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Judge Strikes Down Medicaid Work Requirements in 2 States—Could N.H.’s Be Next?

State House dome
Dan Tuohy

The future of New Hampshire's Medicaid work requirement may be in doubt following a federal court decision that struck down similar work requirements in Arkansas and Kentucky.

In a ruling released Wednesday afternoon, a judge in the federal District Court of Washington D.C. called the decision by the Trump administration to allow the work requirements to go forward in those states “arbitrary and capricious.” 

At issue in the cases was whether the work requirements furthered the overall objectives of the Medicaid program.

The ruling raises questions about the fate of New Hampshire’s work requirement, which is the subject of a different lawsuit filed in the same federal district court.

The legal counsel for the plaintiffs in the Arkansas, Kentucky, and New Hampshire cases is being provided by the same group, the National Health Law Program.

Sarah Somers, an attorney with NHLP, says by allowing the work requirements to go forward, the Trump administration overstepped its authority.

“It is illegal to require Medicaid beneficiaries to work as a condition of them getting insurance coverage,” said Somers. “The purpose of the Medicaid Act is to provide coverage. There’s nothing in the Medicaid Act about requiring people to work.”

Somers says she hopes that in response to this ruling, New Hampshire will pause the program.

“The New Hampshire approval letter is awfully similar to the Kentucky and the Arkansas letters,” said Somers.

Meanwhile, Arkansas Governor Asa Hutchinson said in press conference Thursday afternoon that he disagrees with the federal court’s decision. He is urging the Trump administration to appeal the ruling.

“I remain fully committed to a work requirement and we are in this for the long haul because we believe it is the right policy,” said Hutchinson.

The Trump administration has not yet formally announced whether they are seeking an appeal.

Governor Chris Sununu issued a statement Thursday afternoon downplaying the significance of the decision as "only the first step in the process."

"We are confident that the work requirements approved for New Hampshire and every other state will ultimately be upheld," Sununu's statement continued.

Sununu also promised to vigorously defend New Hampshire's work requirement.

"We will do everything we can to defend New Hampshire’s bi-partisan Medicaid program from those who are attempting to undermine it, including intervening in the lawsuit to assert our state’s interests,” said Sununu in a written statement.

Just hours after Sununu's statement was released, Democrats in the state Senate passed a bill that would roll back some elements of the work requirement by adding exemptions and making it easier for students to comply with the 100 hour per month threshold, among other measures. The bill also includes a provision that would automatically suspend the work requirement if more than 500 people were to lose coverage as a result of non-compliance.

Republicans see the bill as a betrayal of the bipartisan compromise which reauthorized New Hampshire's Medicaid expansion last year.
New Hampshire received federal permission to implement the work requirement in November. Since then, state officials have been gearing up for its full launch this summer. Once in effect, it could apply to more than 20,000 people in New Hampshire.

Note: This story has been updated to include today's vote in the Senate.

Jason Moon is a senior reporter and producer on the Document team. He has created longform narrative podcast series on topics ranging from unsolved murders, to presidential elections, to secret lists of police officers.
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