North Carolina Attorney General Jeff Jackson is challenging new federal guidance that changes how medically frail Medicaid recipients may qualify for an exemption from an upcoming work requirement.
Jackson says the revised North Carolina Medicaid work requirement guidance could force the state and county social services departments to create new eligibility procedures after months of preparing under a different federal interpretation.
Medically Frail Recipients Face Additional Test
Federal law includes an exemption from the 80-hour-per-month Medicaid work requirement for people who are considered medically frail. That category may include individuals with cancer, Parkinson’s disease, cystic fibrosis and other serious or complex medical conditions.
New guidance from the Centers for Medicare and Medicaid Services would require recipients to show not only that they have a qualifying medical condition, but also that the condition substantially limits their ability to satisfy the monthly work requirement.
Jackson argues that Congress did not authorize that additional test. He also says federal officials had previously indicated that states could rely on a broader definition already included in existing Medicaid regulations.
Counties Could Face More Paperwork and Costs
North Carolina and other states had already begun updating eligibility systems, training employees and developing procedures based on the earlier interpretation. The final federal guidance was issued on June 1.
Jackson said changing the standard at the end of that process could waste millions of dollars in taxpayer-funded preparation and require state and county agencies to redesign their systems.
Much of the responsibility for reviewing Medicaid eligibility falls on county departments of social services. State officials warn that the new standard could add paperwork for patients, physicians and county employees at a time when many local offices are already dealing with staffing challenges.
There are also concerns that eligible residents could temporarily lose health coverage while collecting medical documentation or attempting to prove that their condition limits their ability to work.
North Carolina Seeks Emergency Court Order
North Carolina joined attorneys general from 23 other states, along with the governors of Kentucky and Pennsylvania, in a lawsuit challenging the federal guidance.
The states are requesting a preliminary injunction that would pause the new definition while the broader lawsuit moves through federal court. Jackson says the pause would allow states to continue implementing the work requirement under the broader definition they had previously prepared to use.
The legal challenge does not seek to eliminate the federal work requirement. Instead, it focuses on how the medically frail exemption is defined and administered.
A court ruling on the request for temporary relief could determine whether North Carolina must immediately change its eligibility system or continue using its existing implementation plan while the lawsuit proceeds.
Source: This article is based on reporting by Jaymie Baxley of North Carolina Health News and comments from North Carolina Attorney General Jeff Jackson.
