State to appeal Medicaid expansion work requirement ruling

Monitor staff
Published: 7/31/2019 7:24:37 PM
Modified: 7/31/2019 7:24:27 PM

New Hampshire will appeal a federal court’s decision to dismantle the state’s Medicaid expansion work requirement, a spokeswoman for the state’s Department of Justice said Wednesday, adding to what is expected to be a long legal road.

In a decision Monday, the U.S District Court for the District of Columbia vacated the federal waiver allowing the requirement to take effect. Judge James Boasberg found that the federal government had exceeded its authority when it allowed New Hampshire to tack a work requirement onto its expanded Medicaid program.

That ruling was an instant blow to the work requirement, which first took effect in June but was delayed until October after widespread difficulties in reaching out to participants. Under New Hampshire’s requirement, recipients of expanded Medicaid – who include everyone making up to 138% of the poverty level – were required to log at least 100 work or community engagement hours per month, or ask for an exemption.

An appeal by the state and the federal government comes as officials anticipate a fight up to the U.S. Supreme Court over New Hampshire and other states’ attempted work requirements.

Sununu has supported an appeal. On Monday, the governor called the ruling “only the first step in the process,” adding that “we are confident that New Hampshire’s work requirement will ultimately be upheld.”

A spokesman for the governor said Wednesday that the office “would support that course of action.”

The appeal advances a fierce, years-long fight over a piece of New Hampshire’s Medicaid expansion law, which provides health insurance for around 50,000 people in the Granite State.

Plaintiffs in the lawsuit, who include New Hampshire Legal Assistance and the National Health Law Program, say the work requirement would threaten the health care coverage of thousands who might not be able to come into compliance.

Supporters of the requirement said that it was a reasonable use of the federal government’s waiver abilities and argued that increased employment was beneficial to health and wellness.

But Boasberg’s decision requires The Centers for Medicare & Medicaid Services (CMS) to go back to the drawing board when considering its approval of New Hampshire’s waiver request.

What happens next is less clear. New Hampshire is one of three states to have had its Medicaid expansion work requirement tied up in federal court. Kentucky and Arkansas have both had their attempts to impose requirements vacated by the same court and judge that quashed New Hampshire’s rule.

Now, those two states are arguing in Washington, D.C. Circuit Court on appeal; oral arguments have been set for October. New Hampshire’s appeal could be joined with the others, or argued separately.

Meanwhile, CMS could attempt to comply with the directives of the order and issue a new approval of New Hampshire – though that path could require a new application and hearing process by New Hampshire officials.

A spokesperson for CMS was not available Wednesday afternoon.

For New Hampshire Department of Health and Human Services (DHHS) Commissioner Jeffrey Meyers, the next few days and weeks are a waiting game. There is no clear avenue for how the state might reapply for the program even if it decided to, given the court order, Meyers said. At the same time, a law passed this year requires by law that Meyers request an amendment to New Hampshire’s program, adding further uncertainty.

But for now, the program is halted, Meyers said.

For weeks, a team of 50 officials from DHHS and the Department of Employment – about 25 employees in each department – has been attempting to get in touch with Medicaid expansion recipients to tell them about the new work reporting requirements.

As of this week, the door knockers had reached only 2,000 of about 17,000 people who had not yet complied and were at risk of losing coverage, Meyers said. That came after tens of thousands of phone calls – many of which were unsuccessful or not answered, the department said – as well as pamphlets and information session.

With the program vacated, all of those outreach attempts have stopped immediately, Meyers confirmed. The Department plans to send out one final letter to everyone in the program to inform them of the court decision, Meyers said.

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