Opinion ID: 8312801
Heading Depth: 3
Heading Rank: 2

Heading: Seriousness of Disruption

Text: The second factor is a closer call. Arkansas began implementing its demonstration project in June 2018, imposing work requirements on adults ages 30-49 and implementing the changes to retroactive coverage; it began enforcing work requirements as to adults ages 19-29 in January 2019. HHS and Arkansas assert that any interruption in the project would be enormously disruptive because it would interfere with the State's data collection efforts, HHS Reply at 22, and undermine its extensive efforts to educate Arkansas Works beneficiaries on the work requirements. See Ark. MSJ at 38-39. They emphasize that, because the Kentucky program had not yet taken effect at the time of its vacatur, these concerns were not present in Stewart I . Id. The Court is not insensitive to the practical concerns Defendants raise about pausing enforcement of the Amendments, nor does it take lightly the effect of its ruling upon the state today. For the reasons that follow, however, it finds that the probable disruptions are not so significant as to require deviation from the ordinary rule of vacatur. Consider first the nature and extent of the disruptions. If the Court vacates the Secretary's approval of AWA, the state would no longer condition certain Medicaid recipients' coverage on reporting 80 hours of qualifying activities each month and would restore the number of months of retroactive coverage to three. In other words, vacatur would return matters to the way they were before the project was approved. Both changes, HHS asserts, will disrupt the state's data-collection efforts. See HHS MSJ at 29. If Arkansas - as the party responsible for collecting and analyzing data from the project - has concerns about data collection in the event of vacatur, it does not say as much. See Ark. MSJ at 38-40 (mentioning only disruptive effects on education and outreach); ECF No. 45 (Ark. Reply) (same). Indeed, one amicus points out that the Secretary approved this project without a proposed evaluation design. See Amicus Brief of Deans, Chairs, and Scholars at 19-20. The Court assumes, however, that vacatur would interrupt the state's efforts to collect data on the effects of the work requirements and changes to retroactive coverage. While such concerns are not insignificant, they are tempered in the context of this case. Experimental projects are intended to help states like Arkansas test out new ideas for providing medical coverage to the needy, thereby influencing the trajectory of the federal-state Medicaid partnership down the line. See supra S. Rep. No. 1589 at 1961. If, after further consideration or after prevailing on appeal, the Secretary and Arkansas wish to move ahead with work requirements, they will remain able to do so in the future. And if they are dissatisfied with the data gathered from the initial months of the project because of the interruption caused by vacatur, Defendants could extend the project for an additional period of time to collect more information. This is not to minimize the importance of data collection in the context of an experimental project; it is just to say that vacatur will have little  lasting impact on HHS's or Arkansas's interests. That distinguishes this case from others in which the D.C. Circuit has declined to vacate on account of irreversible harms that such a remedy would inflict on the status quo. See Allied-Signal , 988 F.2d at 151 . Defendants also maintain that vacatur will harm Arkansas's education and outreach efforts. Ark. MSJ at 39. In that regard, they explain that a decision invalidating the work requirements will be confusing to Medicaid recipients who have just recently been informed that they have to meet those requirements. Id. at 38-39. The Court grants that vacatur of work requirements that have already been implemented may send mixed messages. But any disruption in this respect is not sufficiently significant to avoid vacatur. For one thing, Defendants have expressed confidence throughout this case that they can communicate with Medicaid recipients regarding the terms of the work requirements. See HHS MSJ at 8; Ark MSJ at 27, 34-35. If that is so, they should be able to inform them that the requirements are paused for now and, if later reapproved, that they are put back into effect. It bears mentioning here, however, that the State's outreach efforts may well be falling severely short. Notably, only 12.3% of persons not exempt from the requirements reported any kind of qualifying activity. See Arkansas Works Reports June-November 2018 at 47, 52. The numbers are even lower for several other months. Id. Arkansas might use the time while the program is paused to consider whether and how to better educate persons about the requirements and how to satisfy them. Admittedly, vacatur could make such outreach complicated. Ultimately, however, the Court finds that the harms to prior and ongoing education do not tip the scales against vacatur. In fact, the structure of the Amendments, considered with the timing of this Opinion, renders vacatur less disruptive that might be expected. As mentioned before, Arkansas Works recipients only lose coverage after three months of non-compliance with the work requirements. See AR 31. And the three-month clock starts over at the beginning of the calendar year. Id. Because fewer than three months have elapsed in 2019, the work requirements have not yet resulted in anyone's being disenrolled, as such actions cannot take place until April 1. As a consequence, vacatur of the Amendments will not require Arkansas to re-enroll persons who have lost their coverage, with the administrative and communication-related headaches that might entail. Instead, it just requires them to communicate to providers that they should not disenroll persons moving forward on account of the requirements. The bottom line: This is not a case in which the 'egg has been scrambled,' and it is too late to reverse course. Allina Health , 746 F.3d at 1110-11 (quoting Sugar Cane Growers Co-op of Fla. v. Veneman , 289 F.3d 89 , 97 (D.C. Cir. 2002) ). Finally, the Court emphasizes that the disruptions to Arkansas's administration of its Medicaid program must be balanced against the harms that Plaintiffs and persons like them will experience if the program remains in effect. Cf. A.L. Pharma, Inc. v. Shalala , 62 F.3d 1484 , 1492 (D.C. Cir. 1995) (explaining that vacatur inappropriate because nothing in the record suggests that significant harm would result from allowing the approval to remain in effect pending the agency's further explanation); see also Tr. at 13 (conceding that court should consider harms to Plaintiffs as part of equitable inquiry into vacatur). Arkansas's own numbers confirm that in 2018, more than 16,000 persons have lost their Medicaid. Defendants offer no reason to think the numbers will be different in 2019; indeed, once the requirements apply  to persons aged 19-29, they seem likely to rise. See Arkansas Works Reports at 18, 27, 36, 45. Weighing the harms these persons will suffer from leaving in place a legally deficient order against the disruptions to the State's data-collection and education efforts due to vacatur renders a clear answer: the Arkansas Works Amendments cannot stand.