After federal court blocks Kentucky’s Medicaid work requirements, Trump admin reapproves them

By the state's own estimate, nearly 100,000 low-income people will lose health coverage.

Kentucky Gov. Matt Bevin speaks as Donald Trump listens.  (Photo by Mark Wilson/Getty Images)
Kentucky Gov. Matt Bevin speaks as Donald Trump listens. (Photo by Mark Wilson/Getty Images)

The Trump administration permitted Kentucky again to require low-income people to report at least 80 hours of work or community engagement per month or lose coverage for six months, even after a federal judge blocked the state’s proposal over the summer.

A U.S. district court judge called Kentucky’s proposal, which includes work rules, “arbitrary and capricious” in June, noting that officials never adequately considered whether the plan actually provided coverage to residents — a central objective of Medicaid. Indeed, the policy was at odds with the Medicaid program, and the state itself said nearly 100,000 low-income people would drop coverage after five years. (Advocates say this is a conservative estimate too.) The judge gave the Trump administration and the administration of Kentucky Gov. Matt Bevin (R) the opportunity to strength their justification.

The Trump administration did not appeal that June ruling and, instead, reopened Kentucky’s proposal for comment on how to proceed. The overwhelming majority of formal, stakeholder comments were negative and opposed work requirements. While the proposal didn’t change much, federal health officials reapproved it Tuesday night.

In addition to conditioning eligibility on reported work, Kentucky is also requiring beneficiaries to pay premiums ($1 dollar per month but cannot exceed 4 percent of the household income). Fail to pay premiums for 60 days and the state withholds health care. The state is also testing a six month non-eligibility period if residents fail to submit the appropriate paperwork during the annual redetermination process. Kentucky will exempt a few groups, like pregnant people, from the new rules.


There are a couple of new additions to the proposal, like Kentucky now has to submit an implementation proposal to the federal government, which wasn’t required before.

Federal officials warned they would not be discouraged by the outpour of criticism.

“I have heard the criticism and felt the resistance, but I reject the premise and here is why: It is not compassionate to trap people on government programs or create greater dependency on public assistance as we expand programs like Medicaid,” said federal Medicaid official Seema Verma in September.

Kentucky’s new rules will go into effect in April, barring any lawsuits. Law groups who sued the Department of Health and Human Services (HHS) over Kentucky’s initial proposal appear set on fighting this one.

“We are disappointed that HHS is uninterested in facts and evidence developed in comments showing that a work requirement will result in individuals and families eligible for Medicaid losing that coverage, while increasing administrative costs of the program,” said Kentucky Equal Justice Center’s Senior Litigation and Advocacy Counsel Ben Carter in a statement. “As we have long-argued, Medicaid expansion in Kentucky is improving lives and health outcomes. The Bevin and Trump administrations are endangering that progress with repeated attempts to undue this work.”


“Same thing, different results: that’s what HHS hopes to achieve by reapproving Kentucky’s Medicaid waiver application without any meaningful changes,” said Sam Brooke, deputy legal director for the Southern Poverty Law Center, in a statement. “We intend to pursue the next court challenge as vigorously as we have before when we won. We have no reason to believe that the results will be any different this time.”

National Health Law Program, among the groups who sued the Trump administration on behalf of Kentuckians on Medicaid, is also suing over Arkansas’ Medicaid work requirements. Unlike Kentucky’s, Arkansas’ policy went into effect over the summer and already officials booted more than 12,000 from Medicaid.