Thread by @mmusumec

An appeals court has unanimously struck down #Arkansas’ Medicaid work requirements, ruling that the Trump administration’s approval was counter to #Medicaid’s statutory objective of providing affordable health coverage.

While today’s decision striking down #AR’s waiver doesn’t directly invalidate #Medicaid work requirement approvals in other states, it does signal that similar approvals are likely to be successfully challenged in litigation.

Today’s decision about the scope of the Secretary’s waiver authority also will be important in looking ahead to any potential challenges to CMS’s recent guidance inviting states to apply for #Medicaid block grant waivers.

In the Arkansas case, the court ruled that, while the Secretary has “considerable discretion” in approving #Medicaid waivers, that discretion is not without limits. Any waiver approvals must be demonstrations that promote program objectives.

The appeals court agrees with the district court that the #Medicaid statute “includes one primary purpose, which is providing health care coverage without any restriction geared to healthy outcomes, financial independence or transition to commercial coverage.”

The AR waiver approval is unlawful because the Secretary failed to consider the waiver’s impact on access to affordable coverage.

Congress articulated 1 primary purpose of #Medicaid, not “a laundry list.” Unlike the TANF or SNAP statutes, Congress has not conditioned #Medicaid eligibility on meeting a work requirement.

The Secretary explained how he thought the AR waiver would promote “an entirely different set of objectives” – but the court ruled that “the alternative objectives of better health outcomes and beneficiary independence are not consistent with Medicaid.”

The #NH appeal, in which the district court reached a similar conclusion, has been on hold at the DC Circuit, pending today’s decision. Applying the court’s reasoning today, it’s likely that the #NH waiver also remains unlawful.

The #IN and #MI waivers are currently being challenged in the district court. In both of those cases, HHS has said that a decision in the AR appeal that upheld the district court’s decision also would make those work requirements unlawful “absent further judicial review.”

HHS argues that other waiver provisions challenged in #IN and #MI such as premiums and healthy behaviors were lawfully approved and can survive even if the work requirement is vacated. This will be up to the district court to decide.

HHS or AR could ask for a review of today’s decision “en banc” before all the judges, not just a panel of 3. Or, they could ask the Supreme Court to take the case.

Today's unanimous decision declaring the Secretary's approval of #Medicaid work requirements in AR unlawful also is notable in that it was heard by a panel of judges that included both Republican and Democratic appointees and authored by an Republican appointee.