On May 1st, Ohio's GOP governor John Kasich officially filed a request with the Department of Health and Human Services to institute Trump's new “work requirements” for Medicaid recipients, forcing approximately 700,000 Ohioans to prove they are employed at least half-time or face losing their health care benefits. Citing the bureaucratic nightmare that would result and the undue burden it would cause for Medicaid recipients, Katy Garvey of Ohio's Legal Aid Society has stated that legal action would be likely to follow, saying “There are certainly grounds to litigate.”
The first lawsuit challenging the new Medicaid rules was filed in Kentucky, which was the first state to implement the new requirements. Ironically, Kentucky was the first southern state to adopt the Medicaid Expansion under the Affordable Care Act in 2014, reducing its number of uninsured residents from over 20 percent to 9 percent within a year.
When GOP governor Matthew Bevin took over in 2015, he immediately shut down the state exchange and set about the task of dismantling the entire program. According to an amicus brief filed by a group of public health scholars , Kentucky's new waiver program not only means that approximately 300,000 Medicaid recipients will lose coverage, but is also in violation of the law.
Plaintiffs in the Kentucky lawsuit argue that Trump's policies “sharply deviate from the congressionally-established requirements of the Medicaid program and vastly exceed any lawful exercise of the Secretary’s limited waiver authority.” Plaintiffs further argue that “States cannot impose additional eligibility requirements that are not explicitly allowed by the Medicaid Act.”
This week, there was more push-back from opponents of Trump's work requirements – this time from Indian tribes who face being subjected to the new Medicaid rules, as well as Democrats and moderate Republicans in Congress. Among the latter is GOP Representative Tom Cole of Oklahoma, himself a member of the Chickasaw Nation. In a letter to HHS, he wrote, “I am concerned that both HHS and CMS are unwittingly about to kick off what may be decades of expensive and needless litigation.”
Aside from the fact that unemployment and addiction rates are already high among Native American populations, opponents point out that imposing Trump's Medicaid requirements would violate federal laws. Indian tribes are considered sovereign nations and therefore exempt from many federal regulations. Trump has argued that Indian nations are not separate governments, but rather a racial group – and therefore not eligible for race-based preferential treatment.
Currently, both sides are watching the Kentucky case closely, as the outcome will have profound consequences for the millions of Americans who depend on the Medicaid program for health care services. The case is expected to come before the D.C. U.S. District Court later this year.