Arkansas officials want the U.S. Supreme Court to revive the state's Medicaid work requirements, maintaining that the program was meant to test if it would improve health outcomes.
Although the U.S. Court of Appeals for the D.C. Circuit ruled that the work requirements weren't consistent with Medicaid's primary objective, Arkansas Attorney General Leslie Rutledge said no community engagement program would be able to meet that test.
"After all, all such requirements trade some risk of coverage loss to achieve healthier outcomes and independence," she wrote in petition for certiorari filed with the high court on Monday. "And under the court of appeals' logic, that will always be an impermissible tradeoff since Medicaid's sole objective is maximizing coverage."
Medicaid waivers for Arkansas and other states primarily required beneficiaries to work or volunteer in "community engagement" activities for 80 hours per month or risk losing their coverage.
Rutledge highlighted several other Medicaid pilot programs that used incentives to promote better beneficiary health, including smoking cessation and weight loss incentive experiments. She also pointed to previous Supreme Court decisions that acknowledged helping people avoid Medicaid assistance is an objective of the program.
"If Congress thought so highly of healthy-behavior-incentive experiments that it mandated the secretary try some, surely the secretary at least has the discretion to try others," she wrote.
Ultimately, the court should have weighed the benefits of better health outcomes against the potential of smaller Medicaid rolls, according to Rutledge.
The D.C. Circuit opinion in February said the lower court was right to toss Kentucky and Arkansas' work requirements. "We agree with the district court that the alternative objectives of better health outcomes and beneficiary independence are not consistent with Medicaid," the opinion said.
But Rutledge argued in her petition that the D.C. Circuit opinion rested on an esoteric section of the Social Security Act that focused on congressional appropriations rather than guidance for the HHS secretary on how to weigh Medicaid experiments.
At the time the work requirement went into effect in 2018, approximately 250,000 people were enrolled in Arkansas Works, the state's Medicaid expansion program. By December, 18,000 people were disenrolled. A study published in the New England Journal of Medicine in June 2019 found the self-reported uninsured rate rose from 10.5% to 14.5% from 2016 to 2018 in Arkansas.
A spokesman for Arkansas Gov. Asa Hutchinson said at the time that 15,000 Medicaid enrollees had found jobs during that period.
So far, 18 states have proposed Medicaid work requirements in some form, but many have been put on hold as Arkansas' and Kentucky's initiatives wend their way through the courts.
"Under the court of appeals' decision, that flexible waiver authority to test policies that may enhance the health and welfare of a state's citizens—and ultimately the nation's—would become a one-way ratchet, serving no purpose but to 'experiment' with means of increasing coverage," the petition said.