WASHINGTON, DC (July 9, 2019) – Two “friend of the court” briefs filed with the U.S. Court of Appeals for the District of Columbia Circuit urge the court to uphold two lower court decisions that block Medicaid work requirements in Kentucky and Arkansas. If Medicaid work experiments are allowed to go forward, as many as 184,000 people in Kentucky and Arkansas alone would lose coverage. Across nine states whose experiments have received approval, an estimated one-quarter to one-third of Medicaid beneficiaries subject to the experiment could lose coverage in the first year alone, a number that could climb to as high as 811,000 people. Health policy scholars say that despite losses of this magnitude, Medicaid work requirements lead to neither more work nor access to workplace health benefits. Furthermore, the scholars argue, the administration has permitted high-risk experiments to proceed without the essential evaluation step required under its experimental authority.
The Kentucky case on appeal represents the second time a federal court has vacated the U.S. Department of Health and Human Services (HHS) Secretary’s approval of Kentucky’s Medicaid work experiments. The court’s decision vacating the Arkansas approval came only 10 months after the experiment was launched, and more than 18,000 state residents lost Medicaid.
Health policy experts around the country are closely watching the case. So far, the HHS Secretary has approved seven additional state work experiments; seven other states have applications pending with the administration, and an additional six states appear to be moving in the direction of proposing a Medicaid work experiment.
Sixty-three public health scholars, including 10 deans of schools of public health, public policy and public administration, filed a “friend of the court” brief in both appeals. Both briefs discuss the ways in which the administration’s actions contravene the special demonstration authority under which these experimental projects will take place. Both briefs also present extensive evidence regarding the degree to which the design of the experiments can be expected to lead to widespread loss of coverage and the degree to which the administration failed to consider the experiments’ impact on beneficiaries and safety net health care providers serving entire communities.
“These demonstrations were intended to support experiments that promote Medicaid's core objective of providing medical assistance to those who need it,” said Sara Rosenbaum, JD, the Harold and Jane Hirsh Professor of Health Law and Policy at the George Washington University Milken Institute School of Public Health (Milken Institute SPH), one of the scholars represented in the amicus briefs. "These experiments do the opposite - they threaten to strip hundreds of thousands of beneficiaries of Medicaid coverage while endangering health care on a community-wide basis."
The public health scholars argue that the Kentucky and Arkansas demonstrations only serve to reduce Medicaid coverage and create barriers to eligibility. They cite a new Commonwealth Fund analysis by researchers at Milken Institute SPH which finds that if the Kentucky and Arkansas demonstrations are permitted to go forward, between 128,000 and 184,000 people would lose Medicaid coverage; with implementation of approved demonstrations in all states to date, between 589,000 and 811,000 beneficiaries stand to lose coverage in the first year alone.
“The evidence is compelling that the policies will cause large numbers of Medicaid beneficiaries to lose insurance coverage, but will not improve either employment or health,” said Leighton Ku, PhD, MPH, the lead author of the analysis and a professor of health policy and management at Milken Institute SPH. “It is alarming that the U.S. Department of Health and Human Services ignored the information available to it, despite the earlier court decision.”
The Trump Administration minimizes the impact of these work demonstration projects by saying that people who lose Medicaid would be able to access care at community health centers. But a separate study conducted by researchers at the Geiger Gibson/RCHN Community Health Foundation Research Collaborative at Milken Institute SPH finds that in 7 affected states with approved work experiments that were the focus of the analysis, between 104,000 and 147,000 health center patients could lose access to care as the number of patients with Medicaid coverage declines and affected health centers lose between $89 million and $125 million in patient care revenue.
The amicus briefs can be accessed here and here. The GW administrators and faculty who signed on to the briefs did so in their individual capacities and not on behalf of GW. The deans and scholars were represented by Edward T. Waters, Phillip A. Escoriaza, and Christopher J. Frisina of the Washington, D.C., law firm of Feldesman Tucker Leifer Fidell, LLP.