Same Judge Blocks Same Medicaid Work Requirement — Again

UPDATE: Arkansas has asked the Trump administration to appeal the judge’s ruling, and Indiana is proceeding nonstop to implement Medicaid work rules without regard to the rulings in Kentucky and Arkansas.

U.S. District Judge James Boasberg has blocked the implementation of work requirements for able-bodied Medicaid recipients in Kentucky and Arkansas. Nine months ago, the judge blocked Kentucky’s planned implementation, but Gov. Matt Bevin, a Republican, threatened to rescind Medicaid expansion in the state if the work requirement were not allowed.

cms-looks-to-sell-health-insurance-across-state-linesInstead, Kentucky applied for a second waiver from the Department of Health and Human Services (HHS) to implement the work rule, which was then granted, with the requirement set to commence this next Monday. However, in stepped Judge Boasberg to apply a second kibosh.

Boasberg ruled that the approval of work requirements by the Department of Health and Human Services “is arbitrary and capricious because it did not address … how the project would implicate the ‘core’ objective of Medicaid: the provision of medical coverage to the needy.”

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NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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McDonald’s Drops Opposition to Minimum Wage Hikes

McDonald’s Corp., which is involved in a lingering legal dispute over whether it is a joint employer, is now dropping its lobbying efforts against minimum wage hikes, an issue that led to its legal wrangle in the first place.

mcdonalds-faces-strike-over-harassment-claimsMcDonald’s unveiled its new position yesterday in a letter to the National Restaurant Association.

“We believe increases should be phased in and that all industries should be treated the same way,” Genna Gent, McDonald’s vice president of government relations, wrote in the letter. “The conversation about wages is an important one; it’s one we wish to advance, not impede.”

The corporation’s dispute with the National Labor Relations Board (NLRB) not coincidentally arose from a group of franchisee employees who marched for higher wages under the banner of “Fight for $15.” The group’s lawsuit against McDonald’s alleges the corporation as a joint employer is responsible for their treatment at the hands of franchise owners, who in many instances terminated them for their protests.

“Since day one, we’ve called for $15 and union rights and we’re not going to stop marching, speaking out and striking until we win both,” said Terrence Wise, an organizer for the movement.


NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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Centene, WellCare Merger to Create Obamacare Behemoth

Centene, a major health insurer based in St. Louis, is paying $17.3 billion in cash and stock to purchase WellCare Health Plans, a provider of government-sponsored health care programs, including Medicaid.

The merger has been approved by both companies’ boards of directors and is expected to be completed in the first half of 2020. Together, the merged company will service about 22 million members with pro forma revenues of about $97 billion annually.

“With the addition of WellCare, we expect to bolster and diversify our product offerings, increase our scale and have access to new markets, which will in turn, enable us to continue investing in technology and better serve members with innovative programs designed to meet their needs,” said Centene’s chairman and CEO Michael Neidorff in a statement.

UnitedHealth Group, the nation’s largest insurer, serves 115 million members and takes in $226 billion annually, ranking it fifth on the Fortune 500 list of largest U.S. companies by revenue.


NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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DOJ Now Argues for Legal Dissolution of the ACA

The Department of Justice (DOJ) under new Attorney General William Barr has changed course and is now calling on the 5th U.S. Circuit Court of Appeals to strike down in its entirety the Affordable Care Act (ACA, or Obamacare).

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U.S. Attorney General William Barr

This is in opposition to its previous position, which argued only for the unconstitutionality of the ACA’s individual mandate and its pre-existing conditions clause.

The appeals court is reviewing the decision rendered by U.S. District Judge Reed O’Connor on Dec. 14 that the entire law is unconstitutional. The filing of the motion yesterday by the Justice Department came just hours after 21 attorneys general from Blue States presented arguments in favor of the ACA.

The one-page filing said the department “has determined that the district court’s judgment should be affirmed.”

Judge O’Connor’s ruling came after Republicans zeroed out the tax penalty for not having health insurance, which the judge claimed not only invalidated the individual mandate but the rest of the ACA as well, ruling the legislation unconstitutional.

No date has been set for full courtroom arguments, but July has been rumored as the earliest opportunity. In the interim, the ACA will remain fully functional following a ruling by Judge O’Connor to keep his injunction in abeyance pending the appeals process.


NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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CMS Gives Grandmothered Health Plans Another Year of Life

In announcing the final tally for enrollment in Obamacare plans for 2019 through the exchanges, the Centers for Medicare and Medicaid Services (CMS) today also announced that health insurance plans that are not compliant with all new mandates but were “grandmothered” in 2014 are being given another year of non-compliant, grandfather status.

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CMS Administrator Seema Verma

CMS today released the Health Insurance Exchanges 2019 Open Enrollment Report. With the Trump Administration’s focus on making healthcare more affordable, the report confirmswhat it calls another successful open enrollment period coinciding with a stabilization of premiums after years of substantial increases.

Specifically, the report shows plan selections in Exchange plans in the 50 states and D.C. remained steady at 11.4 million. This represents a minimal decline of around 300,000 plan selections from the same time last year. Also, as outlined in the report, average total premiums for plans selected through HealthCare.gov dropped by 1.5 percent from the prior year, the first decline since the exchanges began operations in 2014.

