Judge blocks Michigan’s Medicaid work rules in victory for Gretchen Whitmer

Medicaid letter

About 238,000 Michiganders have been ordered to work, go to school, or engage in some related activity for 80 hours a month to keep their Healthy Michigan health coverage.

A federal court has blocked Michigan’s requirement that some of its needy work, attend work training or school, or engage in related activities as a condition of receiving Medicaid health coverage.

The ruling by U.S. District Court Judge James E. Boasberg of Washington, D.C. was filed Wednesday morning, granting Gov. Gretchen Whitmer a partial summary judgment in the case.

The order came at an auspicious moment for the roughly 100,000 Michigan residents who the state contends were bound under the law to report their  January work activities. The state health director said in testimony Wednesday that only about 20,000 of this group — just 1 in 5 — had filed their January work reports under the now-blocked state law. The work rules had been passed by the Republican-run  Legislature and signed by GOP Gov. Rick Snyder in 2018, before Whitmer took office.

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The rules required more than Michiganders ages 19 to 62 who were presumed healthy to work at least 80 hours a month or provide a legitimate reason why they are not working, such as being pregnant or enrolled in school.

With the first of the monthly reports now past due, roughly 80,000 people had not filed documents on their work status by last week, according to Whitmer’s office.

That puts them one step closer to losing health coverage under Healthy Michigan, the state’s expanded Medicaid program, assuming the Medicaid work law is reinstated at some point.  Beneficiaries who fail to properly document their activities for three months in a 12-month period can lose coverage.

    Until Wednesday’s ruling, Michigan has the nation’s only active program requiring those who receive state Medicaid expansion coverage to work for those benefits, engage in activities like school or job training, or prove they are otherwise exempt from the rules. 

    Programs in other states had been suspended by court rulings or even by their own leadership after court challenges elsewhere.

    Michigan’s program, too, was cast into doubt after a U.S. Court of Appeals for the District of Columbia last month upheld a lower court’s order striking down a work rules program in Arkansas. In a unanimous decision, the appeals court found the imposition of work rules do not fit within the primary objective of the Medicaid Act, which is to provide health care coverage to the poor.

    That decision, Whitmer wrote in her request to the court Feb. 25, meant the Michigan program is also unlawful.

    Even with Boasberg’s order Wednesday to pause the Michigan’s work requirements, court challenges remain — challenging the work requirements as well as the larger 2010 Affordable Care Act, which allowed Michigan to expand its Medicaid program, which in turn, lead to the requirements.

    The ruling was filed hours before Robert Gordon, director of the Michigan Department of Health and Human Services, testified before the state Senate Appropriations Subcommittee on Community Health and Human Services, which grilled him on the status of the now two-month-old program.

    Gordon, who along with Whitmer, a Democrat, opposes Medicaid work requirements, told senators that while the Wednesday court ruling makes the program unenforceable, at least for now, the department has spent $30 million to implement the program — hiring staff, overhauling computer systems, creating new outreach for residents impacted by the law, and training consumer advocates at agencies across the state.

    “Since this administration began, the governor and I have said two things: One is that work requirements are ill advised, and the second is that, as long as they are on the books, we would implement them,” Gordon told the senators. 

    The Healthy Michigan program has more than 650,000 beneficiaries. In December, the department said it had cleared all but 238,000 of those beneficiaries as being exempt from work rules because of disability, age, or other reasons. 

    Gordon testified Wednesday another 138,000 were found compliant or exempt in the first two months of 2020, leaving 100,000 people required to file paperwork under the law.   

    Kate Massey, deputy director of the Michigan’s Medicaid office, testified that state was able to determine, in part through documentation in other public assistance programs, that many Medicaid beneficiaries were compliant in January even if they had not filed reports on their January work histories. 

    Health department spokesman Bob Wheaton told Bridge later Wednesday that the 138,000 were cleared for one of three reasons: 

    • They asked for exemptions that were subsequently granted
    • They were no longer eligible for Healthy Michigan for other reasons
    • The January income reports filed for other programs — food assistance, for example — showed they met the January work requirements
    • That left about 100,000 individuals who had to file January reports by the end of February; only about 20,000 did so.

    The low compliance rate was not a surprise, Gordon added upon questioning. 

    He and others have said many hard-to-reach recipients may remain confused about or unaware of work requirements. Many of Michigan’s neediest residents simply don’t open or understand their mail, he and other critics of the law have said.

    Sen. Peter MacGregor, R-Battle Creek, pressed for details from Gordon, noting that the federal court ruling may well be appealed. For that reason, he said, it’s important that the state stay on top of the need to enforce the law. 

    “I've been signaled that there is going to be an appeal. It's not over, so we need to stay vigilant and prepared either way,” MacGregor said.

