Imposing work rules has been a signature issue of President Donald Trump's health department and conservative governors. | Pablo Martinez Monsivais/AP Photo health care Judge strikes down Medicaid work rules in Arkansas, Kentucky

A federal judge today blocked new work requirements on Medicaid recipients for a second time, dealing another blow to the Trump administration's efforts to reshape the safety net health care program.

U.S. District Court Judge James Boasberg ruled that the federal government failed to justify that adding employment conditions and other changes to Medicaid in Arkansas and Kentucky advanced Medicaid's basic purpose of providing health coverage.


“The Court cannot concur that the Medicaid Act leaves the [HHS] Secretary so unconstrained, nor that the states are so armed to refashion the program Congress designed in any way they choose,“ wrote Boasberg, an Obama appointee named to the U.S. District Court for the District of Columbia in 2011.

CMS Administrator Seema Verma suggested in a statement the rulings would not dissuade her efforts to approve employment rules in other states.

“We will continue to defend our efforts to give states greater flexibility to help low income Americans rise out of poverty,” Verma said. “We believe, as have numerous past administrations, that states are the laboratories of democracy and we will vigorously support their innovative, state-driven efforts to develop and test reforms that will advance the objectives of the Medicaid program.”

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More than 18,000 low-income adults in Arkansas were thrown off Medicaid last year for failing to meet requirements that they work or participate in another job-related activity for at least 80 hours per month in order to keep their health care. State data show that few have reapplied, with only 1,900 reenrolling in the first two months of this year, and many Medicaid enrollees have described a confusing system that makes it difficult to comply with the rules.

Arkansas Gov. Asa Hutchinson, in a brief statement late Wednesday, said he was “disappointed in the decision.” The second-term Republican governor, who enacted the work requirement after inheriting a Medicaid program his Democratic predecessor expanded under Obamacare, plans to hold a news conference Thursday.

Kentucky's work rules — which aren't yet in place — are part of a broader envisioned overhaul of the state’s program that overall is projected to reduce its Medicaid rolls by 95,000 residents. In his Kentucky decision, Boasberg, in part, justified invalidating the demonstration project because federal officials “did not consider the health benefits of the project relative to its harms to the health of those who might lose their coverage.”

Gov. Matt Bevin, on the other hand, has threatened to undo the entire Obamacare Medicaid expansion if his Medicaid reforms do not survive a court battle, a move that threatens health benefits for more than 400,000 low-income people.

Both of the court decisions issued Wednesday remand the Arkansas and Kentucky projects back to HHS. But the ramifications of Boasberg’s ruling, issued nine months after he first blocked work requirements in Kentucky last summer, extend beyond those two states.

The Trump administration has made work requirements a linchpin of its agenda to curtail enrollment in the safety net program that now covers roughly one in five Americans, arguing that they promote employment and are necessary to sustain Medicaid’s fiscal health. Despite ongoing litigation, HHS under Trump has moved quickly to approve Medicaid work requirements in seven additional conservative-led states, and proposals from seven others are pending.

Boasberg wrote HHS’ failure to adequately assess the effect on coverage were apparent in both the Kentucky and Arkansas demonstrations, and threw in a baseball reference. “As Opening Day arrives, the Court finds its guiding principle in Yogi Berra’s aphorism, ‘It’s déjà vu all over again.’ In other words…the Secretary’s failures here are nearly identical”

Legal challenges to the work rules are also growing, with national and local legal aid groups arguing that HHS has exceeded its statutory authority in approving them. Advocates earlier this month asked the same federal court in Washington, D.C. to block similar requirements in New Hampshire, making it the third state where litigation has been filed.

“It is nonsensical and illegal to add obstacles to Medicaid for large groups of individuals who are already working or full-time health care providers for family members or suffering chronic health matters that prevent them from work,” said Jane Perkins, legal director of the National Health Law Program, one of the legal aid groups that brought the lawsuits. “Work should not be a key to health care access.“