Judge blocks Kentucky’s Medicaid work requirement

Paper cutout family with house under a Medicaid umbrella

A federal judge has blocked Kentucky from instituting the first-ever Medicaid work requirements, which could be a potential setback to the Trump administration’s efforts to curtail the program which currently covers 70 million Americans. Read the judge’s ruling and an issue brief.

The Kentucky work requirement was approved in January, but it will now go back to the U.S. Department of Health & Human Services for further review. The plan included a requirement that certain adult Medicaid beneficiaries work or participate in a job-related activity for at least 80 hours per month or lose their coverage.

The South Dakota Medicaid program is also developing a waiver imposing work requirements on Medicaid beneficiaries. The South Dakota proposal, known as the Career Connector demonstration, is unique in that it would “test” the concept through a pilot program in Pennington and Minnehaha Counties. South Dakota’s plan also includes a strategy to avoid the so-called subsidy cliff, which has been a challenge for other waiver proposals.

Under South Dakota’s draft proposal participants would have to meet monthly milestones for job searching and skills training or work 80 hours or more a month. Enrollees that don’t meet their set goals would be subject to a corrective action plan and could lose their Medicaid coverage if they continue to fail to improve or meet those goals.

South Dakota has set itself apart from other states by outlining a plan to mitigate coverage losses as enrollees make more money. The state would place these individuals in a transitional coverage program and then move them into a premium assistance program that helps them purchase employer-sponsored health insurance or coverage through a Qualified Health Plan (QHP) on the marketplace.

The program will provide coverage assistance until they reach 150 percent of the federal poverty level for a year. At that point, they will be eligible for cost sharing assistance on the exchange.