Health and Human Services Secretary Azar says he learned from lawsuit and ruling on Ky. Medicaid plan, will keep pushing for it

HHS Secretary Azar at White House
(Photo by Andrew Harrer, Bloomberg)

Health and Human Services Secretary Alex Azar said Thursday that the Trump administration had learned from the ruling that struck down his approval of work and other "community engagement" requirements for 460,000 Kentuckians on Medicaid, and would keep pushing for such requirements.

Azar said in a speech at the Heritage Foundation that the ruling of U.S. District Judge James  Boasberg of Washington was "one blow" to the administration's efforts, but "We’re fully committed to work requirements and community participation in the Medicaid program. … We’ve learned some things from that piece of litigation of which we disagree. But we’re moving forward."

The Centers for Medicare and Medicaid Services said recently that it would reopen Kentucky's proposal for public comment, which would give the administration an opportunity to get into the record evidence addressing Boasberg's concern that Azar's Department for Health and Human Services failed to address the state's forecast that in five years, Kentucky's Medicaid rolls would have 95,000 fewer people with the plan than without it.

Azar's remarks, his first public reaction to Boasberg's ruling, "were striking, and showed just how determined the administration is to press forward on giving states' flexibility to require 'able-bodied' adults to work in some way to qualify for the government-funded health insurance," Colby Itkoiwtz writes for The Washington Post's daily Health 202 report. "Since its creation in 1965, work has never been a prerequisite for Medicaid benefits. But many Republicans argue that the program's expansion under the Affordable Care Act went beyond the original intent of the law to cover the absolute poorest Americans, and gives people an incentive not to work."

Azar is clearly one of those. He said, "Supporting legislation to undo those perverse incentives is a priority for this administration. But in the meantime, we want to rethink how Medicaid serves able-bodied, working-age adults, which is why we have encouraged states to consider work and community engagement requirements for these populations. For these enrollees, Medicaid should be not just a government insurance card, but a pathway out of poverty, to fuller purpose and better health."

Itkowitz writes, "Critics of the work requirement see the push as part of a public-relations campaign by conservatives to change the narrative around Medicaid from a health-care program to a welfare one. Andy Schneider, a professor of health policy at Georgetown University, wrote in a blog post this week that he believes the administration's ultimate goal is to undermine a largely popular program and gin up public support for capping federal Medicaid payments to states."

The administration also acknowledges that its moves on Medicaid are part of its effort to undermine the Patient Protection and Affordable Care Act, which allowed Kentucky and other states to expand Medicaid to people who earn up to 138 percent of the poverty level (about $16,000 for a single person). Kentucky's community-engagement rules would apply to those covered by the expansion.