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On March 27, a federal court blocked both Arkansas and Kentucky from conditioning Medicaid benefits on work or state-specified work alternative activities. For Kentucky, it was a déjà vu decision: back in June of 2018, the same court blocked the state’s initial attempt to implement a similar policy. We discussed the first Kentucky case in an earlier post.
In reaching its latest decisions, the court stressed that imposing work or work alternative requirements on beneficiaries does not serve the primary objective of Medicaid: to provide access to health care to low-income people who are unable to afford it. Yet almost before the ink had dried on the Arkansas and Kentucky court decisions, the federal Centers for Medicare & Medicaid Services (CMS) gave Utah permission to move forward with, among other things, work and work alternative requirements in Medicaid—further muddying the waters. Thus, the issue continues to be fluid. At the same time, CMS also gave Utah permission to implement a partial expansion of its Medicaid program (at the state’s regular federal match rate) and to limit Medicaid enrollment of certain adult populations based on the state’s budget constraints.
Utah’s Work and Work Alternative Requirements
Beginning January 2020, Utah will be allowed to require a portion of its newly-approved adult Medicaid expansion population— adults ages 19 through 59 with income at or below 100 percent of the federal poverty level—to participate in four specified work alternative activities. Individuals who fail to complete all four of the requisite activities—including registering for work through the state’s computer system and applying for at least 48 jobs within three months of an eligibility determination—will lose their Medicaid coverage. Those working at least 30 hours per week are exempt from the work alternative requirement. Even though Utah’s policy has yet to take effect, concern persists that the requirements could result in significant coverage losses, as it did in Arkansas.
The Future of Work and Work Alternative Requirements Remains Unclear
Although court decisions block implementation of work or work alternative requirements in Arkansas and Kentucky, the ruling does not extend to states with similar policies. Thus, the future of work and work alternative requirements remains uncertain. In spite of the recent legal setbacks experienced by Kentucky and Arkansas, other states continue to seek federal approval of waivers that include work and work alternative requirements. More lawsuits are likely to ensue—so stay tuned.
 The Arkansas and Kentucky cases are being appealed in the D.C. Circuit Court.
Edem Hado is a policy research senior analyst at the AARP Public Policy Institute. Her areas of expertise include Medicaid, long-term services and supports, public health, and prevention.
Lynda Flowers is a senior strategic policy advisor at the AARP Public Policy Institute. Her areas of expertise include Medicaid, social determinants of health (including social isolation), oral health, and health prevention/promotion.