Questions raised about legality of work requirements

Ricardo Alonso-Zaldivar
 Associated Press

WASHINGTON (AP) — The Trump administration’s new policy allowing state work requirements for Medicaid recipients is legally questionable, more than two dozen Democratic senators said Thursday, framing an argument likely to be aired in court.

The senators’ letter to acting health secretary Eric Hargan reads like a memo to legal groups preparing a court challenge on behalf of low-income Medicaid beneficiaries.

Last week the administration unveiled its policy letting states to impose Medicaid work requirements, and promptly approved a waiver request by Kentucky to carry out its version.

A copy of the letter was provided to The Associated Press.

When President Barack Obama was in office, congressional Republicans backed litigation to tie up parts of the Affordable Care Act, and now Democrats seem to be following a similar playbook with President Donald Trump's health care agenda.

The letter, drafted by Sen. Ron Wyden, D-Ore., said work requirements “contradict the plain text and purpose” of the Medicaid statute, as well as “Congress’s longstanding intent for the Medicaid program.” The letter was signed by 29 senators ranging from liberals like Vermont independent Bernie Sanders and Elizabeth Warren of Massachusetts to moderates like Pennsylvania’s Robert Casey and Tom Carper of Delaware.

The senators cited the Medicaid law as specifying that the purpose of the program is to “provide medical assistance (to eligible individuals) whose income and resources are insufficient to meet the costs of necessary medical services,” as well as rehabilitation and other services to “attain or retain capability for independence or self-care.”

Although the Medicaid law allows waivers for states to experiment with different ways of providing services, a work requirement could defeat the central purpose of the statute, since people could lose their health care for failing to fulfill the obligation, they argue.

“Harmful ideological policies such as work requirements, mandatory drug testing, time limits, onerous cost-sharing and the like undercut and exceed the statutory authority provided” for the Department of Health and Human Services to grant Medicaid waivers, the letter said.

Such proposals “clearly undermine the purpose of the Medicaid Act, prioritizing ideology over health,” the letter concluded, asking the Trump administration to reconsider its policy.

Medicaid is a federal-state collaboration covering more than 70 million low-income people, making it the largest government health insurance program.

Beneficiaries range from many newborns to elderly nursing home residents. Under Obama, the program was expanded with an option for states to extend coverage to low-income adults, many of whom are already working in jobs that don’t provide health insurance.

There was no immediate response from the Trump administration. In laying out the new policy, Medicare and Medicaid administrator Seema Verma said studies show that work is associated with better health, so that encouraging work is a legitimate goal for the program.

Critics question those studies, arguing that they show healthy people tend to be working, not that work makes people healthy.

The National Health Law Program, a nonprofit providing legal services to low-income people, is considering a lawsuit to block work requirements from taking effect.

Earlier this week, Kentucky's GOP Gov. Matt Bevin said he will end Medicaid benefits for more than 400,000 people covered by the state’s program expansion if the courts overturn the new work requirements. That’s possible because the Medicaid expansion is optional for states.