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Why Trump's Medicaid work requirements lost

Of all the policies the Health and Human Services Department has actually finalized under President Trump, it's hard to think of a more significant rightward turn than the approval of Medicaid work requirements.

Driving the news: Judge James Boasberg is still not having it. He ruled against Kentucky's work requirements yesterday for the second time, citing many of the same reasons from his first opinion — namely, that HHS is not living up to Medicaid's legally defined purpose as a health care program.

  • He noted Kentucky and HHS' acknowledgements that fewer people will have Medicaid coverage as a result of these rules, and also criticized Gov. Matt Bevin for threatening to pull out of the expansion entirely if HHS loses this lawsuit.
  • "The Court cannot concur that the Medicaid Act leaves the Secretary so unconstrained, nor that the states are so armed to refashion the program Congress designed in any way they choose," Boasberg wrote.

Arkansas didn't fare much better, though that case is still earlier in the process than Kentucky's.

  • Boasberg began his Arkansas opinion with the story of a resident who does work, but didn't know he needed to report his compliance with the state's work requirements every month, and therefore lost his Medicaid coverage, got sick, and lost his job.
  • That's a clear sign, the ruling argues, that HHS didn't give sufficient weight to work requirements' burden on Medicaid's objectives as a source of health coverage.

What's next: New Hampshire's work requirements are also being challenged in court.

Go deeper: Medicaid work requirements aren't boosting work in Arkansas