Health

A federal judge has again struck down Kentucky Governor Matt Bevin’s changes to the Medicaid program, including community engagement requirements that would have made some people work to keep coverage.

The Medicaid changes were set to partially go into effect April 1. Wednesday’s decision is the second time U.S. District Judge James Boasberg struck down Kentucky’s proposal – the first was in June 2018.

In his decision, Boasberg wrote that federal approval of Kentucky’s changes didn’t follow the intent of the Medicaid program, which was signed into law in 1965.

“The Secretary continues to press his contention that the program promotes his alternative proposed objectives of beneficiary health, financial independence, and the fiscal sustainability of Medicaid,” Boasberg wrote. “The first two of those three goals are not objectives of the Act in their own right, and, regardless, the Secretary’s failure once again to adequately consider the effects of Kentucky HEALTH on coverage is alone — as it was in Stewart I — fatal to the approval.”

Boasberg wrote that the main goal of Medicaid is insurance coverage and enrollee health, not making Kentucky’s Medicaid program more financially sound or helping enrollee’s become financially independent through finding jobs.

“The Court can now move to Plaintiffs’ main beef: the Secretary’s re-approval of Kentucky HEALTH is, they contend, arbitrary and capricious primarily because he did not adequately consider whether his 1115 waiver promotes the objectives of the Medicaid Act. The Court agrees,” Boasberg wrote.

Bevin proposed requiring enrollees to make mandatory payments to keep coverage — currently the expanded insurance is mainly provided for free — and other tracking requirements. Those changes, called a waiver, were approved by the federal government in 2018, but a lawsuit kept the waiver from going into effect.

Bevin has said he will take away Medicaid expansion coverage from about half a million Kentuckians if a court blocks Kentucky’s changes. In January of last year, he issued an executive order directing the secretary of the Cabinet for Health and Family Services and the Medicaid commissioner to terminate Kentucky’s Medicaid expansion if any part of his plan is struck down in court and once all appeals are exhausted.

This story has been updated. 

Lisa Gillespie is WFPL's Health and Innovation Reporter.