President Biden’s executive orders have included directives to some government agencies to re-examine Trump-era health care policies. Among those to be reviewed are the Medicaid work requirements and short-term health plans. Agencies are specifically directed to re-examine any policies and rules that limit access to health care, such as adding work requirements to Medicaid.

Some states liked those stricter requirements the Trump administration put in place. There may be fallout.

Under the Trump administration’s plan, recipients of Medicaid were to have put in 20 or more hours each week working, looking for work, taking classes, or performing community service to be eligible for Medicaid benefits. Arkansas, Kentucky, Nebraska, and several other states were approved to impose work requirements from the Trump administration. The mandate is not actually in play anywhere, mostly due to legal challenges. Federal judges in Arkansas, Kentucky and New Hampshire blocked the imposition of the work requirements.

The work rules were approved through Medicaid waivers, intended to allow states to test ideas for health coverage.

The Supreme Court is set to hear arguments over federal approvals for work requirements in New Hampshire and Arkansas on March 29. If the Biden administration acts quickly to remove the work requirements, the court case will be moot. Should the case go to the Supreme Court, the decision could help clarify how much authority Health and Human Services (HHS) has over crafting Medicaid waivers.

Section 1115 of the Social Security Act allows HHS to waive Medicaid rules to allow states to try different ways to serve beneficiaries. Seven states have pending work requirement waiver proposals.

The notification from Centers for Medicare and Medicaid Services to the states advising them about the potential for withdrawing the work requirement waivers told the states that in the Centers’ view, the work requirement would not promote the objectives of the Medicaid program. Promoting the objectives of the program – that’s a key factor in the legal case.

An agency spokesperson said, “Medicaid’s primary objective, as set out by Congress, is to provide medical assistance in order to serve the health and wellness needs of our nation’s vulnerable and low-income individuals and families, based on need, not based on one’s ability to find work.” The statute makes no mention of any other objectives, including “improving health outcomes,” an objective cited by the Trump administration in its approvals.

Medicaid covers about 70 million people (nearly one in five Americans), including newborns and pregnant women, disabled people, and elderly nursing home residents. It’s a $600 billion federal-state program. Under Obama’s Affordable Care Act, states could expand the program to low-income adults who were previously ineligible. About 12 million people got coverage as a result.

Though the Trump administration suggested that the work requirements were a means to help people move off Medicaid and into jobs with employer-sponsored health coverage, Democrats were skeptical. They said the requirements really were intended to reduce benefits and coverage, which counters Medicaid’s status as a guaranteed benefit for qualified people.

Medicaid chief Seema Verma, a Trump administration appointee, was critical of Obamacare’s expansion of Medicaid to poor adults. Verma crafted the requirements, insisting that they would get healthy people to work and keep state Medicaid programs from becoming financially unmanageable.

The Trump administration’s 2018 letter announcing the work requirements policy is being withdrawn, and a separate letter they issued earlier this year hoping to make it more difficult for the Biden administration to overturn the policy is being rescinded.

Attorney General Leslie Rutledge of Arkansas called the Biden administration’s decision “an overreach of executive power.” She said, “It is unfortunate that President Biden and his administration felt compelled to take steps to withdraw the approval of Arkansas’s work-requirement pilot program without giving it the opportunity to succeed. The one-size-fits-all Medicaid program doesn’t work.”

Despite the fact that Arkansas was the first state to implement the program, a Harvard University study found that in the ten months before the program was stopped by a judge, 18,000 Arkansans lost coverage. They also noted that there was no increase in employment.

According to a health department draft rollout plan called “Medicaid Work Requirement Rescission,” “CMS has serious concerns that now is not the appropriate time to test policies that risk a substantial loss of health care coverage or benefits in the near term.” The draft document points out that the coronavirus has greatly increased the risk that the Medicaid work policy would lead to “unintended coverage loss.”

“In addition, the uncertainty regarding the lingering health consequences of COVID infections further exacerbates the harms of coverage loss or lack of access to coverage for Medicaid beneficiaries,” the plan noted.

Biden is already making inroads, having reversed a Trump administration policy prohibiting federal aid funds from going to groups that perform abortions or provide related services, and relaunching open enrollment under the Affordable Care Act.

More initiatives are anticipated.