[MM Curator Summary]: Ruh-roh.
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A federal judge has reinstated a Medicaid work requirement program in Georgia, saying that the Centers for Medicare and Medicaid Services, under the Biden administration, unfairly struck down the program that was first approved by the Trump administration.
CMS said last year it was revoking the work requirement, as well as a proposal to charge some Medicaid recipients monthly premiums. That prompted Georgia officials to sue, saying the agency lacked the authority to rescind the provision.
U.S. District Judge Lisa Godbey Wood issued the ruling on Friday, saying CMS’ decision was “arbitrary and capricious.” She said the agency measured pathways against a baseline of full Medicaid expansion rather than taking the demonstration on its own terms.
Wood also said CMS violated federal law by not engaging in reasoned decision-making, and failed to adequately explain why it changed course from the previous administration’s approval. She added that rescinding the approval may mean less Medicaid coverage in the state.
CMS does not comment on litigation as a matter of policy, but said last year that similar work requirements in other states had created confusion and hardship for Medicaid beneficiaries, with more than 18,000 losing coverage in Arkansas upon implementation of that state’s work program.
Georgia’s plan was to add an estimated 50,000 low-income and uninsured residents to the Medicaid rolls within two years, with the requirement that new Medicaid recipients would need a minimum number of qualifying hours through work, job training, education or volunteering.
Georgia Democrats have said full Medicaid expansion would cover hundreds of thousands of people at a much lower cost to the state, owing to expansion options under the Affordable Care Act, with the federal government picking up 90% of the cost of expanding the program to adults who make up to 138% of the federal poverty level.
In a recent Tweet, Georgia Governor Brian Kemp said the state’s plan “would better serve Georgians than a one-size-fits all Medicaid expansion.”
WHAT’S THE IMPACT
CMS began implementing work requirements for Medicaid coverage four years ago, a move opposed by those who said it would kick many receiving coverage off of Medicaid’s rolls.
In order to qualify for the program, individuals must comply with specific requirements, including participating in 80 hours of work monthly, or other qualifying activities. Most people with income between 50% and 100% of the FPL would be required to make initial and ongoing monthly premium payments.
Applicants and beneficiaries with disabilities who require reasonable accommodation will have options available to complete and report their qualifying activities and hours. The state is providing support to those not already working in order to encourage and enable those beneficiaries to obtain employment and take part in other education and job-supporting activities.
THE LARGER TREND
The Biden administration first began taking steps to roll back Medicaid work requirements in 2021, citing the economic and health impacts of the COVID-19 pandemic, which it said could make it more difficult for Medicaid recipients to fulfill the requirements.
“Uncertainty regarding the current crisis and the pandemic’s aftermath, and the potential impact on economic opportunities (including job skills training and other activities used to satisfy community engagement requirements, i.e., work and other similar activities), access to transportation and to affordable child care have greatly increased the risk that implementation of the community engagement requirement approved in this demonstration will result in unintended coverage loss,” CMS said in letters to states at the time.
Hospitals in states that implement Medicaid work requirements could see their Medicaid revenues decrease by as much as 21%, their uncompensated care costs increase as much as 133% and their operating margins fall by upward of 2%, according to estimates by The Commonwealth Fund.