In addition to this report, as part of the administration’s commitment to ensure access to affordable coverage options, CMS is also issuing guidance extending for one additional year, the non-enforcement policy to allow issuers to continue certain health plans, often referred to as “grandmothered” plans, which do not meet all the many mandates and restrictions in the Patient Protection and Affordable Care Act (PPACA).

According to CMS, these plans can be more affordable for people who choose to renew coverage with them.  Extending these grandmothered policies will allow consumers to maintain more affordable coverage than they would have access to through PPACA plans.

“Not extending the grandmothered plan policy would cancel plans that are meeting people’s needs today and, as a result, force people to decide between buying coverage they cannot afford on the individual market or going uninsured,” said CMS Administrator Seema Verma. “By extending the grandmothered plan policy, we are following through on our commitment to protect those left behind by Obamacare.”

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NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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Triangle Shirtwaist Factory Tragedy: 108 Years Ago Today

It was a Saturday in New York City 108 years ago today — March 25 — when fire engulfed by Triangle Shirtwaist Factory, leaving 146 workers dead, some as young as 13.

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Asch Building in New York, site of the Triangle Shirtwaist Factory fire

The factory employed mostly young immigrant women sewing garments in harsh conditions with scant pay to show for it.

The fire started toward the end of the work day, beginning in a rag bin and spreading rapidly through the three top floors of the of the 10-story Asch Building, which housed the sweatshop.

Some women made it to the external fire escape, but it collapsed from the weight and plunged the women to the street below. The owners had locked the doors to prevent theft, so the only other way out was by jumping from a window — to one’s death.

Worse, fire equipment in those days could reach only seven stories up despite the number of skyscrapers in the city, and sprinkler systems were not mandatory. In fact, fire codes were nonexistent.

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NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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New Jersey to Set Up Own ACA Online Marketplace

New Jersey has opted to leave the Affordable Care Act (ACA, or Obamacare) federal exchange at HealthCare.gov and create its own online portal for the start of the 2021 health insurance open enrollment period.

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New Jersey Gov. Murphy

“A New Jersey exchange will be a strong measure of independence at a time when the federal administration continues to undermine and weaken the federal marketplace,” Gov. Phil Murphy said during a news conference at St. Barnabas Medical Center in Livingston.

The governor, a Democrat, said he had already sent a notice of intent to the Department of Health and Human Services (HHS). Having their own exchange would ensure that New Jersey residents would find health care in the state “more accessible, accountable and more responsive,” he explained.

Since taking office in 2018, Murphy has been instrumental in having the state enact its own individual mandate — have insurance or pay a fine — and in setting up a reinsurance program to help cover the costs borne by the state’s high-risk residents.

Both moves are credited with a 9 percent drop in the average price for health care plans sold on the state’s individual market this year.


NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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Overtime Proposal Published, Public Comments Sought

The Department of Labor (DOL) today published a Notice of Proposed Rulemaking (NPRM) regarding its overtime initiative in the Federal Register, opening a 60-day window for the public to offer comments, which will end May 21.

Earlier this month, the DOL sent a draft of the proposed rule to the Office of Management and Budget (OMB) to begin the process of finalizing everything. Today’s action marks the next phase the department must follow when it seeks to establish a new regulation.

The NPRM focuses on the salary threshold above which employees in administrative, professional and executive categories will no longer be eligible for overtime pay. The new threshold is being set at $35,308 a year under terms of the NPRM. The current threshold is $23,660 annually, established in 2004.

In 2016, the Obama-era DOL proposed a salary threshold of $47,476 a year, but a federal judge in Texas blocked that proposed, citing administrative overreach by the department. His injunction now sits before the 5th U.S. Circuit Court of Appeals for review. The review is being held in abeyance at the request of the Trump administration.

The new rule, if finalized, would take effect in 2020.


NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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EEO-1 Pay Data Reporting Still in Limbo

An Obama-era requirement that affected employers must include employee pay data on their annual EEO-1 reports, once nixed by the Trump Office of Management and Budget (OMB) and then restored by a federal judge, is now pending formal announcement by the Equal Employment Opportunity Commission (EEOC).

eeoc-report-could-be-delayedThe EEO-1 online reporting portal opened Monday (March 18) for the traditional Component 1 (race and gender) data, but there was no mechanism for reporting Component 2 data for pay and hours worked.

U.S. District Judge Tanya S. Chutkan has now given the agency until April 3 to clarify how it plans to comply with her order to restore pay data collection.

The EEO-1 reporting period runs through May 31, but speculation abounds that the EEOC may delay collection of the pay data beyond that date to give employers and their own agency time to prepare.

The EEO-1 reporting requirement affects mostly businesses with federal contracts and businesses with 100 or more employees.


NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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Despite Obamacare Options, Employers Still Responsible for COBRA Compliance

Though in many cases a departing employee would be better served obtaining subsidized insurance on the Obamacare exchanges, employers are still required to inform departing employees and their qualified beneficiaries of the option to extend their company-based health insurance based on the circumstances of their departure.

Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), employers with 20 or more full-time employees are required to offer continuation of health coverage for a limited time to employees and their dependents who lose coverage due to a qualifying event.

A qualifying event could be a termination for other than gross misconduct or a loss of coverage due to a reduction in hours, along with five other events (such as death, divorce, etc.).

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NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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