Medicaid is a federal and state government health insurance program for persons of all ages whose income and resources are insufficient to pay for health care. States currently enjoy significant leeway in determining who is eligible for implementation of the program. In recent years, a number of states have received permission from the Centers for Medicare and Medicaid Services to make a beneficiary’s receipt of Medicaid benefits contingent upon fulfilling work requirements.
New Hampshire is one of nine states to approve such Medicaid work requirements. Among other provisions, the program will require all ACA expansion beneficiaries to participate in 100 hours per month of “community engagement activities, such as employment, education, job skills training or community service as a condition of Medicaid eligibility.” While the New Hampshire Governor Chris Sununu praised the decision as empowering recipients, many critics agree that there is no nexus between work requirements and improved health and that thousands of vulnerable citizens will lose coverage for failure to comply. In fact, roughly 18,000 citizens of Arkansas lost Medicaid coverage in the last year for failing to comply with their state’s Medicaid work requirements.
This week, residents of the Granite State became the third to challenge their state’s Medicaid work requirements in court. Petitioners suing the federal government to halt the work requirement are encouraged by a similar Kentucky law which was struck down in a U.S. District Court last year. The chief concern among those bringing the suit is that the massive coverage loss experienced by people in Arkansas will be replicated in New Hampshire. The New Hampshire state Department of Health and Human Services estimated that “up to 15,000 of the roughly 50,000-person Medicaid expansion population in the state are not working or presently exempted.” Not factored into those numbers, argue opponents of the law, are beneficiaries who juggle multiple low-wage service industry jobs with unpredictable, fluctuating hours.
The New Hampshire case against the federal government will be before U.S. District Judge James Boasberg who blocked the Kentucky law last year and who has new and similar cases on his docket from Kentucky and Arkansas. New Hampshire has hinted at the prospect of intervening in this law suit to further argue that the work requirement is beneficial to the health of state Medicaid recipients. Judge Boasberg, however, previously stated that “This is not the purpose of Medicaid,” and that the goal of the law is to provide medical and long-term care service coverage. The results of this case will have a resounding effect on similar efforts in other states to make Medicaid coverage contingent on work requirements.