    And Sen. Kim Lasata, R-Bainbridge, echoed MacGregor’s continuing support for the program, pressing Gordon on how enrollees have filed their reports so far.

    “For me, [work rules are] about empowering people, you know, getting them in the community so they can see what's out there,” she said.

    Even so, Whitmer’s administration and Democratic critics of the work rules signalled their interpretation of the court ruling is that Medicaid work rules are now over in Michigan.

    Attorney General Dana Nessel said in a statement the ruling “will ensure that Michigan won’t be throwing away taxpayer money to enforce unlawful requirements.” 

    Whitmer — also in a statement — lamented that a Republican-led legislature moved ahead with a program that was “clearly going to be thrown out by the courts.”

    The Michigan Health and Hospital Association cheered the decision,  which it said “invalidates” the work rules. The group said it shows that “attaching additional personal responsibility requirements that have nothing to do with healthcare access fail to fulfill Medicaid’s objective of providing healthcare coverage to Michigan’s financially vulnerable population.”

    Meanwhile, Gilda Jacobs, president and CEO of Michigan League for Public Policy and one of the most outspoken critics of work rules, said she is thrilled with Wednesday’s order. 

    The reporting requirement is “a huge anxiety not only for enrollees” but also the Michigan Department of Health and Human Services the administers the program, Jacobs said.

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    Comments

    Lawrence Redmond
    Wed, 03/04/2020 - 12:41pm

    An Obama Appointed Judge.. No Surprise, they went Judge shopping.. This was tried over 30 years ago in Michigan and the ACLU got it tossed out in court. They think it is unfair to require the able-bodied to work for their free hand-outs. This isn't over yet.. Its just one step in the procedure.

    Josh
    Wed, 03/04/2020 - 6:01pm

    Fairness has nothing to do with it. It's simple economics.

    I have a friend who who needs medication. Without it, she can't hold down a job or apartment and has intermittent run-ins with the law. It's cheaper for you, the taxpayer, to pay her minuscule cost for her medications every month than to pay for the law enforcement and social service resources that she would otherwise be using.

    When poor people have access to health care, everyone benefits, not just poor people.

    LLA
    Wed, 03/04/2020 - 12:41pm

    Big win for public health! Medicaid work requirements have never been about "innovation" or "promoting self-sufficiency" as Republicans claim. Their sole (& misguided) purpose is to "reduce costs" to the state by kicking people off Medicaid. Of course, as we know, when people are uninsured, that drives up the cost of healthcare for everyone. Furthermore, the costs to even implement the work requirements were astronomical to taxpayers.

    Kevin Grand
    Wed, 03/04/2020 - 6:03pm

    So, what happens with the makeup of SCOTUS changes very soon?

    When Obamacare, and by extension Snydercaid, gets nullified?

    How will Gov. Whitmer intend to pay for things then?

    Allan Blackburn
    Thu, 03/05/2020 - 9:13am

    She won't. Hospitals will eat the costs as they did prior to Medicaid expansion and more hospitals will close in rural areas. But hey, since you are the only one who pays taxes in Michigan I guess it should be up to you to usually be cruel and lament about where "your" tax dollars are going. Never mind that poor people also pay taxes as well. We never seem to have enough to give to those who already have. We falter for those who are poor and blame them for their poverty. As a healthcare administrator for much of my career I know the behind the scenes work that went in to the ACA and passage of Medicaid expansion in a completely Republican controlled Governorship, legislative branch, judicial branch, etc. It has kept rural clinics thriving in all of the years since its implementation. It's no wonder the current administration wants the court challenges to come out after the election. The general public have no idea how this will turn our healthcare on its head if it goes away. Taking it away is such a Christian act of mercy. Yuck!

    Arjay
    Thu, 03/05/2020 - 9:20am

    Let me edit the headline - Judge Blocks Michigan Medicaid Work Rules in Huge Defeat for Taxpayers. Time for Trump and McConnel to step up appointment of judges who fully understand what the function of the judiciary is.

    Allan Blackburn
    Thu, 03/05/2020 - 9:37pm

    What? Making sure income inequality gets more extreme and income is shoveled upwards. Why is it that when you get your way it's the right judge and when you don't it's the wrong judge? I didn't realize judges were there to make sure that only certain taxpayers get rewards from the taxes they pay and the rest of society is screwed because they haven't paid the larger amount which, according to you purchases influence and giving you what you want,

    Allan Blackburn
    Fri, 03/06/2020 - 12:41am

    What? Making sure income inequality gets more extreme and income is shoveled upwards. Why is it that when you get your way it's the right judge and when you don't it's the wrong judge? I didn't realize judges were there to make sure that only certain taxpayers get rewards from the taxes they pay and the rest of society is screwed because they haven't paid the larger amount which, according to you purchases influence and giving you what you want,