Rosenbaum Parses the Expedited Appeal for Medicaid 1115 Work Experiments

The decision by the U.S. Court of Appeals for the District of Columbia on April 19 to grant the Trump Administration’s request for an expedited appeal of two cases challenging Medicaid work requirements inspired a recent blog in Health Affairs. In it, Sara Rosenbaum, JD, the Harold and Jane Hirsh Professor of Health Law at the George Washington University Milken Institute School of Public Health, shares her thoughts on what will happen to the cases involving the work requirements in Arkansas and Kentucky at the appeal stage.

In both the Gresham v Azar case involving Arkansas and the Stewart v Azar case involving Kentucky, the U.S. District Court for the District of Columbia concluded that the U.S. Department of Health and Human Services Secretary Alex Azar had acted unlawfully in approving the Medicaid 1115 experiments. Both states’ experiments impose multiple eligibility restrictions such as added reporting requirements, premiums, lengthy lock-out periods for non-compliance, and loss of retroactive eligibility.

As Rosenbaum explains, to assess the legality of a federal agency’s conduct, the D.C. Court of Appeals will follow the standard of review of the landmark Chevron USA v Natural Resources Defense Council case of 1984. She details the two-step process that review entails.

The blog also provides a review of the D.C. District Court’s decisions regarding the Medicaid 1115 experiments. “The court found [that] the agency essentially ignored, deflected or sidestepped the central issue of coverage losses and their impact compared to the gains to be made or else attempted to minimize the harm or offer conclusory statements regarding the value of work,” Rosenbaum observes.

In the blog, Rosenbaum also offers some thoughts on the Philbrick v Azar case challenging New Hampshire’s work experiment. She also points out that the U.S. Supreme Court “may well have the final say on 1115 and Medicaid before it is all over.”