ILS joins effort to block Indiana’s Medicaid work requirements

A lawsuit challenging Indiana’s work requirements for Medicaid recipients, which according to the state’s own estimates would result in roughly 24,000 people losing health care coverage each year, was filed in federal court Monday.

This is the fourth federal lawsuit pushing back against the U.S. Department of Health and Human Services’ approval of Medicaid work requirements in other states. The Indiana complaint asserts the Trump Administration is trying to “fundamentally transform Medicaid” and, as a result, “threatening irreparable harm to the health and welfare of the poorest and most vulnerable in our country.”

Hoosiers represented by Indiana Legal Services and the National Health Law Program are seeking to stop the state from enacting a series of changes to the Medicaid program being introduced in the Healthy Indiana Plan 2.0. Along with the work requirement, other changes would impose monthly premiums on certain Medicaid recipients, bar coverage for six months to individuals who do not pay their premiums, eliminate making coverage retroactive for three months before to the enrollment date, and no longer paying for non-emergency medical transportation.

The state began implementing the work requirements Jan. 1, 2019, according to the complaint. It will start suspending coverage to individuals who are not working the requisite hours Dec. 31, 2019.

“These requirements put an extra burden on Medicaid eligibility that jeopardizes the health coverage of our clients and thousands of other vulnerable individuals,” said Adam Mueller, director of advocacy at Indiana Legal Services.

Neither the state of Indiana, any Indiana agency nor Gov. Eric Holcomb are listed as defendants in the lawsuit. Instead, the complaint was filed against federal agencies and administrators, including two officials with strong Indiana ties. Alex Azar II, secretary of the Department of Health and Human Services and former president of Lilly USA LLC, the largest affiliate of Eli Lilly and Co., and Seema Verma, administrator of the Centers for Medicare & Medicaid Services and an architect of the Healthy Indiana Plan 2.0, are among the named defendants.

The case is Monte A Rose Jr., et al. v. Alex M. Azar II, secretary, United States Department of Health and Human Services, et al., 1:19-cv-02848. It was filed in the U.S. District Court for the District of Columbia.

The lawsuit claims by approving Indiana’s requirements, the defendants have violated the Administrative Procedure Act and the Take Care Clause, Article II, section 3, clause 5, of the Constitution. Plaintiffs accuse the defendants of abusing their authority by rewriting the Medicaid Act, ignoring congressional restrictions and acting contrary to 50 years of administrative practice.

HIP 2.0 seeks to have individuals who are not “medically frail” work at least 20 hours a week and, depending on the household income, pay between $1 and $20 each month as a premium.

The four plaintiffs in the lawsuit are all enrolled in HIP 2.0 and worried about losing their Medicaid coverage. Some have reported problems in getting their premium payments recorded.

A 61-year-old visually impaired woman noted the premium invoice has come on different days of the month and has been due on different days. At one point, she received an invoice for $68.96 but no explanation as to why she owed that amount. A 54-year-old woman who struggles with Lyme disease and mental illness has received multiple invoices in a single envelope each showing a different amount owed and has not been reimbursed when she overpaid.

Plaintiffs are asking the district court to stop the implementation of the requirements by enjoining the defendants from approving the requirements in HIP 2.0.

The National Health Law Program has been successful in getting similar Medicaid work rules blocked in Arkansas, Kentucky and New Hampshire. The rulings from Arkansas and Kentucky have been appealed and are scheduled for oral arguments in the U.S. Court of Appeals for the District of Columbia in October.

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