The 48-page Kentucky opinion is the more emphatic of the two rulings, since the judge walks through the reasons he remains unpersuaded by even a second set of arguments by the administration as to why the program should be allowed to go forward. Hutchinson wants an appeal of that ruling.
Arkansas and Kentucky are among eight states that received approval to require many Medicaid recipients to work, take job training or participate in other "qualifying activities". The Republican governor said defunding it would mean giving up the fight over the work requirement.
Those who support imposing work requirements on Medicaid beneficiaries have argued that they help people climb out of poverty and improve their financial independence. Having to meet and report arbitrary work requirements to keep their Medicaid coverage could be especially challenging for these patients. The blind? All but 100 people now on its Medicaid rolls?
Boasberg, of the District of Columbia district court, called the Department of Health and Human Services" decision to approve the requirements "arbitrary and capricious because it did not address. whether and how the project would implicate the "core' objective of Medicaid: the provision of medical coverage to the needy". That's the health insurance plan for many low-income people. It's responsible for adding some 12 million people to the Medicaid rolls in the 37 states that accepted the expansion. Officials in GOP-led states have argued that work requirements and other measures such as modest premiums are needed to ensure political acceptance for the expansion. Republican Gov. Matt Bevin has been trying to implement the new rules since January 2018, when he first got permission from the Trump administration to implement them. That could strip 450,000 people of coverage.
"Every one of the able-bodied people taking (Medicaid), is taking it right out of the hands, right out of the mouths and right out of the pockets of the people for whom Medicaid was designed", Bevin said. The 16 Kentuckians, with the help of their lawyers, again asked Boasberg to block the rules.
"The day of the free lunch is over", Bevin said.
"Cancer patients and survivors often become so sick from treatment and its long-term effects that they are unable or told not to work by their doctors". For the first several months past year, Arkansas allowed Medicaid recipients to report their work hours only online. There are seven similar state work requirements on deck to be considered by CMS, and the rulings have the potential to affect all.
DeWine has described the OH rules as a possible model for other states. The judge's decision suggests that notion is directly opposed to what Medicaid was created to provide: "the provision of medical coverage to the needy".
The requirements generally apply to people who qualified for Medicaid under the expanded program that was part of the Affordable Care Act, enacted during the Obama administration. Arizona's work requirements are scheduled to begin no sooner than next January, she said.
In Kentucky, expansion supporters fear Bevin will react to the ruling by either trying to end the expansion or by cutting benefits, which he did temporarily after Judge Boasberg first blocked the waiver previous year.
Kentucky and Arkansas exempt people from the work requirements if they are too sick to work, pregnant, full-time students, or caregivers for dependent children or disabled family members.
Only recipients who gained coverage through the expansion - and not the regular Medicaid population - were subject to the requirement.
"Arkansas might use the time while the program is paused to consider whether and how to better educate persons about the requirements and how to satisfy them", he wrote.
Critics of the requirement said Hutchinson should drop his support for it and instead focus on restoring coverage to the thousands who were kicked off.
"I am disappointed in today's decision and am reviewing the decision and coordinating with state and federal officials to determine the appropriate course of action".
The future of Arkansas' expansion following the ruling faces a test on Friday, when the state House takes up the budget bill for Medicaid and the expansion.