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Pushing Past the Pandemic: Re-evaluating Tribal Exemptions to Medicaid Work Requirements

Published online by Cambridge University Press:  18 August 2021

Kathrin Lozah
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American Journal of Law & Medicine , Volume 47 , Issue 2-3 , July 2021 , pp. 333 - 340
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© 2021 The Author(s)

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References

1 Letter from CMS, to State Health Official (Jan. 7, 2021) (available at https://www.medicaid.gov/federal-policy-guidance/downloads/sho21001.pdf).

2 Id. at 20-21.

3 See Jessie Hellmann, Senators warn against placing Medicaid work requirements on tribes, The Hill (Apr. 30, 2018, 11:15 AM), https://thehill.com/policy/healthcare/385486-senators-warn-against-placing-medicaid-work-requirements-on-tribes [https://perma.cc/5RNE-48C2]; Marina Villeneuve, Tribes say Medicaid work requirements jeopardize health care, Seattle Times (Jan. 19, 2018, 3:58 PM), https://www.seattletimes.com/nation-world/tribes-say-medicaid-work-requirements-jeopardize-health-care/ [https://perma.cc/S65L-GMQQ].

4 Letter from State Medicaid Director Brian Neale, to Tribal Leader (Jan. 17, 2018) (available at https://www.indianz.com/News/2018/04/23/dttl011718.pdf).

5 See Hellmann, supra note 3.

6 Letter from United States Senate, to Secretary Azar Re Tribal Leader Letter (Apr. 27, 2018) (available at https://www.politico.com/f/?id=00000163-092f-da04-a1fb-1dffcc1d0001).

7 Letter from Director Hill, to State Medicaid Director (Aug. 22, 2018) (available at https://www.medicaid.gov/sites/default/files/federal-policy-guidance/downloads/smd18009.pdf).

8 Letter from Secretary Price and CMS Administrator Verma, to the Nation’s Governors (Mar. 14, 2017) (available at https://www.hhs.gov/sites/default/files/sec-price-admin-verma-ltr.pdf).

9 Press Release, CMS, CMS announces new policy guidance for states to test community engagement for able-bodied adults (Jan. 11, 2018), https://www.cms.gov/newsroom/press-releases/cms-announces-new-policy-guidance-states-test-community-engagement-able-bodied-adults [https://perma.cc/BC9M-BWHY].

10 J. Craig Wilson & Joseph Thompson, Nation’s First Medicaid Work Requirement Sheds Thousands From Rolls In Arkansas, Health Affairs (Oct. 2, 2018), https://www.healthaffairs.org/do/10.1377/hblog20181001.233969/full/

11 Gresham v. Azar, 950 F.3d 93, 95 (D.C. Cir. 2020) (Medicaid-eligible individuals brought suit against the Secretary of HHS, alleging that CMS’s approval of Arkansas’s Section 1115 demonstration project violated the Administrative Procedure Act and the Take Care Clause; the D.C. Circuit Court concluded that the Secretary’s approval was arbitrary and capricious because its objectives were not consistent with the Medicaid Act).

12 Id. at 96.

13 Id.

14 Id. at 97.

15 Id.

16 Id.

17 Stewart v. Azar, 366 F. Supp. 3d 125, 132 (D.D.C. 2019) (beneficiaries of Kentucky’s Medicaid program filed suit against the Secretary of HHS alleging that the Secretary’s approval of Kentucky’s Section 1115 demonstration project, implementing work requirements, violated the Administrative Procedure Act; the D.C. Circuit Court concluded that the Secretary’s approval was arbitrary and capricious because it was not consistent with the objectives of the Medicaid Act).

18 Id. at 134.

19 See United States v. Antelope, 430 U.S. 641, 645–46 (1977); Morton v. Mancari, 417 U.S. 535, 554 (1974); Hellmann, supra note 3.

20 See generally Kevin K. Washburn, Federal Criminal Law and Tribal Self-Determination, 84 N.C. L. Rev. 779, 780 (2006); Vanessa J. Jimenez & Soo C. Song, Concurrent Tribal and State Jurisdiction Under Public Law 280, 47 Am. U. L. Rev. 1627, 1628 (1998).

21 Federal Power Commission v. Tuscarora Indian Nation, 362 U.S. 99, 100 (1960).

22 Id. at 104.

23 Id. at 105.

24 Elk v. Wilkins, 112 U.S. 94, 100 (1884).

25 Federal Power Commission, 362 U.S. at 116.

26 See Donovan v. Couer d’Alene Tribal Farm, 751 F.2d 1113, 1116 (9th Cir. 1985).

27 Id.

28 Allison K. Elder, “Indian” as a Political Classification: Reading the Tribe Back into the Indian Child Welfare Act, 13 Nw. J. L. & Soc. Pol’y. 417 (2018).

