Indiana, Arizona Stall on Medicaid Work Rule, Blaming Lawsuits

Published November 27, 2019

Indiana suspended its rule on October 31, one month after four individuals filed a lawsuit in U.S. District Court against the Trump administration for allowing the work requirement. Indiana was the only state in the nation with a work rule in effect. Federal courts have set aside work rules in Arkansas, Kentucky, and New Hampshire.

The Trump administration has approved Medicaid work requirements in six states, and waivers are pending in nine, according to Kaiser Family Foundation.

Delay in Arizona

Arizona’s Medicaid work requirement was set to go into effect on January 1, 2020, but on October 17, Gov. Doug Ducey’s administration sent a letter to the federal Centers for Medicare and Medicaid Services requesting a delay until the summer of 2020.

The director of the Arizona Health Care Cost Containment System, Jami Snyder, wrote the decision to request a delay was “informed by the evolving national landscape concerning Medicaid community engagement programs and ongoing litigation.”

The suspensions are unnecessary, says Sam Adolphsen, policy director for the Foundation for Government Accountability.

“States have rights,” said Adolphsen. “There is nothing obligating them to suspend these requirements. They should move forward and implement.”

Litigation over work rules in other states should not be a concern, says Adolphsen.

“In other states, the lawsuits have been against the Centers for Medicare and Medicaid Services and the Trump administration, not the state,” said Adolphsen. “If it’s going to go to court, so be it. Take it there, and fight for it, because it is a good policy.”

Small Percentage Affected

Arizona’s Medicaid work rule does not apply to women up to 60 days after giving birth, people taking care of disabled adults or children under age 18, the mentally ill, those with acute medical conditions, full-time students, and the homeless.

 “Work requirements will not apply to most Medicaid recipients,” Arizona state Rep. Nancy Barto (R-Phoenix), who wrote the state’s 2015 law, told Health Care News.

Barto says the work rules are well-intentioned and would be effective.

“[It] can be the encouragement some need to improve their health to the point where they achieve self-sufficiency and no longer need Medicaid benefits,” Barto said.

Employment can do more for a person than provide a paycheck, says Barto.

“We know that being productive and advancing oneself can be the key to a healthier life, which is the goal,” said Barton. “The goal is not to reduce the state’s Medicaid rolls, although that may be the natural result when it is implemented.”

No Lack of Jobs

There are plenty of jobs available for those who will be required to find employment, says Adolphsen.

“Arizona has low unemployment,” said Adolphsen. “A lot of businesses need workers, and the 400,000 able-bodied adults are essentially allowed to sit on the sidelines. We need to move from welfare to work.”

The delay in implementing the requirements is disappointing but understandable, says Barto.

“I do see the value in the state putting implementation on hold until these concerns are satisfied, so we’re not in the position where implementation has to be short-circuited,” said Barto.


Ashley Bateman ([email protected]writes from Alexandria, Virginia.


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Arizona State Representative Nancy Barto, (R-Phoenix):