Judge rejects attempt to add work requirement to Medicaid

A federal judge has put Kentucky’s Medicaid work requirement on hold, ruling that the Trump administration cut too many corners in granting an Obamacare waiver to the state for its experimental policy.

Judge James E. Boasberg, an Obama appointee to the U.S. District Court for the District of Columbia, ordered the federal Health and Human Services Department to go back for a more thorough review of Kentucky’s proposal, saying he needs to prove the work requirement will help more people get medical coverage.

The ruling could derail a major push for states that, while eager to grab federal dollars to expand Medicaid, are also looking to advance conservative policies that would encourage people to get off Medicaid.

The ruling is also the latest in a series of rebukes on issues ranging from environmental policy to immigration by judges who say President Trump’s team is cutting too many corners in its zeal to advance its agenda.

In the Medicaid case, Judge Boasberg said the law requires the health secretary to take into account how any changes to states’ Medicaid systems would affect beneficiaries’ access.

“The secretary must adequately consider the effect of any demonstration project on the state’s ability to help provide medical coverage. He never did so here,” the judge ruled.

He also pointedly noted he was aware of Mr. Trump’s goal of repealing Obamacare, and cast the administration’s efforts to grant waivers as part of that agenda.

Kentucky’s work requirement was supposed to have taken effect Sunday. The judge’s late Friday afternoon ruling puts that on hold, and sends HHS Secretary Alex M. Azar II back to rethink the federal government’s approval.

“Medicaid matters, and today is a victory for Medicaid, Medicaid beneficiaries, and the rule of law,” said Jane Perkins, legal director of the National Health Law Program. “The Trump administration’s attempt to transform the Medicaid program through executive action has been restrained.”

The judge’s ruling suggests the administration could struggle to add work requirements by executive action.

But Congress could step in and add those requirements nationwide, or at least more explicitly grant states the power to experiment.

That movement is growing among congressional Republicans.