Noted Public Health Researchers File Brief in Support of Kentucky Medicaid Work Challenge

A “friend of the court” brief available on this website was filed in the U.S. District Court for the District of Columbia to urge the court to block implementation of the Kentucky HEALTH proposal that would require Medicaid beneficiaries to work, volunteer or train for a job to retain their health coverage. The 48 public health scholars from across the nation who signed the brief contend that if Kentucky HEALTH is upheld, as many as 136,000 will lose their Medicaid in the first year alone.

Kentucky was the first state to win approval for its Medicaid work demonstration project after the Trump administration announced last year it would grant states permission to conduct such experiments under Medicaid Section 1115. Sixteen Medicaid beneficiaries filed a lawsuit, and a federal court struck down Kentucky’s proposal in June 2018. The federal government subsequently reapproved Kentucky HEALTH, and the case known as Stewart v. Azar has landed once again in a U.S. District Court.

In the brief, the public health scholars present the basis for their continued support for the Medicaid beneficiaries. They argue that the program set out in Kentucky HEALTH “is not what Congress envisioned when it permitted experiments under Section 1115.” The group includes eight deans at schools of public health, public policy and public administration at the nation’s top schools of public health, including Columbia University’s Mailman School of Public Health, Harvard University’s T.H. Chan School of Public Health, the University of Michigan School of Public Health and the George Washington University Milken Institute School of Public Health (Milken Institute SPH).

“This experiment by Kentucky threatens to strip hundreds of thousands of beneficiaries of Medicaid coverage with no realistic alternative in sight under untested conditions designed to drive people off the program,” said Sara Rosenbaum, JD, the Harold and Jane Hirsh Professor of Health Law and Policy at the, one of the scholars represented on the amicus brief. “Kentucky HEALTH is not what Congress intended when it permitted experiments under Section 1115.”

The public health scholars argue that the Trump administration’s re-approval of Kentucky HEALTH willfully ignored the harm that will befall Medicaid beneficiaries if the work demonstration project is put in place. An analysis recently published by researchers at Milken Institute SPH estimates that  between 26 percent and 41 percent of those required to comply—representing between 86,000 and 136,000 Kentucky Medicaid beneficiaries—would lose coverage in just the first year of the work demonstration project. This is significantly higher than the estimate provided by Kentucky officials and endorsed by the Trump administration.

“Kentucky’s 2014 Medicaid expansion successfully increased insurance coverage and access to care; the new policy threatens to reverse that progress,” says Leighton Ku, PhD, MPH, of the Milken Institute SPH, the lead author of the revised estimates, which are based on the actual experience of beneficiaries in Arkansas. “It is alarming that Health and Human Services ignored the information available to it, despite the earlier court decision.”  

The amicus brief, available below, was filed on January 18 and accepted by the court on January 22, 2019.  The deans and scholars were represented by Edward T. Waters, Phillip A. Escoriaza and Christopher J. Frisina of the Washington, DC law firm of Feldesman Tucker Leifer Fidell, LLP.