New Hampshire Proposal to Force Medicaid Recipients to Work Would Result in Thousands Losing Health Coverage, Says Amicus Brief

May 22, 2019

WASHINGTON, D.C. (May 23, 2019) – A new “friend of the court” brief urges the U.S. District Court for the District of Columbia to strike down a New Hampshire experiment that would require Medicaid recipients to work at least 100 hours per month or lose their health coverage. The public health amicus brief calls New Hampshire’s Medicaid work experiment “arbitrary, capricious, an abuse of discretion and contrary to law.”

Kentucky was the first state to win Trump administration approval for its Medicaid work experiment project following its announcement in 2018 allowing such demonstrations under Section 1115 of the Social Security Act. The same federal court that will decide the New Hampshire experiment has previously barred similar but less restrictive experiments in Kentucky and Arkansas. 

“Like the others, New Hampshire’s demonstration threatens coverage for thousands of poor people. Its lack of any reasonable basis is especially striking in New Hampshire, whose unemployment rate, even among older workers, is virtually nonexistent,” said Sara Rosenbaum, JD, the Harold and Jane Hirsh Professor of Health Policy and Law at the George Washington University Milken Institute School of Public Health (Milken Institute SPH) and one of the health policy scholars represented by the brief. “Like Arkansas and Kentucky, the New Hampshire program lacks the requisite elements of sound social policy research; the administration has unlawfully deployed experimental authority simply to strip the poor of health insurance.”

The brief argues that the administration’s approval of the New Hampshire Granite Advantage work program ignored the harm that will result if the demonstration project is put in place. Milken Institute SPH researchers Leighton Ku, PhD, MPH, and Erin Brantley, MPH, estimate potential coverage losses of between 15,000 and 23,000 Medicaid recipients in the first year alone.

New Hampshire’s proposed work requirements are the harshest to date, according to the brief. In a state with one of the nation’s lowest unemployment rates and an economy with a large number of seasonal and part-time work, officials nonetheless require at least 25 hours per week of work, with an increasingly limited opportunity to make up for any hourly deficits before coverage ends and with no additional training or job search assistance. New Hampshire’s work experiment also targets beneficiaries through the age of 64, despite evidence that 70 percent of low-income adults ages 50 and older already are in only fair-to-poor health.

The Trump administration has instructed New Hampshire, like other work experiment states, to inform people losing their insurance that they can get free or low-cost care at community health centers.  But, the brief argues, the administration has ignored the experiment’s spillover effects on safety net providers as their patients lose coverage and service capacity drops. Milken Institute SPH researchers Peter Shin, PhD, MPH, and Jessica Sharac, MS, MPH, estimate that coverage losses among health center patients could lead to major capacity and staffing reductions – an estimated 2,500-patient capacity reduction, which translates into nearly 11,000 fewer patient visits per year.

“We remain concerned for people in the Granite state who will lose coverage as a result of the Medicaid work requirement: One person’s loss of coverage is one too many,” said Tess Stack Kuenning, president and CEO of Bi-State Primary Care Association, which represents New Hampshire’s community health centers. “The Granite Advantage Health Care Program is essential to ensuring access to comprehensive services including primary care, substance use treatment, hospital and specialty services as well as lab, x-ray and prescription medicines. People who qualify for this critical support should not be denied coverage. Our health centers will continue to work with patients to navigate the complexities of the work requirement to mitigate its effects on access to health care services.”

In addition to Milken Institute SPH, other universities represented in the brief are Boston University, New York University, University of Michigan and Saint Louis University.

The amicus brief can be accessed here. 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.