A federal judge has once again vacated the U.S. Department of Health and Human Services’ approval of Kentucky’s Medicaid waiver plan, calling its approval “arbitrary and capricious” and contrary to the federal Medicaid Act.

Just as he had last year after the Trump administration first approved the Kentucky HEALTH plan — adding work and volunteer requirements for Medicaid recipients — U.S. District Judge James Boasberg ruled Wednesday that this approval was in violation of the law and the waiver should be remanded to HHS for further review.

The ruling once again blocks the implementation of the Kentucky HEALTH plan by the Cabinet for Health and Family Services, which was scheduled to begin on April 1. The plaintiffs in the case had argued that the requirements in the waiver plan would cause thousands of Medicaid recipients in Kentucky to lose coverage, saying that outcome would be inconsistent with Medicaid’s stated goal of promoting health coverage.

While the Bevin administration had argued that reversing the approval of the waiver would force Kentucky to end its expansion of Medicaid that covers nearly 500,000 in the state, Boasberg rejected that argument.

“Defendants urge the Court to adopt the proposition that the Secretary need not grapple with the coverage-loss implications of a state’s proposed project as long as it is accompanied by a threat that the state will de-expand — or, indeed, discontinue all of Medicaid,” wrote Judge Boasberg. “By definition, so this argument goes, any number of people covered by an experimental Medicaid program would be greater than the number if there were no Medicaid at all; as a result, any demonstration project that leaves any individual on a state’s Medicaid rolls promotes coverage. The Court cannot concur that the Medicaid Act leaves the Secretary so unconstrained, nor that the states are so armed to refashion the program Congress designed in any way they choose.”

In a separate ruling also Wednesday, Judge Boasberg also struck down similar work requirements for Medicaid recipients in a previously approved waiver plan for Arkansas, which has led to roughly 18,000 people in that state losing coverage.

A spokesperson for Gov. Matt Bevin did not immediately return a request for comment on the ruling.

Adam Meier, the secretary for the Cabinet for Health and Family Services, issued a statement criticizing the ruling and suggesting that it would be appealed.

“The judge illogically concluded that Medicaid is all about paying for healthcare for as many people as possible without regard to whether this coverage actually makes people healthier,” stated Meier. “We emphatically disagree because a healthcare program like Medicaid, by its very nature, must take into account whether it improves people’s health. That’s the whole point.”

Calling the ruling “a setback to our implementation schedule,” Meier defended the Kentucky HEALTH as being focused “on actually improving health outcomes,” which is “precisely in line with the objectives of the Medicaid program and squarely within the authority of the HHS Secretary to approve.” He added that “we believe that we have an excellent record for appeal and are currently considering next steps.”

Rich Seckel, the executive director of the Kentucky Equal Justice Center — one of the three organizations representing the Kentucky Medicaid recipients who are plaintiffs in the lawsuit issued a statement that Boasberg’s ruling “recognizes that Medicaid demonstration waivers must adhere to a purpose–to improve coverage and care.”

As for the threat of Bevin and Meier to “unexpand” Medicaid if the lawsuit blocked the waiver, Seckel added that “we’ve always believed that this should be decided based on law rather than threat. That’s what the plaintiffs sought. The governor knows how to appeal if he disagrees; that would be the wiser path for him.”

Emily Beauregard, the executive director for Kentucky Voices for Health, stated that Medicaid expansion “has saved lives” in Kentucky and Wednesday’s ruling “sends the message that 1115 waivers must uphold the purpose of Medicaid, which is to furnish health coverage to low income people.”

State Rep. Joni Jenkins, D-Louisville, issued a statement praising the “great decision” of Judge Boasberg, adding that “my hope is that it finally puts this unnecessary waiver behind us.”

“The facts are clear: The Medicaid expansion has saved lives, it has improved our overall collective health, and it has added billions of dollars to our economy,” stated Jenkins. “It is a win for everyone involved. As we have done from the start, the House Democratic Caucus members are committed to doing all we can to make this expansion the success it deserves to be.”

This story has been updated.