Blog: Coverage of Thousands on the Line as Court of Appeals Reviews Kentucky’s Section 1115 Case

By Morgan Birdy and Teodor Handarov

Sixty-three public health scholars, including 10 deans of schools of public health, public policy, and public administration, recently filed two amicus curiae briefs urging the U.S. Court of Appeals for the District of Columbia Circuit to uphold two lower-court decisions blocking Medicaid work requirements in Kentucky and Arkansas and prevent up to 184,000 Medicaid beneficiaries in those states from losing healthcare coverage in the first year of the experiment alone.

To date, the U.S. Department of Health and Human Services Secretary has approved seven state work experiments in addition to Arkansas and Kentucky. Similar experiments have been given a green light in Arizona, Indiana, Michigan, New Hampshire, Ohio, Utah and Wisconsin. Seven other states currently have pending applications, and an additional six states are developing Medicaid work experiment proposals.

Although only the Kentucky and Arkansas work experiments are before the D.C. Circuit Court, the briefs also cite to a new Commonwealth Fund analysis  that estimates that if all nine state with projects approved by HHS fully implement work requirements, the number of people who could lose Medicaid coverage could eclipse 800,000 in the experiments’ first year alone.

The Trump Administration and the states have consistently argued that those patients who cannot qualify for healthcare via those requirements would still have access to such care provided at community health centers. However, the brief also cites to a separate study published by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative, which estimates that across seven states with approved work experiments, between 104,000 and 147,000 health center patients could lose access to care, while health centers within those states would lose between $89 million and $125 million in patient care revenue.

The Kentucky case on appeal represents the second time a federal court has vacated the U.S. Department of HHS Secretary’s approval of Kentucky’s Medicaid work experiments. It follows a similar case in Arkansas, where the lower court’s decision to vacate the state’s work requirements approval came only 10 months into the experiment, and after more than 18,000 state residents had already lost Medicaid coverage.

The deans and scholars were represented by Edward T. Waters, Phillip A. Escoriaza, and Christopher J. Frisina of the Washington, D.C., law firm of Feldesman Tucker Leifer Fidell, LLP.

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