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Arizona has suspended its plan to force about 120,000 Medicaid recipients to work, volunteer, or go to school in order to receive benefits, according to a letter sent to the Center for Medicaid and CHIP Services on October 17.

Citing the “evolving national landscape” surrounding Medicaid work requirements and “ongoing litigation” against other states’ work requirements, Arizona will delay its plan, previously set to go into effect on January 1, 2020.

The state’s work requirement — or what it calls “community engagement programs”— would force these 120,000 Arizonans, ages 18 to 49, to report at least 80 hours per month of employment, educational activity, job search or training, or volunteer community service to keep their Medicaid benefits.

The decision to delay the program represents a setback to the Trump administration, which has pushed states to implement work requirements on low-income individuals as a condition for them to receive their benefits. Nearly 20 states are in various stages of trying to implement work requirements, according to the Associated Press.

But those efforts haven’t been without pushback. Maine and New Hampshire dropped their efforts to impose work requirements this year, and in March, Judge James E. Boasberg of the US District Court for the District of Columbia struck down work requirements in Arkansas and Kentucky.

Boasberg wrote that the U.S. Department of Health and Human Services failed to “consider adequately” the impact of Arkansas’s plan on Medicaid coverage and said for a second time that the department had similarly not adequately considered whether Kentucky’s plan “would in fact help the state furnish medical assistance to its citizens, a central objective of Medicaid.”

Those cases are now before a federal appeals court.

Arizona, which voted to expand Medicaid in 2013, initially opted not to pursue work requirements, and since the state’s expansion went into effect in 2014, more than 430,000 people have enrolled in the program, according to the Kaiser Family Foundation.

That expansion, which was made possible because the Affordable Care Act expanded Medicaid eligibility to cover more low-income adults, has played a key role in driving down Arizona’s uninsured rate, according to the Center on Budget and Policy Priorities (CBPP), a left-leaning think-tank. Since Arizona expanded Medicaid, the state’s uninsured rate has fallen from 17.1% in 2013 to under 11% in 2018, according to data from the U.S. Census Bureau.

However, the ACA — and by extension Medicaid — has also been under continued attack. Republicans have voted to repeal the Affordable Care Act (ACA) more than 60 times, an outcome that would also roll back Arizona’s Medicaid expansion.

Sen. Martha McSally (R-Ariz) is among the Republican representatives who have voted to cut Medicaid. Then a member of the House, McSally voted to repeal the ACA in 2015 and to repeal and replace it with the American Health Care Act (AHCA) in 2017.

The AHCA would have cut billions from Medicaid and the Children’s Health Insurance Program, which together cover nearly one out of every four Arizonans. 

The AHCA didn’t pass, but that hasn’t stopped the attacks on Medicaid.

As the Trump administration began to encourage states to implement work requirements in 2017, they found an ally in Arizona Gov. Doug Ducey (R-Ariz).

Under Ducey, the state passed a law in 2015 requiring the state’s Medicaid program, the Arizona Health Care Cost Containment System, to request a federal waiver to add work requirements for certain able-bodied adults. Since then, the state has made implementing work requirements a priority, and finally received approval for its waiver in January 2019.

The Trump administration says these requirements would make people healthier by pushing them to get jobs, which the administration claim will help them get private health insurance.

“This policy is about helping people achieve the American dream,” Seema Verma, Administrator of The Centers for Medicare & Medicaid Services, told reporters in 2018. “People moving off of Medicaid is a good outcome because we hope that means they don’t need the program anymore.”

The administration has continued to make similar arguments in recent weeks. The Washington Post reports that Alisa Klein, a Justice Department attorney defending the work requirements in Arkansas and Kentucky, said earlier this month that the administration believes forcing low-income people to work, train or volunteer can improve their health and help them get private health plans, freeing up money that states could use for other Medicaid services.

Opponents of the requirements say they would jeopardize health care for lower-income Americans who are already struggling to afford child care, transportation, and other costs.

Hospitals and patient advocates have also spoken out about the proposed work requirements, saying they could lead to significant losses in coverage and interruption to care for those with chronic conditions. They argue that low-income adults would have a difficult time finding and keeping a job if the government took away their health insurance. 

“All it does is increase the uninsured rate,” Jessica Schubel, a senior policy analyst for the CBPP, told the Associated Press. “It takes coverage away from people who are working and people who should get exemptions because they get caught up in the red tape.”

Critics also point to the fact that thousands of Medicaid recipients lost coverage in states that imposed similar work requirements. In Arkansas, nearly 17,000 Medicaid beneficiaries lost their coverage because of work requirements before the U.S. District Court stepped in. 

There’s also no evidence that work requirements increase the number of Medicaid-eligible individuals who work, according to the CBPP.

Opponents of the requirement also cite the fact that 66% of adult Medicaid enrollees in Arizona are already working as proof that a requirement is unnecessary. 

Despite the opposition to work requirements and several ongoing lawsuits, Heidi Capriotti, a spokeswoman for Arizona’s Medicaid agency, said the state remains committed to implementing work requirements in the future. “We’re just going to hold on the program until we know more about what’s happening with other state litigation,” Capriotti told the AP.

State Rep. Nancy Barto (R-Phoenix), who introduced the 2015 bill creating Arizona’s work requirements, also remains committed to its implementation, despite the recent delay. Barto told the AP that “it’s better to delay implementation by a few months than to start it based on our plans then to have to stop and restart it” if the courts stepped in.

The state will now wait for the US Court of Appeals for the DC Circuit to rule on the work requirements in Arkansas and Kentucky. 

In oral arguments earlier this month, the court appeared skeptical of the Trump administration’s arguments that requiring low-income people to work, train or volunteer could improve their health and help them obtain private health plans. According to the Washington Post, all members of the three-judge panel repeatedly said senior Trump administration health officials had failed to consider that Americans would lose health insurance under the proposals.