{
  "id": "R44802",
  "type": "CRS Report",
  "typeId": "REPORTS",
  "number": "R44802",
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      "id": 585890,
      "date": "2017-07-07",
      "retrieved": "2020-01-02T14:19:23.166611",
      "title": "Judicial Review of Medicaid Work Requirements Under Section 1115 Demonstrations ",
      "summary": "Proposals have been introduced in the 115th Congress to reform the Medicaid program, which provides medical assistance to low-income and needy individuals. One such approach, taken by House-passed H.R. 1628, the American Health Care Act of 2017, would allow states to impose work requirements on certain categories of individuals as a condition of coverage under the Medicaid program. A similar approach is also taken in the discussion draft of the Better Care Reconciliation Act, a proposed amendment in the nature of a substitute to H.R. 1628, which was published by the Senate Budget Committee on June 22, 2017, and updated on June 26, 2017.\nIn addition to these proposals, which would take the form of legislative amendments to the Medicaid statute, work requirements have also been discussed in the context of waivers granted to states under the existing demonstration authority provided in Section 1115 of the Social Security Act (SSA). Section 1115 authorizes the Secretary of Health and Human Services (HHS) to waive a number of Medicaid requirements to the extent necessary to allow a state to undertake an \u201cexperimental, pilot, or demonstration project\u201d that is likely to assist in promoting the objectives of Medicaid. Several states have recently sought waivers to impose some type of Medicaid mandatory work incentives under Section 1115, but to date, the Secretary has not approved such a waiver. This report examines the scope of authority to grant such waivers under Section 1115, including the degree to which such waivers may be judicially reviewable and the level of scrutiny courts would apply in such cases.\nNumerous federal courts have held that the Secretary\u2019s decision to grant a waiver under Section 1115 is reviewable under the Administrative Procedure Act (APA). Such review uses the deferential \u201carbitrary and capricious\u201d standard to evaluate the permissibility of agency action. In cases where Section 1115 waivers have been challenged, courts have held that the APA does not empower judges to substitute their judgment for that of the agency, but only to consider whether the Secretary\u2019s decision was based on consideration of relevant factors and whether there has been a clear error of judgment. Therefore, a court\u2019s evaluation of a particular Section 1115 waiver will likely turn upon the sufficiency of the actual administrative record relied upon by the HHS Secretary when deciding to grant a waiver.",
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    {
      "source": "EveryCRSReport.com",
      "id": 460025,
      "date": "2017-03-28",
      "retrieved": "2017-03-29T20:01:45.267134",
      "title": "Judicial Review of Medicaid Work Requirements Under Section 1115 Demonstrations",
      "summary": "Proposals have been introduced in the 115th Congress to reform the Medicaid program, which provides medical assistance to low-income and needy individuals. At least one of these legislative proposals would allow states to impose work requirements on certain categories of individuals as a condition of coverage under the Medicaid program. While such proposals have been included as legislative amendments to the Medicaid statute (such as the American Health Care Act, H.R. 1628), work requirements have also been discussed in the context of waivers granted to states under the existing demonstration authority provided in Section 1115 of the Social Security Act (SSA). Section 1115 authorizes the Secretary of Health and Human Services (HHS) to waive a number of Medicaid requirements to the extent necessary to allow a state to undertake an \u201cexperimental, pilot, or demonstration project\u201d that is likely to assist in promoting the objectives of Medicaid. This report examines the scope of authority to grant such waivers under Section 1115, including the degree to which such waivers may be judicially reviewable and the level of scrutiny courts would apply in such cases.\nNumerous federal courts have held that the Secretary\u2019s decision to grant a waiver under Section 1115 is reviewable under the Administrative Procedure Act (APA). Such review uses the deferential \u201carbitrary and capricious\u201d standard to evaluate the permissibility of agency action. In cases where Section 1115 waivers have been challenged, courts have held that the APA does not empower judges to substitute their judgment for that of the agency, but only to consider whether the Secretary\u2019s decision was based on consideration of relevant factors and whether there has been a clear error of judgment. Therefore, a court\u2019s evaluation of a particular Section 1115 waiver will likely turn upon the sufficiency of the actual administrative record relied upon by the HHS Secretary when deciding to grant a waiver.",
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}