Public Health Leaders Urge HHS to Withdraw Medicaid Work Requirement Rule, Warning It Could Strip Coverage from Millions

FOR IMMEDIATE RELEASE
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A coalition of leading public health organizations and health policy scholars has submitted public comments urging the U.S. Department of Health and Human Services (HHS) to withdraw its interim final rule implementing the Medicaid work requirements Congress passed as part of H.R. 1, arguing the regulation unlawfully exceeds the statute and would unnecessarily jeopardize health coverage for millions of Americans.

The comment letter, submitted by the American Public Health Association, Grantmakers in Health, and the George Washington University Milken Institute School of Public Health's Jacobs Institute of Women's Health and National Center for Medical-Legal Partnership, together with 169 public health deans and scholars, argues that the proposed rule unlawfully narrows statutory exemptions for people who are "medically frail."

The coalition contends the rule would require people with serious medical conditions, disabilities, or mental health and substance use disorders to prove their conditions "significantly impair" their ability to work—a standard they argue Congress did not include in the law and that is inconsistent with congressional intent.

"Work requirements don't improve health; they make it harder for sick people to get the care they need," said Alison Barkoff, George Washington University's Hirsh Health Law and Policy Associate Professor and Hirsh Program Director, who led the development of the comments. "Congress excluded from these harsh requirements people with serious or complex medical conditions, with disabilities and others considered “medically frail” and promised the public these populations would not be impacted. This rule illegally and cruelly undermines access to critical healthcare coverage for those who need it the most."

According to the coalition, the rule would:

• Restrict eligibility for statutory exemptions intended to protect individuals considered “medically frail” because they have disabilities, serious or complex medical conditions, or mental health and substance use disorders.
• Increase administrative burdens on states, providers and Medicaid beneficiaries, despite congressional direction to rely on existing data whenever possible.
• Force states to adopt policies that conflict with longstanding Medicaid requirements promoting simple administration and timely access to care.
• Lead to preventable coverage losses, particularly among people with chronic illnesses and disabilities, while increasing uncompensated care costs for hospitals and community health centers.

“This damaging rule goes well beyond the concerning provisions contained in the underlying legislation, which APHA also strongly objected to during its consideration in Congress,” said Georges C. Benjamin, chief executive officer of the American Public Health Association. “Not only will this proposal result in the loss of health coverage for millions of Americans, but it will also disproportionately harm those most at risk, including those with chronic and complex medical conditions. The administration should revoke this rule, and any revised rule must adhere to Congressional intent to honor the exclusions from the community engagement requirements explicitly mandated in the text of H.R. 1.”

The comments also argue the rule violates the Administrative Procedure Act because HHS failed to adequately justify major policy changes, disregarded extensive evidence from previous Medicaid work requirement programs and overlooked the likely effects on beneficiaries, health care providers and state Medicaid programs.

Drawing on evidence from prior Medicaid work requirement demonstrations in states such as Arkansas and Georgia, the coalition argues that administrative complexity - not failure to meet work requirements - has historically been the primary reason eligible individuals lose coverage. The letter also cites analyses projecting that millions of people could lose Medicaid coverage under the new requirements, with many becoming uninsured despite remaining eligible under federal law.

In its comments, the coalition urges HHS to withdraw the rule in its entirety or, at minimum, eliminate provisions requiring individuals to demonstrate that medical conditions significantly impair their ability to work, restore broader self-attestation and data-based verification options, and align implementation with congressional intent.

The comment can be found here and is a part of the George Washington University Hirsh Health Law and Policy Program’s Health Scholars Legal Initiative. 

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The American Public Health Association champions optimal, equitable health and well-being for all. With our broad-based member community and 150-year perspective, we influence federal policy to improve the public’s health. Learn more at www.apha.org.