The Biden administration's program of unfucking the government continued this week, with what looks like to be a definitive end to attempts by several red states to add work requirements for Medicaid recipients, a brilliant fuck-the-poor innovation that the Trump administration invited states to try starting in 2018. Only one state, Arkansas, had actually managed to roll out its work requirements, but they were put on hold by a federal court in 2019. Other states had either been approved under Trump but had not yet implemented the rules, or were in various stages of getting regulatory approval from the Centers for Medicare and Medicaid Services (CMS). But in February, the new Biden team at CMS sent letters to a bunch of states to tell them nah, the Trump policy was being rescinded, so don't go expecting your applications to be approved.

As Los Angeles Times financial columnist Michael Hitzik explains, those February letters "left the door ajar by a crack if states could show that the rules made sense," but now, Acting Medicaid Administrator Elizabeth Richter "has slammed the door shut." Richter sent letters Wednesday to let Arkansas and New Hampshire — "the two states that had moved furthest along in imposing this stupid and useless policy" — know that after a final review, her office was withdrawing permission for them to demand that non-disabled adults work for their health care.

Says Hiltzik, "One would hope that this action puts the red-state effort to punish Medicaid enrollees in the ground forever." We hope so too, but the ingenuity of Republicans in making life miserable for poor people seems endless.


As we're contractually obligated to mention every time "work requirements" come up, most Medicaid recipients already work. (Hey, if Team Biden really has killed off work requirements, maybe we won't have to say that again anytime soon!) The main point of work requirements is to allow Republican leaders to tell voters that they're making sure no poor people are getting away with being lazy, pure and simple. But as Hiltzik points out, work rules sure are good at getting people thrown off Medicaid!

In Arkansas, the only state that actually put the rules into practice, more than 18,000 enrollees lost their coverage in just its first five months, from August through December 2018; nor was there evidence that the work rules helped anyone find a job.

The Arkansas rules have been suspended by that 2019 court challenge, as we noted; Arkansas (and New Hampshire, which Trump's CMS had approved to impose similar rules) appealed up to the Supreme Court. The Supremes earlier this month granted a Biden administration request to cancel oral arguments in the case because the administration will be rescinding the policy. Elizabeth Prelogar, the acting solicitor general, also asked the Court to consider dismissing the case altogether, although Arkansas still wants it to go forward.

On top of all that, in one of its coronavirus aid bills last year, Congress prohibited states from disenrolling anyone from Medicaid coverage, effectively putting work requirements on hold until the pandemic is over.

Good thing too, since Arkansas's work rules were confusing and complicated. Recipients had to prove they had put in at least 80 hours a month working or volunteering, or that they qualified for an exemption. If they failed to do so for any three months out of a year, they'd be booted from the program. And here's the kicker: In a state with the second-lowest home internet access rate in Our Great Nation, the only option for recipients to prove they were meeting the program's requirements was to log in to a state website. No option for reporting the info by mail, phone, or in person. And as Hiltzik points out, that website was "often inoperative."

Why, it's almost as if the system had been designed to kick people off Medicaid instead of to provide healthcare coverage. That, more or less, was why the DC Circuit judge tossed the work requirements for Arkansas (and Kentucky, too) in 2019. In his decision, the judge patiently explained that Medicaid is a program to provide healthcare coverage, and if you add requirements that cause tens of thousands of people to lose healthcare, well then you're not providing healthcare coverage, you rodent-felching dipshits (we're paraphrasing, a bit).

And that's more or less why Richter wasn't impressed by Arkansas's attempt to claim its work requirement should stay in place, Hiltzik explains:

The state, Richter wrote, failed to demonstrate that "it has the infrastructure in place — such as subsidies for job-skills training and transportation ... that may be necessary to make compliance with the community engagement requirement feasible for beneficiaries and prevent large-scale coverage losses, and it did not provide evidence that such infrastructure would be in place in the aftermath of the pandemic."

Indeed, the fact that 18,000 Arkansans lost their coverage, many because they weren't adequately informed about how to meet the work standards, "indicates that there was inadequate infrastructure in place" while the rules were in effect.

So it looks like the latest Republican effort to kill off Medicaid has finally been exorcised, shot with a silver bullet, dropped in a vat of molten steel, and nuked from orbit. You'd think.

At least until some bright aide to a red-state governor says, "Hey, what if we required everyone on Medicaid to get jobs drug-testing Food Stamp recipients?"

[LAT / Healthcare Finance News / Healthcare Dive / Georgetown University Health Policy Institute]

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Doktor Zoom

Doktor Zoom's real name is Marty Kelley, and he lives in the wilds of Boise, Idaho. He is not a medical doctor, but does have a real PhD in Rhetoric. You should definitely donate some money to this little mommyblog where he has finally found acceptance and cat pictures. He is on maternity leave until 2033. Here is his Twitter, also. His quest to avoid prolixity is not going so great.

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