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Federal Judge Blocks N.H.'s Medicaid Work Requirement


A federal judge has blocked the implementation of New Hampshire's Medicaid work requirement.

The ruling reverses a move by the Trump administration that allowed New Hampshire to impose a 100-hour-a-month work requirement on beneficiaries of expanded Medicaid. 

(Scroll down to read the ruling.)

The ruling came from U.S. District Court Judge James Boasberg, who previously ruled against similar work requirements in Arkansas and Kentucky. In his decision blocking New Hampshire’s work requirement Boasberg wrote, "we have all seen this movie before."

Boasberg ruled that the federal government failed to adequately consider the potential for the work requirement to kick significant numbers of people off of Medicaid. He points out that neither the Trump administration nor the state of New Hampshire offered an estimate of the number of people who would lose their health insurance under the program.

“That omission is particularly startling in light of information before the Secretary about the initial effects of Arkansas’s markedly similar project — namely, that more than 80% of persons subject to the requirements had reported no compliance information for the initial months, and nearly 16,900 people had lost coverage,” wrote Boasberg.

Dawn McKinney with New Hampshire Legal Assistance, which served as co-counsel to plaintiffs in the case, reacted to the ruling on Monday afternoon.

“This is huge. It’s going to give our clients and thousands of Granite Staters peace of mind,” said McKinney. “I think a lot of people will sleep better tonight knowing that their health insurance isn’t at risk.”

Lawyers for the Trump administration argued the work requirement would further the aims of Medicaid by making the program more fiscally sustainable.

Boasberg rejected that argument writing, the U.S. Department of Health and Human Services “made no finding that Granite Advantage would save the state ‘any amount of money or otherwise make the program more sustainable in some way.”

Attorneys for the state of New Hampshire intervened in the case to defend the work requirement. In a written statement Gov. Chris Sununu said

“The decision today is disappointing but not surprising given this judge’s past rulings.”

Signaling a potential appeal, Sununu went on to call the ruling “only the first step in the process, and we are confident that New Hampshire’s work requirement will ultimately be upheld.” Sununu also asserted that New Hampshire was implementing the work requirement “in a manner that would ensure that no individual would inappropriately lose coverage.”

State officials paused the work requirement earlier this month because two-thirds of beneficiaries, nearly 17,000 people, were in non-compliance and at risk of losing their health insurance.

Boasberg’s decision offers state officials and the Trump administration two paths to continue pursuing the Medicaid work requirement. Either the Trump administration can repeat the administrative process of examining New Hampshire’s work requirement in a way that satisfies Boasberg’s ruling, or they can appeal the ruling.

Both Arkansas and Kentucky’s Medicaid work requirements are currently on appeal in federal circuit court. Rulings in those cases could come by the end of the year. The decisions in those cases will offer an indication of the likely fate of New Hampshire’s work requirement.

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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