Restoring a work requirement to Arkansas' Medicaid program would harm the health and finances of low-income residents, increase the state's health care costs and reduce the amount of money going to health care providers, a coalition of health industry groups, including the Arkansas Hospital Association, argue in a court filing.

The requirement "will create new administrative expenses, and increase Medicaid costs, when healthy beneficiaries lose their coverage only to re-enroll when their health has worsened and their conditions are more costly to treat," the groups said in the filing.

The filing is among five friend-of-the court briefs, filed Thursday afternoon and evening, urging the U.S. Court of Appeals for the District of Columbia Circuit to uphold a federal judge's rulings in March that struck down Medicaid work requirements in Arkansas and Kentucky.

The Kentucky Hospital Association filed its own brief last month arguing that the requirement in Kentucky should be reinstated.

It called that state's mandate a "reasonable experiment" meant to test whether "linking Medicaid benefits to work-sponsored commercial insurance, may encourage beneficiaries to maintain -- and use -- health care coverage even while healthy."

Arkansas' requirement, which went into effect in June of last year, resulted in 18,164 enrollees losing their coverage for noncompliance.

The March 27 rulings by U.S. District Judge James Boasberg of Washington, D.C., prevented as many as 5,492 more enrollees from losing coverage in April and stopped Kentucky's requirement from going into effect.

The judge found that President Donald Trump's administration exceeded its authority in approving the requirements because it failed to consider how they would affect the Medicaid program's goal of providing health coverage to needy people.

In their appeal, the administration and the two states say the requirement is designed to make the Medicaid program more financially sustainable by encouraging recipients to get jobs and move off of public assistance.

They also argue that research has shown a correlation between employment and improved health, a link that work requirement opponents dispute.

In their brief in the Arkansas case, the health industry coalition said many Medicaid recipients would not qualify for an exemption from the state's work requirement but have physical or mental-health conditions that limit their ability to work.

Those who are employed may lose their coverage anyway due to difficulties reporting their work hours using a state website or over the phone, the groups argue.

The loss of coverage would reduce enrollees' access to health care, including preventative screenings, and "may be nothing short of catastrophic" for those diagnosed with cancer or other diseases, the groups said in the brief. As enrollees' conditions worsen, they would have more difficulty staying employed and would be more expensive to care for when they eventually regain coverage, the groups argue.

The reduction in reimbursement from the Medicaid program would also hurt health care providers and could cause some rural hospitals to close, the groups said in the brief.

In addition to the Arkansas Hospital Association, the groups signing onto the brief included the American College of Physicians, the American Heart Association, the American Medical Association, the American Psychiatric Association, the Catholic Health Association of the United States, the Cystic Fibrosis Foundation, the March of Dimes, Mental Health America and the National Alliance on Mental Illness.

The same coalition of groups, minus the Arkansas Hospital Association and with the addition of the American Academy of Pediatrics and American Cancer Society Cancer Action Network, filed a similar brief in the Kentucky case.

In another brief, submitted in both the Arkansas and Kentucky cases, a group of 63 health policy professors and researchers, including the deans or associate deans of 10 public health or policy schools, said the law used by the Trump administration to approve the work requirements was meant to test approaches that expand, rather than limit, benefits.

"No past Administration has approved Medicaid demonstrations whose express purpose is to deprive people of eligibility of coverage and [the federal Centers for Medicare and Medicaid Services] has rejected proposals seeking such ends," the researchers said in the brief. "Indeed, over the past quarter century, the [U.S. Health and Human Services] Secretary has used this authority virtually always to permit experiments aimed broadly at expanding eligibility, improving coverage, and introducing health care innovations."

The researchers also noted that federal officials had not approved a plan for evaluating the results of Arkansas' requirement at the time of Boasberg's rulings despite a federal regulation requiring such evaluations.

"This policy of 'experiment first and evaluate maybe' makes a mockery of [Section 1115 of the Social Security Act's] experimental powers and ignores the voluminous comments in the record that warned of the design's likely impact," the researchers wrote, referring to public comments submitted by advocacy groups and others before the work requirements in the two states were approved.

In another brief, the Lawyer's Committee for Civil Rights Under Law and the National Women's Law Center, both based in Washington, D.C., argued that the requirements would be especially harmful to women and racial minorities -- both groups that make up a disproportionate share of Medicaid recipients.

The AARP, AARP Foundation, American Lung Association and other groups also filed a brief opposing the reinstatement of Kentucky's work requirement, saying that state's mandate would "devastate older adults and people with disabilities or chronic conditions."

The Kentucky requirement would have applied to recipients age 19-64, while Arkansas' applied to those age 19-49.

The lawsuits that led to Boasberg's rulings were filed by advocacy groups on behalf of several Medicaid recipients in each state. A brief by the federal government in support of the work requirements is due July 18.

To meet Arkansas' requirement, recipients had to spend 80 hours a month on work or other approved activities, unless they qualified for an exemption, and report what they did using a state website or over the phone.

Those who failed to meet the requirement for three months during a year were kicked off the program and barred from re-enrolling for the rest of the year.

The requirement was the first ever implemented for a Medicaid program under a Section 1115 waiver. It applied to enrollees in Arkansas Works, which covers people who became eligible for Medicaid when the state expanded it in 2014 to cover people with incomes of up to 138% of the poverty level.

This year the income cutoff is $17,236 for an individual or $35,535 for a family of four. More than 239,000 Arkansans were covered by the program as of June 1. Most enrollees receive the coverage through private plans, with the Medicaid program paying most or all of the premium.

According to the San Francisco-based Kaiser Family Foundation, a health policy research organization, seven other states also have received federal approval to add work requirements to their Medicaid programs, including requirements that have taken effect in New Hampshire and Indiana.

Metro on 06/29/2019