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Medicaid Work Requirement Waivers Revoked in Michigan, Wisconsin

April 7, 2021, 7:35 PM

The Department of Health and Human Services broadened its attack on work requirements in state Medicaid programs, informing Michigan and Wisconsin that it is withdrawing approval for must-work provisions approved during the Trump administration.

The move came three weeks after the HHS took similar action against Medicaid work requirements in Arkansas and New Hampshire, and over a month after the department informed Michigan and Wisconsin officials that it had preliminarily concluded work and community-engagement requirements don’t promote the objectives of the Medicaid program.

Requiring poor adults to work as a condition of receiving health care would likely decrease Medicaid enrollment without increasing employment, the HHS said in the Tuesday letters.

“Research has been clear that Medicaid work requirements don’t actually support people’s efforts to become employed, but they are very effective in kicking people off coverage,” said Joan Alker, executive director of Georgetown University’s Center for Children and Families. “The unwinding can’t happen overnight, but the outcome is clear—states will not be kicking people off coverage for non-compliance with work requirements during the Biden administration.”

Appeal Unlikely

The states will have 30 days to appeal the determination before the HHS’s Departmental Appeals Board, but that development appears unlikely. Neither state chose to defend the work-requirement provisions in its Medicaid program to the HHS after the department warned in February that a re-evaluation was underway.

The 2018 gubernatorial elections in Michigan and Wisconsin also shifted control of the Medicaid program in each state from a Republican supporter of work requirements—Michigan Gov. Rick Snyder (R) and Wisconsin Gov. Scott Walker (R)—to a Democratic opponent—Michigan Gov. Gretchen Whitmer (D) and Wisconsin Gov. Tony Evers (D).

Representatives of the Michigan Department of Health and Human Services and the Wisconsin Department of Health Services didn’t immediately respond to requests for comment.

Supreme Court Review

Lawsuits testing whether work requirements in the Arkansas and New Hampshire Medicaid programs are permissible under the Social Security Act had been teed up for Supreme Court review in the current session, but recent orders from the court suggest that the cases may be dismissed.

The court removed the cases from the oral argument calendar March 11, and issued an order April 5 holding the cases in abeyance.

The Biden administration has asked the court to remand the cases to the HHS without issuing a ruling, and to throw out the lower court rulings invalidating the Trump-era proposals. The administration argues that the issue is no longer ripe for review in light of the effort it is undertaking to roll back work requirements administratively.

But Arkansas asked the court to keep the case and issue a ruling, and signaled in its filings that it is willing to fight for its work requirements. The administration’s effort to revoke prior approvals of work and community-engagement requirements will lead to a “cascade of litigation,” Arkansas said in a March 22 brief.

Georgia, too, has suggested it is willing to go to court to defend its Medicaid work requirements.

The HHS hasn’t yet revoked the Georgia provisions, but on Feb. 12 gave the state the same notice of preliminary disapproval that it sent to other states with work requirements.

Revoking Georgia’s work requirements would be “arbitrary and unlawful,” the state said in a March 12 reply to the HHS.

To contact the reporter on this story: Christopher Brown in St. Louis at ChrisBrown@bloomberglaw.com

To contact the editors responsible for this story: Fawn Johnson at fjohnson@bloombergindustry.com; Karl Hardy at khardy@bloomberglaw.com

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