An Old Movie: New Hampshire’s Medicaid Work Requirement Faces Same Fate as Others

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A federal district court has vacated New Hampshire’s Medicaid work and community engagement requirements—just a few months after the policies were implemented. Stating “we have all seen this movie before,” the court’s decision is consistent with its two previous rulings that halted similar policies in Arkansas and Kentucky. Once again, the court found that work and community engagement requirements do not support the basic objective of the Medicaid program—to provide health care coverage to low-income individuals. The court also determined that the state failed to consider the impact of the policy on Medicaid enrollment.

Here’s what you need to know about New Hampshire’s work requirement:

The Requirement

In November 2018, New Hampshire received federal permission to amend its section 1115 waiver to, among other things, condition Medicaid eligibility on participation in work or community engagement activities. Under the policy, non-disabled adults ages 19 to 64 would be required to complete at least 100 hours of work or community engagement activities per month, or demonstrate that they qualified for an exemption. Those not fulfilling the work or community engagement requirement and lacking the exemption would be considered noncompliant and therefore face losing Medicaid coverage.

In March of this year, advocates filed a lawsuit in federal court arguing that the federal government exceeded its legal authority in approving New Hampshire’s work or community engagement requirements.

Rocky from the Start

In June, with the lawsuit pending, New Hampshire moved forward with implementation of its work requirement. Disenrollment for noncompliance was set to begin in August, with an estimated 17,000 Medicaid beneficiaries facing loss of coverage.

The prospect of having to disenroll such a large number of beneficiaries within a month of implementation led state officials to seek permission to delay the penalty until more public outreach and education efforts could get underway. Following the request, in early July Governor Sununu delayed the imposition of penalties for noncompliance. Then on July 29 court ruling vacating the policy was issued.

The Road Ahead

The court rulings in the Arkansas and Kentucky cases have been appealed, and the federal government is likely to appeal the New Hampshire decision as well. Meanwhile, state section 1115 waiver activity with work requirements continues.

In light of the court’s consistent stance against upholding work requirements, it remains to be seen whether the Centers for Medicare & Medicaid Services will continue to authorize similar policies and whether states with approved work requirements will move forward with implementation—setting the stage for a replay of the same old movie.