NC Budget and Tax Center

Federal court strikes down Medicaid work requirements — this time in New Hampshire

On Monday, a federal judge overturned approval given by the U.S. Secretary of Health and Human Services that would have allowed New Hampshire to impose work-reporting requirements on Medicaid recipients. Such requirements are at odds with the objective of Medicaid to provide medical assistance, the judge stated, citing the experience in Arkansas where more than 16,000 individuals lost their Medicaid coverage.

“In short, we have all seen this movie before,” U.S. District Judge Boasberg stated in his decision. The same judge struck down similar waivers in Arkansas and Kentucky earlier this year.

Proponents of work-reporting requirements claim that they improve enrollee health and incentivize community engagement. However, the reality is that many low-income adults who need health coverage in order to enter the workforce lose coverage as a result of the requirements, thereby making it harder to manage their health needs.

Adults who meet exemption criteria are unaware that they do, or are unable to jump over the hurdles necessary to prove that they are exempt. Others don’t meet the narrow criteria for disability that would grant them an exemption. A recent study (summarized here) from Arkansas found that many of the individuals who lose coverage are actually meeting the requirements but are unable to report their hours for various reasons.

Our findings estimate that 88,000 North Carolinians could lose coverage due to work reporting requirements.

In addition to the harm they impose on Medicaid recipients, work reporting requirements are costly and complicated to administer. Modifying current systems to determine eligibility and exemption, creating and implementing ways for recipients to report work hours, and disseminating information about the new requirements as a condition of Medicaid coverage are just a few of the costly steps to administer and that require hiring additional staff.

The legal precedent supported by this latest federal court ruling should discourage states from following a similar path to Medicaid expansion with a waiver, given that they’ve been deemed illegal in three states so far. Instead, states should seek to increase access to Medicaid coverage through “clean” expansion and not by erecting barriers that create harm and unnecessary cost.

Suzy Khachaturyan is a Policy Analyst at the Budget and Tax Center, a project of the North Carolina Justice Center.

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