Federal Advocacy: Medicaid Work Requirements Struck Down and ACA Updates

Medicaid Work Requirements Struck Down

Yesterday, a U.S. District Court Judge ruled, for the second time, against taking away Medicaid coverage from people who do not meet work requirements in Kentucky and Arkansas. NAMI applauds this ruling, as work requirements hurt people with mental illness.

More than 10 million people with mental illness across the country rely on Medicaid, including many who live with severe conditions. While NAMI supports the goal of employment and recognizes that people with mental illness are disproportionately unemployed, cutting off Medicaid for people with mental illness won’t improve their mental health—or help them get or keep a job.

The Centers for Medicare and Medicaid Services (CMS) has approved work requirements in eight states, including Arkansas and Kentucky. Seven more states have work requirement proposals pending. Prior to the ruling, Kentucky’s work requirement was set to go into effect next Monday, April 1. In Arkansas, more than 18,000 people have lost their Medicaid coverage under the work requirement.

While states may exempt some vulnerable people from work requirements, most states do not have effective ways to do so. Additionally, there are people with mental illness who have not been determined disabled, but may not be ready to work, including:

  • Young adults with the first symptoms of a serious mental illness;

  • People whose mental health symptoms are so severe they are not able to navigate the disability system; and

  • People who have been discharged from psychiatric hospitalization but need ongoing treatment.

Unfortunately, because of the complexity of work requirement programs, many people with mental illness fall through the cracks and lose their coverage.

NAMI has submitted comments opposing each state’s work requirement proposal, reiterating that it would be more effective for states to invest in robust, evidence-based Supported Employment programs that many people with mental illness need to get and keep competitive employment.

In January, NAMI filed an amicus brief in the lawsuit against the work requirements in Kentucky, along with The American Academy of Pediatrics, The American College of Physicians, The American Medical Association, The American Psychiatric Association, The Catholic Health Association of the United States, and March of Dimes. In November, NAMI filed an amicus brief in a similar lawsuit in Arkansas. You can read both briefs and a joint statement issued by NAMI and the above groups here

We expect that the Administration will fight this decision and appeal the ruling.

Affordable Care Act Updates

On Tuesday, legislation was introduced in the U.S. House of Representatives to amend the Affordable Care Act (ACA) to improve access to coverage and make health care more affordable. The Protecting Pre-Existing Conditions and Making Health Care More Affordable Act of 2019 aims to help individuals and families afford health care and improve protections for people with pre-existing conditions, including mental health conditions. The bill would:

  • Provide more financial help to families who buy their own insurance and lower premiums for 13 million Americans;

  • Protect people with preexisting conditions by repealing policies like the expansion of Short-Term, Limited Duration (STLD) plans; and

  • Increase support to help millions of Americans understand insurance options and sign up for coverage.

NAMI joined 25 other patient advocacy groups in support of this bill. Read our joint statement here. You can learn more about this bill in this analysis from the Center for Budget and Policy Priorities.

This bill comes after the Department of Justice (DoJ) announced on Monday that they support a recent court ruling that would invalidate the entire Affordable Care Act (ACA). In December, a U.S. District Court Judge ruled in Texas v. United States that the entire ACA is unconstitutional.

Fortunately, because the ruling is being appealed, no one has lost their coverage or had any protections stripped away due to the ruling.

The case is now with the 5th Circuit Court of Appeals and could go to the Supreme Court. If the decision is upheld, it would touch nearly every corner of the health care system and affect virtually every American. See the attached memo from December for more details on what this would mean for people with mental illness.

NAMI will continue to provide updates on these issues and share opportunities for NAMI advocates to take action.