Judge Strikes Down Kentucky’s Medicaid Work Requirements


A federal judge has blocked Kentucky’s first-in-the-nation work requirements for Medicaid beneficiaries. The Trump administration had approved Kentucky’s waiver which allowed for the state to implement work requirements. In his opinion, U.S. District Judge James Boasberg said that the administration had failed to consider whether work requirements violated the central purpose of Medicaid, which is to provide health care for already vulnerable citizens.

The decision vacated the Trump administration’s approval of Kentucky’s waiver and sent it back to the Centers for Medicare and Medicaid Services (CMS) for further review.

The case is a victory for Kentucky residents who had sued over the waiver saying that it violated Medicaid as a program. The decision also adds a roadblock to similar work requirement applications pending in several states.

Conservatives have long advocated for expanding work requirements for earned benefits in an effort to ‘incentivize’ people to get out of poverty, as though living in poverty wasn’t a sufficient condition for wanting to get out of it. Kentucky’s work requirements mandated that nondisabled Medicaid recipients would have to work or volunteer for 20 hours a week to receive the benefit. Beneficiaries would also have to pay premiums ranging from $1-15 per month.

Kentucky’s Governor Matt Bevin has said that if the case didn’t break his way, he would discontinue Medicaid expansion in the state. By the Governor’s own calculation the work requirements plan would remove 100,000 residents from Medicaid over five years. Ending expansion entirely would likely speed up that process and increase the number of people who end up without coverage to as many as 500,000.

Kentucky officials are planning to appeal.

Medicaid expansion in Kentucky has been enormously popular with local residents, many of which qualified for healthcare for the first time. Medicaid expansion in addition to a federally backed ACA insurance exchange raised the number of insured people in Kentucky to record levels.

Judge Boasberg’s 60-page opinion stated in no uncertain terms that he found the state’s arguments for work requirements capricious and that they violated the central purpose of Medicaid.

The full opinion is available here.