Ronnie Maurice Stewart, et al., v. Alex M. Azar II

After the Trump administration made changes to the federal Medicaid program that threatened to strip health insurance away from millions of low-income people, the SPLC filed a federal lawsuit on behalf of Kentucky residents in danger of losing their coverage.

The Trump policy allowed states to seek “waivers” of federal rules – essentially permitting states to place onerous new conditions on poor people that they must meet before receiving medical benefits. Kentucky was the first state to obtain such a waiver.

The SPLC lawsuit, which was brought with co-counsel on behalf of 15 Kentucky residents, alleges that federal health officials who approved the state’s plan acted illegally and in conflict with federal law that only Congress can change. It was the first lawsuit to challenge a Trump administration Medicaid waiver approval.

Kentucky was among the states that expanded Medicaid under former President Barack Obama’s Affordable Care Act. But that was before the Tea Party-supported Gov. Matt Bevin took office in 2015.

After the U.S. Department of Health and Human Services (HHS) approved Kentucky’s waiver in January 2018, Bevin promptly signed an executive order calling for the end of the state’s Medicaid expansion if the waiver is ruled illegal. The move was seen as an attempt to bully Medicaid recipients into accepting the change without challenging it in court.

The plaintiffs represented Kentuckians from all walks of life who rely on Medicaid for their health care. They resided in all parts of the state, and are active in various ways in their communities. They included a minister (who is also a mortician), a church administrator, a mechanic, a musician, a retired health care worker, and students, caregivers, house cleaners, a bank teller and housekeepers for a health care center and a university. The plaintiffs have a variety of health care concerns, from high blood pressure, diabetes and mental health problems to poor vision and dental problems.

In June 2018, a federal judge blocked the U.S. Department of Health and Human Services’ (HHS) initial approval of the plan, stating that the government acted in an “arbitrary and capricious” manner in approving it. The court found that HHS failed to adequately consider whether it would help Kentucky provide Medicaid coverage to its low-income residents.

The federal judge sent the plan back to HHS to reconsider it in accordance with the Medicaid Act.

In November 2018, federal health officials announced that they had approved Kentucky’s Medicaid work requirements again, despite evidence that the plan will lead to thousands of hard-working Kentuckians losing access to vital health care coverage.

The SPLC and its partners filed an amended complaint in January 2019 in the same court, on behalf of more than a dozen Kentucky Medicaid recipients who stood to lose their benefits. They sought to have the new approval also declared “arbitrary and capricious.”

On March 27, 2019, the federal district court blocked the federal government’s second approval of Kentucky’s work requirement waiver and granted partial summary judgment to plaintiffs.The federal government, and the Commonwealth of Kentucky which intervened as a defendant, appealed that ruling to the U.S. Court of Appeals for the District of Columbia Circuit.