, who was appointed by Barack Obama. Actually, the state's projection is not that 95,000 particular individuals will lose coverage, just that the rolls would be reduced that much. That many people enroll in or go off Medicaid in just a few months; the program has a lot of what officials call "churn."
The state said in its application that some of the reduction would be a result of members not complying with requirements of the program, which include regular reporting and premium payments. Violation would result in a six-month "lock-out" from the program, unless the member completed a course in health literacy or financial literacy. The Kaiser Family Foundation has estimated that a clear majority of lock-outs would be a result of failure to report.
Boasberg noted that experts who submitted comments to the state and HHS cited "extensive research, including from past Medicaid demonstrations . . . would likely reduce health-care access and utilization. To top it off, numerous comments also suggested that these new administrative requirements would increase “clerical and tracking errors and delays,' which in turn would 'cause inadvertent terminations'."
The requirements for work and other "community engagement" were to take effect in Campbell County on Sunday, July 1.
The state is expected to appeal, and Bevin has said the issue will ultimately be decided by the U.S. Supreme Court. Bevin said in his executive order for the plan that if courts ruled against it and the state's appeals failed, six moth later the Medicaid expansion would end.
Boasberg's decision is at https://ecf.dcd.uscourts.gov/cgi-bin/show_public_doc?2018cv0152-74.
U.S. District Judge James Boasberg of Washington, D.C., vacated the U.S. Department of Health and Human Services' approval the new rules, saying federal officials "never adequately considered whether" the plan "would in fact help the state furnish medical assistance to its citizens, a central objective of Medicaid." Calling that a "signal omission," Boasberg declared the waiver of normal Medicaid rules "arbitrary and capricious," key points for overturning an administrative decision.
Lawyers for the 16 Kentucky Medicaid members who filed the suit argued that the plan was not likely to promote the objectives of the program, and that Health and Human Services Secretary Alex Azar "entirely failed to consider" or alter the state's projection that in five years, Kentucky Medicaid would have 95,000 fewer members than it would without the waiver. Academic health experts said in a friend-of-the-court brief that a more likely range was 175,000 to 297,500.
Medicaid covers 1.4 million Kentuckians, almost half a million of them under the state's 2014 expansion of eligibility to people with incomes up to 138 percent of the federal poverty level, as provided by the 2010 Patient Protection and Affordable Care Act. Most on the expansion work.
"The record shows that 95,000 people would lose Medicaid coverage, and yet the secretary paid no attention to that deprivation," wrote Boasberg, who was appointed by Barack Obama. Actually, the state's projection is not that 95,000 particular individuals will lose coverage, just that the rolls would be reduced that much. That many people enroll in or go off Medicaid in just a few months; the program has a lot of what officials call "churn."
The state said in its application that some of the reduction would be a result of members not complying with requirements of the program, which include regular reporting and premium payments. Violation would result in a six-month "lock-out" from the program, unless the member completed a course in health literacy or financial literacy. The Kaiser Family Foundation has estimated that a clear majority of lock-outs would be a result of failure to report.
Boasberg noted that experts who submitted comments to the state and HHS cited "extensive research, including from past Medicaid demonstrations . . . would likely reduce health-care access and utilization. To top it off, numerous comments also suggested that these new administrative requirements would increase “clerical and tracking errors and delays,' which in turn would 'cause inadvertent terminations'."
The requirements for work and other "community engagement" were to take effect in Campbell County on Sunday, July 1.
The state is expected to appeal, and Bevin has said the issue will ultimately be decided by the U.S. Supreme Court. Bevin said in his executive order for the plan that if courts ruled against it and the state's appeals failed, six moth later the Medicaid expansion would end.
Boasberg's decision is at https://ecf.dcd.uscourts.gov/cgi-bin/show_public_doc?2018cv0152-74.
from Kentucky Health News https://ift.tt/2ICvN4x - Health News
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