"We agree with the district court that the alternative objectives of better health outcomes and beneficiary independence are not consistent with Medicaid", the court ruled in its 19-page opinion, authored by Judge David B. Sentelle, a Reagan appointee. They heard arguments on October 11. "It means that thousands of low-income people in Arkansas will maintain their health insurance coverage - coverage that enables them to live, work and participate as fully as they can in their communities".
A federal appeals court has struck down a Trump administration approval of a state plan to add work requirements to the healthcare program that helps with medical costs for some low-income people, known as Medicaid.
A study by researchers at Harvard University past year showed that when the requirements were temporarily in effect in Arkansas before a lower court ruling halted them, almost 20,000 residents lost their health coverage-while the employment rate also went down by 4%.
Kentucky, under a new Democratic governor, terminated the work requirements at the end of 2019 and asked to dismiss the case at the appeals court.
"The Secretary's approval of the Arkansas Works Amendments is arbitrary and capricious because it did not address-despite receiving substantial comments on the matter-whether and how the project would implicate the "core" objective of Medicaid: the provision of medical coverage to the needy", he wrote. But in 2010, Congress expanded the program to low-income adults that didn't fit the previous categories. ME abandoned the work requirement for its low-income health insurance program in January.
The federal government says the ACA authorized grants for states that give Medicaid recipients incentives for various "healthy behaviors" such as community engagement and financial independence. The state later reported more than 18,000 people dropped from the rolls, but it wasn't clear how many obtained other coverage.
One of the requirements the court noted received the most attention was for Medicaid recipients between 19 and 49, requiring them to "work or engage in specified educational, job training, or job search activities for at least 80 hours per month".
"We hope the federal government and the states will return to focusing on expanding coverage and access, so that everyone-regardless of economic status-can be healthy", said Sam Brooke, deputy legal director at the Southern Poverty Law Project.
What's next: The most likely next step is an appeal to the Supreme Court.
It isn't clear whether the justices would take the case.
The court found that it is "indisputably correct that the principal objective of Medicaid is providing health care coverage" and that work requirements for "able-bodied" people lack specific legal authorization.
Friday's ruling may serve as a warning for future approvals.
Critics of the temporarily-imposed restrictions, which the Trump administration has adopted in 10 states but which have faced legal challenges and have been halted across the country, applauded the challenge to what disability rights advocate and attorney Matthew Cortland called "work-or-die requirements". "But they probably won't".