INDIANAPOLIS – Indiana is the latest state forced to defend its work requirement to qualify for health insurance, with a federal lawsuit filed Monday challenging the Medicaid waiver project.
The complaint was filed on behalf of four Indiana residents whose Healthy Indiana Plan benefits are in jeopardy, including one woman from Fort Wayne. They are represented by Indiana Legal Services and the National Health Law Program.
It is the fourth such lawsuit seeking to block a work component approved by the U.S. Department of Health and Human Services as a condition of coverage for adults. Initial rulings in New Hampshire, Arkansas and Kentucky have barred the mandate.
“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, advocacy director at Indiana Legal Services.
Gov. Eric Holcomb's office provided the following statement: “Our state's Healthy Indiana Plan has become the national model for successful state innovation that meets citizens' healthcare needs and improves lives. We intentionally designed the Gateway to Work program to connect HIP members with opportunities to work, learn or serve.”
“Importantly,” the statement continues, “we are building this program unlike any other state in the country, with robust supports and pathways to ensure Hoosiers can easily skill up, volunteer in their community, or get a better paying job while driving towards better health outcomes. It's disappointing a lawsuit has been filed before the program has had an opportunity to prove its success.”
About 440,000 low-income Hoosiers are on the HIP program, which is funded by federal Medicaid dollars but requires a financial contribution by the participant.
Indiana began implementing the work requirements Jan. 1 and will begin suspending the coverage of individuals who have not met the work requirements Dec. 31.
An initial projection shows about 130,000 able-bodied HIP members could be affected by the new requirement. Many others either already meet the employment requirement or fall under one of 14 exemptions.
Some of those exemptions include being medically frail, older than 60, full- and part-time students, primary caretakers of young or disabled children, pregnant women, participants in substance abuse treatment, the recently incarcerated and former foster children.
The lawsuit alleges the work requirement is projected to jettison thousands from coverage through the Healthy Indiana Plan.
“This case challenges the ongoing efforts of the executive branch to bypass the legislative process and act unilaterally to fundamentally transform Medicaid, a cornerstone of the social safety net,” the filing states.
“Purporting to invoke a narrow statutory waiver authority that allows experimental projects 'likely to assist in promoting the objectives' of the Medicaid Act, the executive branch has instead effectively rewritten the statute, ignoring congressional restrictions, overturning a half century of administrative practice, and threatening irreparable harm to the health and welfare of the poorest and most vulnerable in our country,” the filing continues.
Mary Holbrock, a 54-year-old Fort Wayne woman, is one of the plaintiffs. She has a Ph.D. in linguistics and taught at the university level until 2010, when she lost her job in the recession.
Holbrock now works part time grading standardized tests, and her hours fluctuate significantly. Some weeks she works 20 to 30 hours, and some weeks she does not work at all, according to the summaries provided. She enrolled in Medicaid after she lost her job.
On average, Holbrock earns $400 a month and receives food assistance. She has Lyme disease, which has caused numerous health problems, including memory loss, muscular weakness, and chronic pain. Holbrock also has post-traumatic stress disorder, anxiety and depression.
The summary said she uses Medicaid coverage to get regular treatment for these conditions. She is currently classified as medically frail, yet her health plan has revoked her medically frail status twice without explanation even though her health conditions had not improved.
She received a letter informing her that she is exempt from the HIP work requirements – likely because she is medically frail. But if she loses her exemption, she will have to work at least 20 hours per week to maintain Medicaid coverage. Holbrock is concerned that she will not be able to meet that requirement given her fluctuating work assignments.
Jane Perkins, National Health Law Program's legal director, said the HHS Secretary has again taken authority he does not have.
“Congress has defined the scope of the secretary's power to waive portions of the Medicaid Act, and that scope is limited,” she said. “This approval will not promote coverage, but it will result in significant coverage losses, and that is the administration's goal – to weaken the Medicaid program and cull people whom it deems unworthy from it.”