The Trump administration has lost another court battle over Medicaid work requirements, as a federal judge blocked New Hampshire's "community engagement" waiver on Monday.
"The issues presented in this case are all too familiar," U.S. District Judge James Boasberg write in his decision brief, referring to his previous decisions. "In the past year or so, this Court has resolved challenges to similar programs in Kentucky and Arkansas, each time finding the Secretary's approval deficient."
The judge has vacated the Trump administration's approval of New Hampshire's desire to demand 100-hours per month of employment or community service from "able-bodied" adults enrolled in its Medicaid program, Granite Advantage.
He said his remedy won't disrupt Medicaid operations since New Hampshire hasn't fully implemented these requirements and has actually continued modifying its Medicaid program since the CMS approved is "community-engagement requirements" waiver.
In his brief, the judge doubled down on the state and HHS for their seemingly contradictory position on work requirements as an effort to save money in Medicaid.
"The state has represented that it neither intends for the demonstration to reduce costs nor expects it to do so," Judge Boasberg wrote.
He noted that during oral arguments New Hampshire's attorneys said the state does not have the same financial worries about its Medicaid program as Kentucky, and that its goal with the work requirements demonstration is not to cut the state's health spending.
This goes against the Trump administration's argument that the work requirement addendum would help stretch New Hampshire's Medicaid dollars, the judge continued.
"The glaring disconnect between the secretary's position and New Hampshire's raises substantial questions about how the agency came to believe the program would improve the state's fiscal circumstances, underscoring the need for reasoned analysis of this issue," Boasberg said.
Medicaid beneficiaries who were subject to the state's work requirements were supposed to start reporting their work or volunteer hours in June. New Hampshire was set to start cutting those who didn't comply by August.
But earlier this month, state health department Commissioner Jeffrey Meyers told GOP Gov. Christopher Sununu and the legislature in a letter that he would delay the community engagement provisions until the end of September. He cited pragmatic considerations, including the need for IT system updates and testing.
The commissioner also said the health department, as of July 8, didn't have compliance information for nearly 17,000 Medicaid enrollees who would be subject to the work requirement. He said of the more than 50,000 phone calls the department made to beneficiaries, fewer than 10% answered the phone and only 10% of those were able to identify themselves so officials could discuss health information.