Philbrick v. Azar
Issue: Was the HHS Secretary’s approval of New Hampshire’s Section 1115 demonstration waiver, which conditioned Medicaid eligibility on meeting a work reporting requirement, arbitrary and capricious?
Background: Medicaid enrollees sued to challenge the HHS Secretary’s approval of New Hampshire’s Section 1115 demonstration waiver, which conditioned Medicaid eligibility on meeting a work reporting requirement. The district court vacated the approval, finding that the Secretary’s decision was arbitrary and capricious and therefore violated the Administrative Procedure Act (APA) because he failed to consider the demonstration’s impact on Medicaid’s core purpose of providing health coverage to low-income people. Upon appeal, the D.C. Circuit summarily affirmed, citing its opinion in Gresham v. Azar. The Trump Administration appealed to the U.S. Supreme Court. Subsequently, the Biden Administration notified the Court that it preliminarily had determined that the work requirements approved by the Trump Administration did not further Medicaid program objectives and therefore was initiating a process to determine whether to withdraw demonstration approval. As a result, the Supreme Court vacated the lower courts’ judgments and dismissed the appeal as moot.
Current Status: Final decision issued
Supreme Court Amicus Brief, Feb. 25, 2021*
*Combined with Becerra v. Gresham
Amici: 73 public health deans and scholars
Argument Summary: Congress enacted Section 1115 to permit states to test new approaches to expand access, provide better services, and strengthen social programs. Early Section 1115 demonstrations heeded congressional intent that experiments strengthen Medicaid. Since 1965, Congress has added important protections to ensure demonstrations promote Medicaid’s purpose. The Secretary cannot use Section 1115 as a shortcut for reversing the Affordable Care Act’s Medicaid expansion. The Secretary’s approvals of eligibility restriction experiments in Arkansas and New Hampshire violated research norms by lacking a basis in evidence and by failing to ensure states conduct adequate demonstration evaluations. HHS consistently sidestepped evaluation principles contained in their own Section 1115 guidance.
Medicaid expansion’s remarkable achievements in providing medical assistance to uninsured adults made the impact of imposing work requirements, coverage lock-outs and limited retroactive eligibility even more catastrophic. Expansion in Arkansas and New Hampshire achieved dramatic reductions in total uninsured adults. Extensive commentary in the administrative record made clear the risks created by work requirements and coverage restrictions. There is no realistic expectation that those leaving Medicaid for work will find alternative sources of health insurance.
D.C. District Court Amicus Brief, May 17, 2019
Amici: 10 public health deans and scholars
Argument Summary: Congress intended Section 1115 Medicaid demonstrations to improve the program, not to remove thousands of eligible people. Because Section 1115 cannot be a pretext to restrict Medicaid eligibility or coverage, the Secretary’s approval of New Hampshire’s demonstration was arbitrary, capricious, and contrary to law. New Hampshire’s remarkable achievements in providing medical assistance to uninsured adults make the impact of imposing work requirements, coverage lock-outs, and limited retroactive eligibility even more catastrophic. New Hampshire’s demonstration will affect access to healthcare community-wide.
Outside Counsel: Feldesman Tucker Leifer Fidell, LLP
Related Resources:
GW Media Relations. Medicaid compelled work experiments represent an abuse of research authority, have stripped thousands of eligible people of coverage. March 11, 2021. https://mediarelations.gwu.edu/medicaid-compelled-work-experiments-represent-abuse-research-authority-have-stripped-thousands
Rosenbaum S. Medicaid work requirement experiments at the Supreme Court: what happens now? To the Point (blog). Commonwealth Fund. Jan. 12, 2021. https://doi.org/10.26099/vyxm-wa81