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A federal appeals court on Friday sharply questioned the Trump administration's work requirements for Medicaid recipients, casting doubt on a key part of a governmentwide effort to place conditions on low-income people seeking taxpayer-financed assistance. All three judges on a panel of the U.S. Court of Appeals for the District of Columbia Circuit lobbed hard questions at a Justice Department lawyer defending the policy at a hearing. The administration is appealing after losing the first round before a lower court. (Alonso-Zaldivar, 10/11)

In oral arguments at the U.S. Court of Appeals fro the District of Columbia Circuit, the three-judge panel vigorously questioned the government's attorney about the purpose of the work requirements and agreed with an earlier ruling that the agency didn't adequately consider the effects the Section 1115 waivers would have on enrollment. (Brady, 10/11)

During oral arguments in a pair of cases involving work requirements in Kentucky and Arkansas — with high stakes for other states — all members of a three-judge panel of the U.S. Court of Appeals for the D.C. Circuit repeatedly said senior Trump health officials had neglected to consider that people would lose health insurance under the new rules. Noting that state Medicaid experiments must fulfill the basic purposes of the program, Judge Harry T. Edwards told a Justice Department attorney, “You are failing to address the critical statutory objective” of providing vulnerable residents with health coverage. (Goldstein, 10/11)

Lawyers representing the people at risk of losing coverage if these work requirements are permitted argued that these requirements would not necessarily result in people transitioning to another form of health care coverage, but would certainly cause massive losses in coverage. “Cutting costs by reducing coverage is not acceptable,” said Ian Gershengorn an attorney from Jenner & Block and the National Health Law Program, a health rights advocacy group. He also brought up the objective of the ACA — to provide health care coverage for more people, he said, as he argued that this provision doesn’t follow that objective. (Marquez, 10/11)

District Judge James Boasberg previously rejected the administration’s approval of Kentucky’s program, and blocked the implementation of the Arkansas program, after he said the administration ignored the fact that work requirements would result in tens or hundreds of thousands of people losing Medicaid coverage. The appeals panel referred back to Boasberg’s opinion numerous times. Judge Harry Edwards, who was appointed by President Carter, said Klein never addressed the central issue. “There are adverse effects. People are going to lose coverage. You haven’t addressed that,” Edwards said. “You can’t point to other objectives. The principal objective [of Medicaid] is coverage.” (Weixel, 10/11)

Klein argued that Boasberg “misunderstood” that any reduction in the number of people receiving coverage meant people would go without any coverage at all. Klein argued that while it was too early to draw conclusions, people could shift to other forms of insurance, such as coverage provided by an employer or private insurance purchased through an exchange. She did not provide any evidence that people who lost coverage in Arkansas had gained other insurance. If more people shifted from Medicaid expansion coverage to other types of insurance, Klein noted that this would free up money for other parts of the Medicaid population. (Raman, 10/11)

In related news —

Mr. Ellis is one of more than 18,000 people who were cut from the Medicaid rolls after Arkansas embarked on a closely watched experiment in June 2018, when it became the only state to fully implement a work requirement for program recipients. The outcome in Arkansas could help shape the future of Medicaid, a state-federal program for low-income and disabled people that covers one in seven adults across the U.S. President Trump and Republicans promote the mandate as a way to rein in safety-net costs and increase employment. In a blow to the GOP, a federal judge in U.S. District Court for the District of Columbia in March blocked Arkansas’ Medicaid work requirement, saying federal officials didn’t adequately consider its potential to cause recipients to lose coverage. (Campo-Flores and Armour, 10/13)

A Medicaid work requirement has emerged as a divisive policy issue in the 2020 presidential election. President Trump has called for adding a mandate nationwide, while some Democratic candidates are proposing a single federal health system that would subsume the program. The Trump administration has approved requests from nine states, including Arizona, Michigan and Utah, to impose a work mandate on Medicaid recipients. Applications from nine other states are pending. (Armour, 10/13)

More than $4 million in state and federal money was spent rolling out a Medicaid work requirement in New Hampshire that was later struck down by a federal judge. The numbers, which come from state estimates provided to the Government Accountability Office, are the first estimate of the total cost of the now defunct program. (Moon, 10/11)