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Medicaid work requirement in Kentucky gets second approval

After a judge blocked the attempt, CMS opened a new federal public comment period and says it believes KY HEALTH promotes the objectives of Medicaid

Susan Morse, Managing Editor

The Centers for Medicare and Medicaid Services has again approved a waiver for Kentucky to impose a work requirement for able-bodied Medicaid beneficiaries as a condition to receiving the benefit.

CMS previously, on January 12, approved Kentucky's request for a 1115 demonstration project waiver that included work requirements. 

However, in June, a district court judge blocked the attempt and sent the case back to the Department of Health and Human Services for review. HHS never adequately considered whether the work requirements would meet Medicaid's goal of providing medical assistance to its citizens, the judge said.

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CMS opened a new federal public comment period. In reaffirming the waiver for Kentucky, it said it believed the KY HEALTH program would likely promote the objectives of Medicaid.


Opponents to work requirements tied to Medicaid say it kicks people off of the rolls, reducing the number of people who have covered access to care. This increases uncompensated care for hospitals.

When it was implemented in Arkansas, it reportedly resulted in 8,500 fewer beneficiaries.


In early November, CMS approved a waiver for Wisconsin as the fourth state, joining Indiana, Arkansas and New Hampshire in using the requirement as an incentive for job training and employment.


Kentucky HEALTH applies to certain adult Medicaid beneficiaries under age 65 who do not qualify for Medicaid on the basis of a disability. This is primarily the Affordable Care Act expansion population and two groups of low-income parents and caretaker relatives, CMS said. Kentucky amended its state plan in 2014 to include Medicaid expansion under the ACA.

KY HEALTH is effective April 1, 2019 through September 30, 2023. 

It includes a substance use disorder program available to all Kentucky Medicaid beneficiaries and continued coverage to former foster care youth from another state, effective this year.