The Trump administration's efforts to push the poor toward self-sufficiency were dealt a blow Wednesday, when a federal judge ruledundermined the program's mission of providing health care for the needy. U.S. District Judge James E. Boasberg in Washington, D.C., blocked work requirements for low-income people in two states - Arkansas and .
Boasberg found the states' requirements pose numerous obstacles to getting health care that have gone unresolved by federal and state officials.
Boasberg sent the federal Health and Human Services Department back to the drawing board. But he stopped short of deciding the central question of whether work requirements are, a federal-state program that traditionally allows states broad leeway to set benefits and eligibility.
HHS approval of the Arkansas work requirement was "arbitrary and capricious because it did not address ... whether and how the project would implicate the 'core' objective of Medicaid: the provision of medical coverage to the needy," wrote Boasberg. The judge used similar language in his ruling on Kentucky.
Work requirements are already in effect in Arkansas, but Kentucky's program has been on hold because of lawsuits. Both states want "able-bodied" adults who get health insurance through the Affordable Care Act's Medicaid expansion to work, study, volunteer, or participate in "community engagement" activities.
About 6 in 10 adults on Medicaid already work in low-wage jobs, according to the nonpartisan Kaiser Family Foundation. Most of those not working cite reasons such as poor health, caring for an elder or child, or going to school.
Kentucky Gov. Matt Bevin quickly said his state would appeal. Bevin, a Republican, has threatened to end Kentucky's Medicaid expansion covering more than 400,000 people if work requirements are ultimately struck down.
"We have one guy in Washington who thinks he owns Kentucky," said Bevin, apparently referring to the judge. "We're right, and we'll be right in the end. And one guy can gum up the works if he wants, for a while, but this, too, shall pass."
Arkansas Gov. Asa Hutchinson, also a Republican, said he was disappointed by the decision and would publicly address it Thursday.
The GOP leader of the Arkansas Senate said he doesn't believe the ruling jeopardizes the future of Medicaid expansion, which covers more than 200,000 residents. About 18,000 have lost coverage as a result of the work requirements.
"I don't think there's any reason for the state to panic," said Senate President Jim Hendren, who's also the governor's nephew. "This is another obstacle in our path to try to do the best we can in Arkansas with the chips the federal government and the judiciary gives us."
Advocates for the poor say that Medicaid is a health care program and that work requirements have no place in it.
"It is nonsensical and illegal to add obstacles to Medicaid for large groups of individuals who are already working, or full-time health care providers for family members, or suffering chronic health matters," said Jane Perkins, legal director of the National Health Law Program, a nonprofit that sued the government.
"Work should not be a key to health care access."
There was no immediate reaction from the Trump administration, which supports work requirements for public programs across the government.
Last year, President Trump signed an executive order directing Cabinet agencies to add or strengthen work requirements for programs including subsidized housing, food stamps and cash welfare. HHS had already acted. Early in the administration, top officials invited states to apply for waivers that would allow Medicaid work requirements. Officials said they believed work was important to improving the health and well-being of Medicaid recipients.
Eight states have had their requests approved, though not all have put their programs in place, according to the Kaiser Family Foundation. Requests from seven others are pending. In one of those states, Virginia, a work requirement was key to getting the legislature to approve Medicaid expansion.
Nationally, some 12 million people are covered by the Medicaid expansion, a key component of former President Barack Obama's health care law, adopted by 37 states. Officials in GOP-led states have argued that work requirements and other measures such as modest premiums are needed to ensure political acceptance for the expansion.
Overall, Medicaid is the government's largest health insurance program, covering about 1 in 5 Americans, ranging from many pregnant women and infants, to severely disabled people and elderly nursing home residents.
Boasberg was nominated to the federal bench by Obama.