Kentucky Medicaid Enrollees Sue To Block Work Requirement Waiver

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Groups representing Kentucky Medicaid beneficiaries sued the federal government Wednesday to block the state from implementing its Medicaid waiver program that includes a work requirement.

The proposed class action complaint alleges the changes, which include premiums, cost-sharing and a controversial work requirement, will lead to substantial reductions in Medicaid coverage.

The CMS approved Kentucky’s Medicaid waiver application this month. The controversial work requirement means able-bodied beneficiaries will have to complete 80 hours per month of community engagement activities, such as employment, education, job skills training or community service to maintain their Medicaid eligibility.

More than 1 million Kentucky residents are Medicaid beneficiaries, and 15 were named plaintiffs in Wednesday’s suit.

Nine other Republican-led states are seeking to require some residents to participate in work, education or volunteer activities to receive and keep their Medicaid benefits.

The CMS released guidance earlier this month to help states reshape their Medicaid programs and include provisions like work requirements. CMS Administrator Seema Verma said at the time she believes the waiver approvals would prevail in litigation.

“The 1115 (statute) gives broad authority to the secretary to approve state experiments and programs that promote the objectives of the Medicaid program,” Verma said.

The CMS is expected to OK Indiana’s similar proposal soon.

Kentucky’s Republican Gov. Matt Bevin had threatened to end his state’s Medicaid expansion, which covers more than 400,000 low-income adults, if waiver opponents sued to halt the waiver program. Bevin’s office did not respond to a request for comment on the lawsuit or what he will do now.

Bevin has argued that people who receive public health benefits should be required to work, and that it will be better for their health.

The Medicaid beneficiaries’ lawsuit alleges that the Trump administration’s approval of the Kentucky waiver violates the HHS secretary’s authority because the waiver provisions are not consistent with the objective of the Medicaid statute, which is to furnish health coverage.

“The evidence shows that imposing a Medicaid work requirement gets it exactly backward, because having insurance and staying healthy enables people to work,” said Jane Perkins, legal director at the National Health Law Program, the lead attorney in the suit.

She criticized Bevins for threatening to end the Medicaid expansion if the suit was filed. “The threat by the governor to cut off insurance for 400,000 Kentuckians is alarming and hard-hearted.”

Meanwhile, a liberal advocacy group released an analysis Wednesday challenging claims by Kansas Republican Gov. Sam Brownback that his state’s proposed Medicaid work requirement would improve the health and financial well-being of low-income Medicaid recipients.

The Center on Budget and Policy Priorities’ report examined state-collected data on work requirements for families in the Temporary Assistance for Needy Families program, which provides cash benefits for very low-income people. The group found that the vast majority of families leaving the TANF program due to the work requirement did not find economic security as proponents in Kansas claimed.

Instead, the group said, these families were left without access to cash assistance for their families when they hit tough financial times. Although some families’ earnings rose after leaving TANF, most remained far below the federal poverty line.

The Kansas Department of Health and Environment, which runs the state Medicaid program, did not respond to a request for comment.

The Kansas Medicaid waiver proposal, called Kancare 2.0, would have Medicaid managed-care plans connect beneficiaries to jobs, educational services or employment training. Because the state has not expanded Medicaid and the income eligibility threshold is far below the federal poverty level, people who work even a part-time job at minimum wage might no longer qualify for Medicaid coverage.

“Those who work are healthier and achieve a greater well-being and self-sufficiency,” said Kansas Republican Lt. Gov. Dr. Jeff Colyer.

But the Kansas Hospital Association said in comments to the CMS that “making people ineligible for services through work requirements and time limits does not equate to self-sufficiency or earnings levels that would allow them to purchase health insurance.”

Critics, including many healthcare providers, say Medicaid work requirements will cause a significant number of people to lose access to healthcare, which will harm their health and make it more difficult for them to work. The Bevin administration itself projects that 95,000 fewer Kentuckians will have Medicaid coverage in five years due to the new requirements for premium payments, work and regular reporting updates on income.

While the CMS this month argued that requiring Medicaid beneficiaries to work or participate in other community engagement activities would improve their health, there’s no clear research evidence backing that position, according to a recent report by the Kaiser Family Foundation. The report said work requirements likely would cause many people to lose coverage because of the complex new state documentation and administrative processes involved.

In contrast to its new Medicaid work requirement, in the 1990s, Kentucky launched the so-called Ready to Work program for TANF designed to help low-income parents gain a post-secondary education. It provided supports such as transportation, child care and mentoring.

That voluntary educational approach has been more effective than a mandatory work requirement in helping low-income people move into decent-paying employment, said Rich Seckel, director of the Kentucky Equal Justice Center, who opposes the Medicaid requirement.

“The programs that really work empower the person to pursue something they’re interested in, with mentors,” he said. For the Medicaid work program, he added, “I’m not sure we have the elements on the most successful programs.”

