CT joins 24 other states suing CMS over Medicaid work requirements
Twenty five states, including Connecticut, and the District of Columbia, have filed a lawsuit againstagainst the federal Medicaid administration (CMS) for going beyond the language of the law (HR-1) that imposed work requirements on 300,000 HUSKY Part D members.
Medicaid provides healthcare coverage to Connecticut’s most fragile residents, easing both health and economic frailty. That’s why it exists and why it’s so important.
The suit cites the recently published federal regulations that require medically frail members to prove both their disabling health condition but also their inability to work, volunteer, or attend school. According to the suit, “CMS’s final rule will cause harm and chaos for the Plaintiff States.” The states are asking the court to halt implementation of the rule now and eventually to overturn it.
The inability to work is not included in the law’s medical frailty language. According to the suit, “H.R. 1’s broad statutory exclusions exist for good reason. People with disabilities, patients in the middle of cancer treatment, or those struggling with another serious or complex health condition, shouldn’t be at risk of losing the care that helps maintain their health.”
According to the suit, “Nowhere in H.R. 1 does Congress state that individuals’ ability to work must be impaired in order to be ‘medically frail or otherwise have special medical needs,’ or to have a ‘serious or complex medical condition.’”
The suit also notes that the additional burden on states and members was unexpected. The requirement that medically frail members also prove they cannot work was added by CMS after “months of regular communications with CMS and preliminary guidance materials upon which Plaintiff States based their implementation plans.”
Relying on that early CMS guidance, DSS searched medical claims data and identified 126,000 people who should qualify as medical frail. States were led to believe that they could exempt these frail members based on their medical conditions without requiring busy healthcare providers and frail HUSKY members to submit documentation. As the complex work requirement also requires states to implement this very complex change in an unprecedented hurry, the data-based exemption process would reduce errors.
The suit points out that while CMS offers no guidance on how to assess whether someone is able to work, the rule places states at risk of “harsh penalties” for guessing wrong.
The suit also describes why the rule violates the stated goal of supporting work. “The IFR [regulation] makes numerous other changes that will create unnecessary bureaucracy and lead people who are either already working or eligible for an exclusion to lose or be denied coverage. These changes fly in the face of substantial evidence that was or should have been considered by the agency in its decisionmaking, without adequately considering reasonable alternatives or significant downsides, and without making clear what is being asked of Plaintiff States.”
The suit describes the impact of the rule, “Extensive evidence from past experiments with Medicaid work requirements makes clear what the real-life consequences of the IFR will be—consequences that Defendants were required to consider but did not. Added administrative burdens will cause individuals who are eligible for Medicaid to lose or be denied coverage. It will disproportionately hurt people who are already at risk, such as older adults who are not yet eligible for Medicare and people with serious chronic conditions. Defendants’ action will cause immediate and irreparable harms to Plaintiff States’ operation of their state Medicaid programs. It will further strain safety net providers, lead to more uncompensated emergency care, and raise other costs associated with newly uninsured, medically frail residents. And it will cause rural hospitals to be even more likely to shutter.”
Work requirements only apply to the 300,000 HUSKY Part D members; people covered by HUSKY Parts A, B, or C are not affected. Work requirements for Part D members begin January 1st for new applicants and for renewals. HUSKY Part D members will also need to renew coverage every six months, rather than annually. DSS has an excellent HR-1 website for more information, including a simple pre-screener to cut through the complexities and find out if the work requirement applies to you.