A federal judge in Washington D.C. has struck down Kentucky's plan to start requiring some Medicaid recipients to work or volunteer in order to continue receiving benefits.
The ruling blocks Gov. Matt Bevin's administration from implementing the change, which was scheduled to start Monday in one Northern Kentucky county and extend to most of the rest of the state by the end of the year.
Sixteen Kentucky Medicaid recipients sued the federal government in January to block Bevin's planned changes to the state's Medicaid program. The plaintiffs claim that Bevin's plan — known as Kentucky HEALTH — should not have been approved; they say it violates the 1965 law establishing Medicaid because it will reduce poor people's access to health care.
Simultaneously, to uphold Kentucky HEALTH, Bevin is suing those same 16 Medicaid recipients in Frankfort before U.S. District Judge Gregory VanTatenhove.
The Frankfort lawsuit is about a month behind its Washington counterpart, setting up the possibility that a judge in one federal circuit could strike down Bevin's Medicaid changes while a judge in another could say that he had every right to make them.
Bevin says that if he loses in court and cannot prevail on appeal, he will end expanded Medicaid in Kentucky, which has extended health coverage to about 400,000 people with incomes just above the poverty line.
"Kentucky HEALTH was developed in Kentucky for Kentuckians, and its validity ought to be decided in Kentucky," Bevin's attorney, Stephen Pitt, wrote in a May court filing before VanTatenhove. "This matter should be decided quickly so that the commonwealth can move forward with Kentucky HEALTH or withdraw from expanded Medicaid."
While much of the controversy over Kentucky HEALTH has focused on Bevin’s 80-hour-a-month "community engagement" requirement, which could be satisfied by work, school or volunteering, the Washington-based suit also called attention to other new hurdles that Medicaid recipients will have to jump in order to keep their coverage.
Those hurdles include monthly premiums, initially from $1 to $15, although they eventually top out at $37.50; monthly check-ins to report employment and income status; annual re-enrollments; and ongoing verification of extra tasks people must complete if they want to win back the vision and dental coverage they previously had as part of their basic coverage.
Missing a payment or notification could trigger a six-month lockout on basic health coverage. Missing the enrollment window could mean waiting nine more months for the next opportunity.
The Bevin administration estimates 95,000 people will lose their coverage over the next five years out of the more than 400,000 Kentuckians just above the poverty line who are currently enrolled in expanded Medicaid under the Affordable Care Act.
Bevin made this bluff back in January that if the courts blocked these work requirements, that he'd end Medicaid for 10% of the state or so. He's locked into that now, as that bluff has been called.
What will he do?
We'll find out.