Court of Appeals Blocks Medicaid Work Requirements in Arkansas

By Aryana Thompson

A U.S. Court of Appeals has upheld an injunction against an Arkansas program that imposes work-related requirements on Medicaid recipients.

In its February 14 ruling, the Court of Appeals for the District of Columbia Circuit said Health and Human Services Secretary Alex Azar’s approval of the program was “arbitrary and capricious.”

The program, known as Arkansas Works, requires some Medicaid recipients to “work or engage in specified educational, job training, or job search activities for at least 80 hours per month” in order to receive health benefits. The legal standard the Court used was from the Medicaid statute: The Secretary is only authorized to approve “any experimental, pilot, or demonstration project which… is likely to assist in promoting the objectives” of Medicaid (42 U.S.C. § 1315(a)).

The decision in Charles Gresham, et al., v. Alex Michael Azar, II, Secretary, United States Department of Health and Human Services in his official capacity, et al. was unanimous (3-0) and upheld the original injunction issued by U.S. District Judge James E. Boasberg in March 2019. The ruling only pertains to Arkansas.

Charles Gresham, along with nine other Arkansas residents, filed for injunctive relief against Secretary Azar in August of 2018. The district court had held that the Secretary’s action was not based upon consideration of relevant factors because he failed to analyze whether the demonstrations would promote the primary objective of Medicaid. The District Court determined the primary objective of Medicaid is to “furnish… medical assistance” to people who cannot afford it (Stewart I, 313 F. Supp. 3d at 260-61).

The Court of Appeals said “the primary objective of Medicaid is to provide access to medical care” for people who “could not afford it”. The Court reasoned that instead of analyzing whether Arkansas Works would promote the objective of providing coverage, the Secretary identified three alternative objectives which all point to better health outcomes as the objective of Medicaid.

The statute makes no mention of the better health outcome objective, and Congress “has not conditioned the receipt of Medicaid benefits on fulfilling work requirements or taking steps to end receipt of governmental benefits.” Therefore the Appeals Court concluded that “the Secretary’s approval of Arkansas Works was arbitrary and capricious”, and they “affirmed the district court’s judgement vacating the Secretary’s approval.”