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A group of public health scholars has asked a federal judge to block Kentucky’s planned Medicaid overhaul, citing an estimate that up to 136,000 people could lose coverage in the first year of a new work requirement.

The 48 scholars, from universities including Harvard, Yale, Boston and Columbia, filed a friend of the court brief Tuesday in U.S. District Court in Washington, D.C.

The brief was filed in support of more than a dozen Medicaid beneficiaries who are suing the Trump administration over its November re-approval of the state’s Section 1115 waiver, also known as Kentucky HEALTH.

In an initial legal challenge by a similar group of Medicaid beneficiaries last year, Judge James Boasberg sent Kentucky’s waiver back to the U.S. Department of Health and Human Services for further review, saying Secretary Alex Azar “never adequately considered whether Kentucky HEALTH would, in fact, help the state furnish medical assistance to its citizens, a central objective of Medicaid.”

In his ruling last June, Boasberg also called the January 2018 approval “arbitrary and capricious,” which the scholars say is also the case with the November re-approval.

What’s more, they say, this court vacated the Trump administration’s “original approval of Kentucky HEALTH due to the Defendants’ ‘sleight of hand’ in proclaiming a new purpose of Medicaid yet turning a ‘blind eye’ to Medicaid’s principal purpose of providing medical assistance.”

In short, they added, the secretary still has not conducted the analysis necessary for authorizing the waiver.

Kentucky HEALTH, which is set to begin in April, would require eligible adults to do 80 hours a month of work or other forms of “community engagement,” such as volunteering or job training, to keep their benefits. Other features include premiums or copays, and a My Rewards account to earn virtual dollars for some services, such as routine dental and vision care.

“This experiment by Kentucky threatens to strip hundreds of thousands of beneficiaries of Medicaid coverage with no realistic alternative in sight,” Sara Rosenbaum, a professor in the George Washington University Milken Institute School of Public Health, said in a news release.

The scholars cite a new analysis by researchers at the Milken Institute School of Public Health that estimates that 86,000 to 136,000 Kentucky Medicaid beneficiaries would lose coverage in just the first year of the state’s work requirement. That’s higher than Kentucky’s initial estimate that 95,000 could lose coverage within five years because of Kentucky HEALTH.

In their brief, the scholars take the Trump administration to task for not considering the impact that a similar program is having in Arkansas, where the “experience of Arkansas enrollees and providers … underscores the unreasonableness of approving these types of demonstrations.”

“Through January 7, 2019, a total of 18,164 beneficiaries have lost Medicaid coverage due to failing to meet work and reporting requirements since they were implemented in Arkansas in June 2018,” according to the scholars, who also note that “numerous studies estimated that the losses in Arkansas’s Medicaid enrollment would be significantly lower than the losses that are actually occurring.”

Many of the same scholars filed a friend of the court brief last year after Medicaid beneficiaries initially filed a legal challenge to block Kentucky HEALTH.

In the news release, the scholars note that community health centers would likely be hurt by Kentucky HEALTH as Medicaid beneficiaries lose coverage. An analysis by the Milken Institute School of Public Health indicates that as many as four in 10 adult Medicaid patients served by health centers could lose coverage due to the state’s “work experiment.”

“Ultimately, some centers would have to lay off staff and the number of patients served by these centers would go down,” Rosenbaum said in the release.