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Kentucky enrollees, advocates, file lawsuit against Medicaid work requirement

The suit claims CMS Administrator Seema Verma, acting HHS Secretary Eric Hargan and others bypassed legislative processes.

Susan Morse, Senior Editor

Fifteen Medicaid enrollees in Kentucky have filed a lawsuit in U.S. District Court in Washington, D.C. asking for class action status against the Trump Administration's new policy requiring able-bodied beneficiaries to work to receive benefits.

The suit against Centers for Medicare and Medicaid Services Administrator Seema Verma, acting Health and Human Services Secretary Eric Hargan and others, said the Executive Branch bypassed the legislative process to comprehensively transform Medicaid.

[Also: Republicans make changes to healthcare bill, soften blow for seniors while allowing Medicaid work requirements]

"This change will harm Kentuckians across the state--housekeepers and custodians, ministers and morticians, car repairmen, retired workers, students, church administrators, bank tellers, caregivers, and musicians--who need a range of health services, including check-ups, diabetes treatment, mental health services, blood pressure monitoring and treatment, and vision and dental care," the lawsuit said. "It's an unauthorized attempt to rewrite the Medicaid Act."

Earlier this month, CMS issued guidance on the Administration's work or community involvement requirements for able-bodied beneficiaries to receive Medicaid. This went with a Jan. 11 letter from CMS to state Medicaid directors announcing an intention to approve state waiver applications containing work requirements.

[Also: Montana's Medicaid work requirement program could be litmus test for other states]

The next day, on January 12, CMS granted such a waiver to Kentucky.

Nine other states have asked Washington for similar waivers. 

Kentucky Governor Matt Bevin had submitted the waiver in 2016 to implement Kentucky Health, a program requiring Medicaid enrollees to work to receive health insurance. 

Kentucky Health would charge premiums to individuals with household income below 150 percent of the federal poverty level, up to 4 percent of income, the lawsuit said, and impose cost sharing of $20 for emergency room visits.

The state estimated it would take 95,000 adults off of Medicaid enrollment and reduce payments by about $2.4 billion, the lawsuit said.

Kentucky implemented Medicaid expansion in January 2014. Bevin, who ran on a platform to end the Affordable Care Act's expansion of Medicaid in the state, was elected in 2015.

Medicaid expansion in Kentucky has been associated with a variety of positive health outcomes, including increased use of preventive services, decreased reliance on the emergency room, fewer skipped medications due to cost, lower out-of-pocket spending on medical services, and improved self-reported health, the lawsuit said. 

The lawsuit was submitted by the National Health Law Program in North Carolina, Kentucky Equal Justice Center and the Southern Poverty Law Center in Alabama.

The advocates ask the court to declare that the issuance of the Dear State Medical Director letter and Kentucky Health waiver application violates the Administrative Procedure Act, the Social Security Act and the Constitution.

Twitter: @SusanJMorse
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