LEXINGTON, Ky. _ A federal judge has once again struck down Gov. Matt Bevin's tougher eligibility rules for people receiving health coverage through Kentucky's Medicaid program. The new rules were set to take effect next Monday.
U.S. District Judge James Boasberg in Washington, D.C., rejected Bevin's Kentucky HEALTH proposal and returned the matter to the secretary of the U.S. Department of Health and Human Services for more consideration. The states cannot refashion Medicaid in any way they choose, Boasberg wrote in an order handed down late Wednesday.
"As a consequence, once again finding the re-approval was both contrary to the (Affordable Care Act) and arbitrary and capricious, the court will vacate and remand to HHS for further review," Boasberg wrote.
Sixteen Kentucky Medicaid recipients sued the federal government in January to prevent Bevin from adding 80-hour-a-month work, study or volunteering requirements; premiums; monthly reporting duties; and six-month coverage lock-out periods for failing to cooperate for able-bodied adults who are enrolled in the state's $9.7 billion-a-year Medicaid program.
A similar group of plaintiffs successfully blocked Bevin's Kentucky HEALTH initiative last summer. However, in November, the U.S. Centers for Medicare and Medicaid Services re-approved Bevin's Medicaid waiver proposal with minor changes, prompting an amended lawsuit to be filed this year, again in Boasberg's court in Washington.
Among the outside groups that filed briefs against Bevin's plan in court were the American Medical Association, the American Psychiatric Association, the Catholic Health Association of the United States, the American Academy of Pediatrics, the American College of Physicians, AARP, the National Academy of Elder Law Attorneys, and the Disability Rights Education and Defense Fund.
In their briefs, the groups said tens of thousands of Kentuckians unfairly would be pushed out of Medicaid as the state charged premiums from people living near the poverty line; made them search for work or volunteer positions even in poor, rural communities where few opportunities exist; and required them regularly to report their shifting hours and wages to a state agency, or else be locked out of their coverage.
These critics have pointed to Arkansas, where 18,000 Medicaid recipients have lost their coverage since that state last year added work requirements and other rules similar to Bevin's proposal, most of them without finding jobs.
More than 1.3 million Kentuckians were enrolled in Medicaid last fall, about 30 percent of the state's population.
Insurance coverage for Kentuckians surged under the Affordable Care Act. The uninsured rate fell from 20.4 percent in 2013 to 7.8 percent in 2016, the nation's biggest decline, according to the University of Louisville's Commonwealth Institute of Kentucky. Most health researchers credit the decline to the decision by former Gov. Steve Beshear to expand Medicaid to Kentuckians living at or below 138 percent of the federal poverty level _ many of them working but without employer-provided insurance.
Bevin, who was elected to succeed Beshear in 2015, repeatedly has threatened to terminate Kentucky's expanded Medicaid for more than 400,000 low-income adults if the courts prevent him from going forward with the tougher eligibility rules of Kentucky HEALTH.
Bevin has promoted Kentucky HEALTH by saying that able-bodied adults on Medicaid will be healthier if they are engaged in their communities as workers, volunteers or students, and if they contribute toward the cost of their care. Monthly premiums would begin at $1 to $15, eventually topping out at $37.50.
"This idea that we are somehow punishing people _ that somehow this will be a detriment to people _ I think is a huge, huge misunderstanding of what people need, the dignity and the respect that comes from giving people an opportunity," Bevin told reporters last year.
The long-running battle over how Kentucky's expanded Medicaid program should be managed might be made irrelevant by another looming courtroom fight.
This week, President Donald Trump's administration filed paperwork in the 5th U.S. Circuit Court of Appeals arguing that the entire Affordable Care Act should be scrapped, including the section that allows states to expand their Medicaid programs to the working poor. If Trump and a coalition of Republican state leaders are successful in this case, an estimated 21 million Americans could lose their insurance, including those who receive federal subsidies for private plans and those covered by expanded Medicaid.
