| Welcome to Overnight Health Care, sponsored by the Pharmaceutical Care Management Association. We're so happy it's Friday (and that it’s Jazz in the Garden weather, too). On this summer afternoon, we look first at the lawsuit advocates in Kentucky have brought against the Trump administration over its approval of Medicaid work requirements and other changes to the program. The lawsuit is being argued in Washington, D.C. and Nathaniel brings us the view from the courtroom: Attorneys for the Department of Health and Human Services, as well as for Kentucky Gov. Matt Bevin (R) argued Friday that a federal judge should rule against a group of Kentucky activists, and keep intact the state's Medicaid changes. Kentucky was the first of four states to win approval for work requirements and other conservative changes, but the case has implications beyond Kentucky. Close to a dozen other states are looking to adopt their own work requirements. Kentucky and HHS tried a couple different arguments on Judge James Boasberg, an Obama appointee: - The defendants said the activists have no legal standing to sue. The attorneys said Bevin's threat to end Medicaid expansion if the state loses means the plaintiffs can't prove they will be harmed by the work requirements. Essentially, they will lose Medicaid coverage no matter which way the court decides.
- They also argued that a decision against Kentucky would have a chilling effect on other states who are thinking about expanding Medicaid, but who will only do so if they can impose policies like work requirements, premiums, and coverage lockouts.
- Kentucky's waiver addresses dental coverage, vision coverage, and substance abuse treatment. If the work requirements are invalidated and Bevin ends the state's expansion, the state argued that coverage would also end.
The plaintiffs, represented by the National Health Law Program, the Kentucky Equal Justice Center and the Southern Poverty Law Center, argued the state's waiver goes against the purpose of Medicaid. Medicaid is a health assistance program, they argued, and Kentucky's policies do not help people get coverage-- as many as 95,000 people would actually lose Medicaid if the waiver takes effect, according to the state's own estimates. Tipping his hand? Boasberg didn't seem to favor one side or the other. He seemed to ignore the arguments about standing made by Kentucky. He got the attorneys to clarify that Bevin can't unilaterally end expansion -- he needs to submit an amendment to HHS. He also seemed skeptical of the plaintiffs request to invalidate the CMS guidance and letter to Medicaid directors that essentially gave permission for work requirements. Decision time: Kentucky's waiver is scheduled to take effect July 1. Boasberg said he will aim to have a decision by the end of the month. | 
