Dec 13, 2019

South Carolina is the next battleground for Medicaid work requirements

President Trump and CMS Administrator Seema Verma. Photo: Alex Wong/Getty Images

The Trump administration is losing the legal battle over Medicaid work requirements — one of its most impactful and controversial health care policies — but it is leaning into that fight even more aggressively.

Driving the news: The Centers for Medicare & Medicaid Services formally signed off yesterday on South Carolina's work requirements. Medicaid recipients in the state will have to perform 80 hours per month of work or community service, unless they receive an exemption.

Why it matters: Other states have primarily sought work requirements as a condition of their Medicaid expansions, but South Carolina will impose its new rules without expanding.

Where it stands: A federal judge has already ruled against work requirements in Arkansas, Kentucky and New Hampshire, arguing that they’re inconsistent with Medicaid's statutory goals.

  • Judge James Boasberg has leaned heavily on the fact that work requirements would cause thousands of people to lose their Medicaid coverage. 
  • That will also happen in South Carolina, and those coverage losses will be a factor in the inevitable lawsuits over these rules.

Yes, but: Those rulings are working their way through the appeals process, and rather than change course or slow down in the face of legal setbacks, the administration is getting work requirements on the books wherever it can and hoping for an eventual win in the courts.

Go deeper: Why Trump's Medicaid work requirements lost

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With Kansas deal, Medicaid expansion marches on

Illustration: Sarah Grillo/Axios

Kansas will likely become the 37th state — 38th if you count D.C. — to expand Medicaid under the Affordable Care Act.

Driving the news: The state's Democratic governor and Republican Senate leader announced a deal yesterday to expand the program, though it still needs to get through the state legislature.

Go deeperArrowJan 10, 2020

State and local officials fight to keep Medicaid for inmates

Angola prison in Louisiana. Photo: Giles Clarke/Getty Images

Some local and state officials want Medicaid to start picking up the tab for inmates' health care, Stateline reports.

How it works: Medicaid beneficiaries lose their coverage while they're incarcerated — including pretrial detention for people who can't make bail — and county governments are generally responsible for providing their care.

Go deeperArrowJan 9, 2020

Health policy in 2020 will be made in the states

Illustration: Aïda Amer/Axios

With legislation in Congress likely to be blocked by partisan division and interest group opposition, much of the real action in health care this year will be in the states.

The big picture: States don’t have the money or purchasing power the federal government does, but their decisions nevertheless affect millions of people, and they could signal the future of federal reform.

Go deeperArrowJan 6, 2020