Boasberg, of the U.S. District Court for the District of Columbia, blocked New Hampshire’s plan four months after he ruled that Arkansas needed to stop the work requirements it had begun the previous June. At the same time, the judge struck down similar requirements in Kentucky for a second time.

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“In short, we have all seen this movie before,” Boasberg wrote in his 35-page New Hampshire ruling.



His opinion said that the rules New Hampshire has been preparing to put into effect are “more exacting” than in the other two states, applying to a wider age range of low-income residents and calling for 100 hours a month — 20 hours more — of work, school, job training or volunteering to meet the requirement.

New Hampshire had been intending to start its requirements, known as Granite Advantage Community Engagement, this month. But Gov. Chris Sununu (R) announced three weeks ago that the state would postpone them until September, after nearly 17,000 of about 25,000 Medicaid recipients who do not have an exemption from the rules did not provide required evidence in June that they met the requirements.

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The state is now undertaking a door-to-door campaign to try to increase awareness of the requirements.

Sununu issued a statement calling Boasberg’s decision “disappointing but not surprising given this judge’s past rulings.”



The governor called the work rules “a key provision” of New Hampshire’s law that expanded its Medicaid program under the Affordable Care Act. He said the state was putting in the requirements “responsibly and in a manner that would ensure that no individual would inappropriately lose coverage.” As for whether the state will appeal, the governor said, “a ruling from one federal trial court judge in Washington D.C. is only the first step in the process” and predicted New Hampshire’s rule eventually will be upheld.

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In Arkansas, about 18,000 residents lost their insurance before the judge ruled that federal health officials had not adequately considered the rule’s effects.

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The requirements and the court challenges are part of an ideological seesaw about the Great Society-era program that is the nation’s largest form of safety-net health insurance. For the first time in Medicaid’s half-century, the Trump administration announced in early 2018 that it would allow states to impose work requirements as a condition of getting Medicaid benefits.

Conservatives contend that emphasizing work in Medicaid, as the nation’s main welfare program has done for two decades, would help poor people become self-reliant and move them away from government assistance. Liberals counter that Medicaid coverage helps people be healthy enough to find and keep a job.

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So far, the administration has approved work requirements in eight states, with several more pending. One of those states, Indiana, began phasing in its requirements earlier this year, but no one is yet being penalized.

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After Boasberg’s latest ruling Monday, Johnathan Monroe, a spokesman for the Department of Health and Human Services’ Centers for Medicare and Medicaid Services, said in a statement: “As we have said before, we will continue to defend our efforts to give states greater flexibility to help low-income Americans rise out of poverty . . . [W]e will vigorously support their innovative, state-driven efforts to develop and test reforms that will advance the objectives of the Medicaid program.”