  • TecumsehUnfaced

    “The programs that really work empower the person to pursue something

    they’re interested in, with mentors,” he said. For the Medicaid work
    program, he added, “I’m not sure we have the elements on the most
    successful programs.”

    Certainly not in the State House.

    ““Those who work are healthier and achieve a greater well-being and
    self-sufficiency,” said Kansas Republican Lt. Gov. Dr. Jeff Colyer.

    How the heck would he know? He doesn’t even understand that would depend on the work.

  • richardprofumo

    Kentucky plan is a sham! The state against the people!!!!!!!

  • First, there has to be a guaranteed right TO a job and enough jobs for all. There isn’t. Second, employers don’t accommodate people who have chronic health issues. I have Crohn’s disease (which means I frequently have to shit and it comes out like water). Other Crohn’s sufferers have been FIRED by employers for taking too many bathroom breaks – even though that’s a necessary workplace accommodation for someone with that disabling, and debilitating chronic and incurable disease.

    I also have extreme SUI as a direct result of pelvic floor injuries from sexual trauma as a direct result of having been trafficked as a homeless child when I was 23. The problems just from the SUI alone, which even the max absorbancy Depends sometimes fails to protect me from what would be horrific, humiliating (not to mention smelly and soaking wet) accidents in spaces where I wouldn’t be able to just duck into the shower to get cleaned up and have clean dry clothing to change into, is enough to render me unemployable. Not to mention dealing with a piss-soaked chair in a workplace cubicle that I would have no way to properly clean and deoderize (if that would even be possible).

    You find me a job I actually CAN do physically as a disabled 50 year old woman, where my health issues and disabilities won’t preclude success at keeping the job, and I will GLADLY go to work right the fuck now – because if anyone thinks for one second that it’s fun being poor with no income and no economic stability in life, I’ve got a bridge for sale for a wooden nickel to go with some beachfront property in the Sahara Desert.

  • Cynthia Lewis

    “You find me a job I actually CAN do physically as a disabled 50 year old woman, where my health issues and disabilities won’t preclude success at keeping the job, and I will GLADLY go to work right the fuck now” I suggested specific at-home work to you last year, that can be completed at any time of the day or night, as much or as little as you want or are able to do in a given time period, other than some very low minimums per several-month period. You rejected it as not paying enough (It paid $13 per hour when I did it, likely more now). I had suggested it in response to a post you made complaining of your inability to afford dental work. It may not have been high-paying or fulfilling, but it would have paid for that dental care.

    Your resume on LinkedIn claims that you are an accomplished computer programmer. There are telecommute and freelance jobs that you would be qualified for if you actually tried. I too am a middle-aged woman. I know there is discrimination, but I also know that there are plenty of middle-aged women who make their living as a programmer (I am one) and/or work from home (I did that too). Your attitude is so incredibly negative at this point that that is what’s holding you back the most. You are stuck in a mental loop and don’t apparently see how that’s not serving you.

    Based on your past responses to being challenged, I suspect you’ll have a set of defenses and rationalizations that will allow you not to look at the truth of what I’m saying. I still want to offer the feedback; perhaps someday you’ll have some insight into how to move forward (there ARE ways, and it doesn’t involve constantly reviewing your hurts and the world’s unfairness).

  • I AM working freelance jobs in the “gig economy” – and getting a whole hell of a lot of zero-hour contracts, and outlandish bs like people who want an entire F# desktop application built for only $50 – for something that takes at least a week to build. Gee, can YOU live on such a low income like that?

  • Sherwood Forrest

    Are you the same Cynthia Lewis who was a development director (fundraiser) for WPFW in the 90s.
    I can see how a hard-nosed ideology is necessary for that sort of gig. You are just as set in your ways as Jacqueline, but suppressing you empathy and higher consciousness. Why would you stray off your selfish path to criticize a victim? Is she your competitor? Are you still in the game?

  • Cynthia Lewis

    LOL. No idea what you are talking about. Why don’t you come out from behind your of fake identifty, or are you too lame to stand by your comments? Talk about lack of empathy, making ASSumptions about the character of someone you know nothing about and haven’t interacted with. I tried to help Jacqueline, off-site (as I often do–it’s those pesky HIGH empathy levels), only to hear a thousand more excuses for why she couldn’t take any opportunity offered to her. She is (or should I say, you are?) a professional victim at this point, invested in whining about her situation rather than doing the things that are available to remedy it.

  • Cynthia Lewis

    You’re right, I no longer care about your situation. I did, which is why I connected with you on LinkedIn and tried to help you by suggesting specific freelance work. I indeed *have* been poor and struggling, to the point of being evicted (twice). I know what it’s like to not be able to pay rent, to not afford food to eat. I guess you don’t remember speaking to me off-site, because we discussed these things, and more. I found you to be unreasonable and invested in your victim mentality. i also find you to be not a very nice human being at this point. I regret bothering to act on my sympathy with you previously.

  • Sherwood Forrest

    Fentanyl speaks.