29 Morton, 417 U.S. at 535.

30 Id. at 536.

31 Id. at 553.

32 Id. at 554.

33 Id. at 555 (emphasis added).

34 See Wilson & Thompson, supra note 10.

35 Villeneuve, supra note 3.

36 See Hellmann, supra note 3; Rachana Pradhan, Trump exempts most tribes from Medicaid work rules, Politico (Jan. 18, 2019, 1:34 PM), https://www.politico.com/story/2019/01/18/trump-medicaid-work-rules-1099559 [https://perma.cc/4BY5-5MCL].

37 MaryBeth Musumeci, Medicaid Work Requirements at the U.S. Supreme Court, KFF (Feb. 11, 2021), https://www.kff.org/policy-watch/medicaid-work-requirements-at-u-s-supreme-court/ [https://perma.cc/9YYR-26D5] (“Before leaving office, the Trump Administration asked the Court to decide whether Medicaid work requirements are legal. A decision is expected by the end of the term in June – unless the Court agrees that the Biden Administration’s reversal makes the cases moot.”).

38 See Morton, 417 U.S. at 554; Dan Diamond, Trump challenges Native Americans’ historical standing, Politico (Apr. 22, 2018, 7:07 AM), https://www.politico.com/story/2018/04/22/trump-native-americans-historical-standing-492794 [https://perma.cc/3B2P-2CMS].

39 See Diamond, supra note 38.

40 The federal government has a general trust responsibility towards the tribes, meaning that it should look out for the welfare of tribal members. See Morton, 417 U.S. at 541-42.

41 Id. at 555.

42 Antelope, 430 U.S. at 645–46.

43 See United States v. Forty-Three Gallons of Whiskey, 93 U.S. 188, 196 (1876) (quoting “from the commencement of its existence the United States has negotiated with the Indians in their tribal condition as nations.”).

44 45 C.F.R. § 80.3(d) (2021).

45 Donovan, 751 F.2d at 1116.

46 See id. (stating when a tribal operation affects open markets it is unlikely the operation is purely intramural).

47 See Reich v. Mashantucket Sand & Gravel, 95 F.3d 174, 179 (2d. Cir. 1996) (describing intramural matters to mean aspects of tribal membership, inheritance rules, domestic relations, and generally consist of conduct, “the immediate ramifications of which are felt primarily within reservation by members of tribe.”).

48 See infra, Section IV.

49 See Gresham, 950 F.3d at 103; Stewart, 366 F. Supp. 3d at 145.

50 42 U.S.C. § 1396j (2021).

51 Id.

52 See Taking Away Medicaid for Not Meeting Work Requirements Harms American Indians and Alaska Natives, Ctr. Budget Pol’y Priorities (Mar. 10, 2020), https://www.cbpp.org/research/health/taking-away-medicaid-for-not-meeting-work-requirements-harms-american-indians-and [https://perma.cc/U4AN-B6YY].

53 National Council of Urban Indian Health, Increase funding for HIS and Urban Indian Health Care, NCUIH (Jun. 10, 2019), https://documentcloud.adobe.com/link/track?uri=urn:aaid:scds:US:8c5652eb-1372-4300-83a5-47a6fd13c0b8 [https://perma.cc/J48A-J42B].

54 See 42 U.S.C. § 1396j.

55 42 U.S.C. § 1315 (2021).

56 Supra note 52.

57 Arnav Shah et al., The Challenge of COVID-19 and American Indian Health, Commonwealth Fund (Aug. 12, 2020), https://doi.org/10.26099/m5ww-xa13 [https://perma.cc/7BPZ-DE98].

58 Id.

59 Id.

60 Rachel Garfield et al., Work Among Medicaid Adults: Implications of Economic Downturn and Work Requirements, KFF (Feb. 11, 2021), https://www.kff.org/report-section/work-among-medicaid-adults-implications-of-economic-downturn-and-work-requirements-issue-brief/ [https://perma.cc/C3HD-T3AB].

61 Erik Ortiz, Native American health center asked for COVID-19 supplies. It got body bags instead., NBC (May 5, 2020, 5:56 PM), https://www.nbcnews.com/news/us-news/native-american-health-center-asked-covid-19-supplies-they-got-n1200246 [https://perma.cc/X4WW-563G] (a community health center caring for the area’s Native American population made an urgent request for medical supplies but instead received body bags).

62 Garfield, supra note 60.

63 Id.

64 Id.

65 Id. (federal agencies are directed to reconsider rules and other policies that limit Americans’ access to health care and consider actions that will instead protect and strengthen that access).