DC Circuit Court of Appeals Rejects Arkansas Work Requirements

In an unanimous decision last Friday, the DC Circuit Court of Appeals affirmed Judge Boasberg’s finding that Secretary Azar had acted arbitrarily and capriciously in approving Arkansas’s request to impose work requirements on people in Arkansas who get their health insurance through Medicaid. The Arkansas requirements were more lenient than Kentucky’s plan, yet still resulted in 18,000 people losing coverage in the first three months’ of the program’s implementation. The Arkansas case, Gresham v. Azar, had been joined for purposes of appeal with Kentucky’s case, Stewart v. Azar. (KEJC challenged Sec. Azar's approval of work requirements in Stewart alongside our co-counsel: NHeLP and SPLC.)

In defending its approval of the work requirements program in Arkansas, the federal government claimed that there were three additional purposes of Medicaid beyond furnishing medical assistance to people who can’t afford health care: 1) improving health outcomes, 2) addressing behavioral or social factors that influence health outcomes, and 3) incentivizing people to engage in their own health care and achieve better outcomes.

In the District Court, Judge Boasberg did not base his opinion on finding that the federal government’s claimed purposes of Medicaid were not, in fact, purposes of Medicaid. Instead, he found that the Secretary failed to analyze those claimed purposes against the coverage losses likely to occur under the proposals.

However, in concluding its Opinion on Friday, the DC Circuit Court of Appeals rejected the Secretary’s analysis and said, "the Secretary disregarded this statutory purpose [provide medical assistance to people who cannot afford it] in his analysis. While we have held that it is not arbitrary or capricious to prioritize one statutorily identified objective over another, it is an entirely different matter to prioritize non-statutory objectives to the exclusion of the statutory purpose.”

That is, the DC Circuit Court of Appeals went further: explicitly rejecting the additional purposes Secretary Azar claimed were part of the Medicaid statute and instead finding that the Medicaid statute had one “purpose”: “to provide health care coverage.”

Friday's decision is a huge victory for people across the nation who get their health insurance through Medicaid and the hard-working and brilliant advocates at NHeLP, SPLC, and Legal Aid of Arkansas who brought the challenge. Read NHeLP's press release about the decision here.